Restless legs syndrome is not associated with migraine with aura: a clinical study

Based on recent data about the association between restless legs syndrome (RLS) and migraine, we performed an observational study on the occurrence of RLS in patients affected by “pure” migraine with aura (pMA). We recruited 63 patients (33 females and 30 males) affected by MA without other types of primary headache among all patients referred in five Italian headache centers in a 1-year period. The prevalence of RLS in pMA patients (9.5%) is similar to that observed in Italian headache-free subjects (8.3%). No significant differences were found between pMA patients with and without RLS about clinical features of MA attacks and systemic and psychiatric diseases were investigated. Moreover, no association appeared between RLS and familial cases of MA. Differently from migraine without aura, our data do not confirm the existence of an association between RLS and MA, not even when a genetic factor is involved.

     

Lack of association between antiphospholipid antibody and WHO classification in lupus nephritis

OBJECTIVE: To study the prevalence of antiphospholipid antibody (aPL) in patients with biopsy proven lupus nephritis (LN) and to investigate if there is any association between the presence of serum aPL and WHO classes. METHODS: Seventy-one patients (68 female and 3 male, mean age 31 years, range 10-67) meeting ACR criteria for the classification of SLE and with biopsy proven LN were included. For every patient, we evaluated anticardiolipin antibodies, lupus anticoagulant and renal biopsy classified according to the WHO classification criteria (activity and chronicity scores were included). Twenty-four hour urinary protein at the time of biopsy was considered. RESULTS: Twenty-nine patients had class V LN, 27 had class IV, 11 had class III, 3 had class II and 1 had class I. Twenty-seven (40.2%) patients were aPL positive. The prevalence of aPL positive patients was 45% in class V, 33.3% in class IV and 45.6% in class III. We did not find any significant association between the presence of aPL and the WHO class (p = 0.61 with class V, p = 0.31 with class IV and p = 0.73 with class III). There was no association between the presence of aPL and activity (p = 0.52) or chronicity scores (p = 0.42). We also did not find any association between proteinuria and the presence of aPL (p = 0.3). CONCLUSIONS: Our results suggest that there is no association between the presence of aPL and the different WHO classes. The presence of these antibodies does not seem to be related to histological activity or the chronicity of lupus nephritis nor proteinuria.     

Future trends in drugs for migraine prophylaxis

Migraine prevention hinges on a variety of non-specific drugs that mainly reduce neuronal hyperexcitability, the putative pathophysiological hallmark for migraine. The improved knowledge about migraine circuitry and neurobiology has prompted research to develop new specific migraine preventive medications targeted to innovative sites and mechanisms. Drugs designed to inhibit cortical spreading depression, for example tonabersat, might offer a useful option for the management of migraine with aura but not for migraine without aura. Inducible nitric-oxide synthase (iNOS) inhibition seems ineffective as a prophylactic strategy. Results are awaited from recent and ongoing phase II trials with glutamate receptor antagonists, third-generation antiepileptics, melatonin agonists, vitamin D3 and statins.     

IgA nephropathy in cystic fibrosis

The kidney does not usually present specific lesions in cystic fibrosis (CF), although in recent years renal involvement has been reported, particularly amyloidosis and immune complex glomerulonephritis. IgA nephropathy is rare. We report four cases of IgA nephropathy out of five renal biopsies performed in the last three years in patients with CF and renal involvement and discuss the possibility of a relationship between IgA nephropathy and CF.     

The role of anti-CGRP antibodies in the pathophysiology of primary headaches

Calcitonin gene-related peptide (CGRP), a potent vasodilator and pain-signaling neuropeptide, is a validated therapeutic target for migraine and cluster headache. Four anti-CGRP monoclonal antibodies (mAbs) have been developed, representing the first specific, mechanism-based, migraine prophylactic treatment. CGRP mAbs demonstrated good efficacy coupled to excellent tolerability and safety in 5 phase II clinical trials. Notably, CGRP mAbs induced complete migraine remission in a patients’ subset. To date, more than 20 phase III trials using CGRP mAbs for of episodic and chronic migraine and cluster headache prevention are ongoing. Future investigations will shed light on migraine endophenotypes predictive of good CGRP mAbs responsiveness and provide answers on their long-term cardiovascular safety.     

Hypertension as a risk factor for migraine chronification

Aim of this study is to verify whether there is concordance between disease’s severity, health-related quality of life (HRQoL) and disability in patients with Myasthenia gravis (MG). 102 MG patients were clustered on the basis of HRQoL and disability scores into three groups: low disability and low HRQoL decrement (51 patients), intermediate disability and HRQoL decrement (28 patients), severe disability and high HRQoL decrement (23 patients). Cross tabulation with symmetric measures (Cramer’s V and Contingency Coefficient) was used to verify the relationships between disease severity groups, based on the Myasthenia Gravis Foundation of America (MGFA) criteria, and obtained clusters. Results confirm a significant relationship between MG severity groups, HRQoL and disability profiles. In our opinion, HRQoL and disability instruments should be employed in clinical trials to match efficacy of treatments, measured on symptoms’ reductions only, with their effects on patients’ disability and HRQoL.