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Archive for October, 2016

Central autoimmune channelopathies: a link between Neurology and Psychiatry

31 Oct, 16 | by Dr Jose Manuel Matamala, JNNP web editor.

 

Since the recognition of antibodies against voltage – gated potassium channel (VGKC) and their pathogenic implication in central nervous system disorders (such as limbic encephalitis) in 2001, critical immunological and neurological advances have been achieved during the last 15 years. One of the main discoveries has been that these VGKC antibodies usually target proteins outside of the channel protein, which are part of the VGKC complex (e.g. contactin-associated protein 2). Moreover, each specific antibody is associated with distinct clinical phenotypes, which commonly overlap.

Clinically the primary neurological syndrome associated with VGKC antibodies is limbic encephalitis, classically presenting with severe memory impairment and secondary hippocampal atrophy. However, recently emerging psychiatric syndromes have been linked to this autoimmune condition.

In the current issue of JNNP, Prüss and Lennox have published a review describing novel psychiatric syndromes associated with VGKC complex antibodies. In the review, the authors described the recent highlights about the pattern of cognitive involvement and reversibility of memory dysfunction in limbic encephalitis, response to treatment with immunotherapy, immunology of VGKC complex antibodies and the relevance of the titre levels, and mood and psychotic disorders associated with VGKC complex antibodies.

 

Emerging psychiatric syndromes associated with VGKC complex antibodies. Psychiatric symptoms are frequently present in patients with limbic encephalitis secondary to VGKC complex antibodies. However, its role in psychiatric diseases is not well understood.

Emerging psychiatric syndromes associated with VGKC complex antibodies. Psychiatric symptoms are frequently present in patients with limbic encephalitis secondary to VGKC complex antibodies. However, its role in psychiatric diseases is not well understood.

 

Although, evidence regarding the pathogenic role of VGKC complex antibodies in psychiatric conditions is missing and many questions remain to be answered in this field, it is important that neurologists and psychiatrists combine their expertise to gain a better comprehension of this neuropsychiatric disorder. It is relevant for neurologists to be aware of psychiatric manifestations associated with autoimmune channelopathies and for psychiatrists to keep in mind that VGKC complex antibodies could be part of the differential diagnosis in patients with atypical psychiatric manifestations and autoimmune features.

 

Read more at http://jnnp.bmj.com/content/87/11/1242.full

 

 

Melatonin an effective alternative for migraine prevention

7 Oct, 16 | by Dr Jose Manuel Matamala, JNNP web editor.

 

In the current issue of JNNP, Gonçalves and colleagues have published a randomized control trial (RCT) comparing melatonin, amitriptyline and placebo for migraine prevention.

Migraine is a chronic neurological disease and has been ranked as the sixth disabling condition by World Health Organization (WHO). The goals of migraine prophylaxis are to reduce migraine attacks, limit the need for analgesic intake and improve the quality of life. However, despite the different pharmacological treatments available, only a small fraction of patients receive adequate preventive treatment, which amongst other reasons is related to unfavourable drug security profile.

In this study, after randomizing 196 patients into melatonin (3 mg), amitriptyline (25 mg) or placebo (randomization ratio 1:1:1) and following up for 12 weeks, the authors reported a significant reduction in the number of migraine headache days per month with melatonin or amitriptyline versus placebo. Even though melatonin and amitriptyline were equally effective for the primary endpoint, the number of patients with greater than 50% reduction in migraine headache days was significantly higher in the melatonin group. Moreover, the number of adverse effects was also significantly lower in this group compared with amitriptyline. These results support the efficacy and tolerability of melatonin as a prophylaxis therapy for migraine.

Melatonin a new therapeutic option for the treatment of migraine patients

Melatonin a new therapeutic option for the treatment of migraine patients

 

Melatonin is a hormone produced mainly in the pineal gland, and it plays an essential role as an endogenous synchronizer of internal circadian rhythms. Melatonin has demonstrated efficacy and safety in the treatment of nociceptive and neuropathic pain in several studies. Specifically in migraine, melatonin receptors have been described in the nuclei of the trigeminal nerve, suggesting that may decrease trigeminovascular nociception. Moreover, melatonin levels have been described to be reduced in migraine patients. Regarding the security profile, melatonin is remarkably well tolerated and it only has minor side effects such as daytime sleepiness, dizziness, and stomach pain. These features make melatonin a good candidate for migraine prophylaxis.

 

In short, this is an interesting article that has clear and immediate clinical application.

 

Read more at http://jnnp.bmj.com/content/87/10/1127.full.pdf

 

 

Latest from JNNP

Latest from JNNP