Familial hemiplegic migraine treated by sodium valproate and lamotrigine

Nadine Pelzer; Anine H Stam; Johannes A Carpay; Boukje de Vries; Arn Mjm van den Maagdenberg; Michel D Ferrari; Joost Haan; Gisela M Terwindt

doi:10.1177/0333102413520086

Familial hemiplegic migraine treated by sodium valproate and lamotrigine

Cephalalgia. 2014 Aug;34(9):708-711. doi: 10.1177/0333102413520086. Epub 2014 Jan 17.

Authors

Nadine Pelzer¹, Anine H Stam¹, Johannes A Carpay², Boukje de Vries³, Arn Mjm van den Maagdenberg⁴, Michel D Ferrari¹, Joost Haan⁵, Gisela M Terwindt⁶

Affiliations

¹ Department of Neurology, Leiden University Medical Center, the Netherlands.
² Department of Neurology, Leiden University Medical Center, the Netherlands Department of Neurology, Tergooi Hospitals, the Netherlands.
³ Department of Human Genetics, Leiden University Medical Center, the Netherlands.
⁴ Department of Neurology, Leiden University Medical Center, the Netherlands Department of Human Genetics, Leiden University Medical Center, the Netherlands.
⁵ Department of Neurology, Leiden University Medical Center, the Netherlands Department of Neurology, Rijnland Hospital, the Netherlands.
⁶ Department of Neurology, Leiden University Medical Center, the Netherlands G.M.Terwindt@lumc.nl.

PMID: 24443394
DOI: 10.1177/0333102413520086

Abstract

Background: Familial hemiplegic migraine (FHM) is a rare monogenic subtype of migraine with aura that includes motor auras. Prophylactic treatment of FHM often has marginal effects and involves a trial-and-error strategy based on therapeutic guidelines for non-hemiplegic migraine and on case reports in FHM.

Methods: We assessed the response to prophylactic medication in an FHM family and sequenced the FHM2 ATP1A2 gene in all available relatives.

Results: A novel p.Met731Val ATP1A2 mutation was identified. Attack frequency was reduced significantly with sodium valproate monotherapy (n = 1) and attacks ceased completely with a combination of sodium valproate and lamotrigine (n = 2).

Conclusions: We report dramatic prophylactic effects of sodium valproate and lamotrigine in an FHM2 family, making these drugs worth considering in the treatment of other FHM patients.

Keywords: Migraine; anticonvulsants; familial hemiplegic migraine; ion transport; neurogenetics.