Pathophysiology and Therapy of Associated Features of Migraine

Cells, Год журнала: 2022, Номер 11(17), С. 2767 - 2767

Опубликована: Сен. 5, 2022

Migraine is a complex and debilitating disorder that broadly recognised by its characteristic headache. However, given the wide array of clinical presentations in migraineurs, headache might not represent main troublesome symptom it can even go unnoticed. Understanding migraines exclusively as pain process simplistic certainly hinders management. We describe mechanisms behind some most disabling associated symptoms migraine, including relationship between central peripheral processes take part nausea, osmophobia, phonophobia, vertigo allodynia. The rationale for efficacy current therapeutic arsenal also depicted this article. to apart from painful component, are frequent, under-recognised be more deleterious than itself. anamnesis patient should enquire about symptoms, treatment considered individualised. Acknowledging fundamental migraine has permitted deeper coherent comprehension pathophysiology migraine.

Язык: Английский

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Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review

The American Journal of Gastroenterology, Год журнала: 2023, Номер 118(7), С. 1157 - 1167

Опубликована: Фев. 15, 2023

Cyclic vomiting syndrome (CVS) is a chronic disorder of gut-brain interaction characterized by recurrent disabling episodes nausea, vomiting, and abdominal pain. CVS affects both children adults with prevalence approximately 2% in the United States. more common female individuals all races. The pathophysiology unknown combination genetic, environmental, autonomic, neurohormonal factors believed to play role. also closely associated migraine headaches likely have shared pathophysiology. diagnosis based on Rome criteria, minimal recommended testing includes an upper endoscopy imaging studies abdomen. frequently anxiety, depression, autonomic dysfunction. Patients commonly use cannabis therapeutically for symptom relief. By contrast, cannabinoid hyperemesis be subset heavy leading hyperemesis. Due recalcitrant nature illness, patients often visit emergency department are hospitalized acute flares. Guidelines management recommend biopsychosocial approach. Prophylactic therapy consists tricyclic antidepressants (amitriptyline), antiepileptics (topiramate), aprepitant refractory patients. Abortive triptans, antiemetics (ondansetron), sedation. Treatment comorbid conditions extremely important improve overall patient outcomes. has significant negative impact patients, families, healthcare system, future research understand its develop targeted therapies needed.

Язык: Английский

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Kynurenine Pathway of Tryptophan Metabolism in Migraine and Functional Gastrointestinal Disorders

International Journal of Molecular Sciences, Год журнала: 2021, Номер 22(18), С. 10134 - 10134

Опубликована: Сен. 20, 2021

Migraine, the leading cause of disability in population aged below 50, is associated with functional gastrointestinal (GI) disorders (FGIDs) such as nausea, cyclic vomiting syndrome, and irritable bowel syndrome (IBS). Conversely, changes intestinal GI transit may diarrhea or constipation are a component autonomic symptoms pre- post-dorsal phases migraine attack. These mutual relationships provoke question on common trigger FGIDs. The kynurenine (l-kyn) pathway (KP) major route for l-tryptophan (l-Trp) metabolism transforms l-Trp into several neuroactive compounds. Changes KP were reported both Migraine was largely untreatable, but drugs approved lately by FDA, including monoclonal antibodies calcitonin gene-related peptide (CGRP) its receptor, create hope breakthrough treatment. Derivatives l-kyn efficient pain relief mechanism CGRP inhibition. products important ligands to aryl hydrocarbon receptor (AhR), whose activation implicated pathogenesis migraine. Toll-like receptors (TLRs) play role IBS pathogeneses, metabolites detected downstream TLR be an marker. TLR4 signaling observed initiating maintaining migraine-like behavior through myeloid differentiation primary response gene 88 (MyD88) mouse. aim this review justify view that modulation provide triggers FGIDs involvement TLR, AhR, MyD88 activation.

Язык: Английский

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Whole exome/genome sequencing in cyclic vomiting syndrome reveals multiple candidate genes, suggesting a model of elevated intracellular cations and mitochondrial dysfunction

Frontiers in Neurology, Год журнала: 2023, Номер 14

Опубликована: Май 5, 2023

Objective To utilize whole exome or genome sequencing and the scientific literature for identifying candidate genes cyclic vomiting syndrome (CVS), an idiopathic migraine variant with paroxysmal nausea vomiting. Methods A retrospective chart review of 80 unrelated participants, ascertained by a quaternary care CVS specialist, was conducted. Genes associated symptoms were identified querying dominant cases intermittent both discomfort disability; among which raw genetic sequence reviewed. “Qualifying” variants defined as coding, rare, conserved. Additionally, “Key Qualifying” Pathogenic/Likely Pathogenic, “Clinical” based upon presence corresponding diagnosis. Candidate association to on point system. Results Thirty-five per review. Among these, 12 scored “Highly likely” ( SCN4A , CACNA1A CACNA1S RYR2 TRAP1 MEFV ) “Likely” SCN9A TNFRSF1A POLG SCN10A POGZ, TRPA1 related. Nine additional OTC, ATP1A3, ATP1A2, GFAP, SLC2A1, TUBB3 PPM1D CHAMP1 HMBS had sufficient evidence in but not from our study participants. status mitochondrial DNA confirmed data. above-listed 22 genes, Key Qualifying 31/80 (34%), any present 61/80 (76%) These findings highly statistically significant p < 0.0001, = 0.004, respectively) compared alternative hypothesis/control group regarding brain neurotransmitter receptor genes. Additional, post-analyses, less-intensive all (exome) outside 13 “Possibly” Conclusion All are either cation transport energy metabolism (14 directly, 8 indirectly). Our suggest cellular model aberrant ion gradients lead dysfunction, vice versa, pathogenic vicious cycle hyperexcitability. non-paroxysmal identified, 5 known causes peripheral neuropathy. is consistent multiple current hypotheses CVS.

Язык: Английский

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Compritol-Based Nanostrucutured Lipid Carriers (NLCs) for Augmentation of Zolmitriptan Bioavailability via the Transdermal Route: In Vitro Optimization, Ex Vivo Permeation, In Vivo Pharmacokinetic Study

Pharmaceutics, Год журнала: 2022, Номер 14(7), С. 1484 - 1484

Опубликована: Июль 18, 2022

Migraine is a severe neurovascular disease manifested mainly as unilateral throbbing headaches. Triptans are agonists for serotonin receptors. Zolmitriptan (ZMP) biopharmaceutics classification system (BCS) class III medication with an absolute oral bioavailability of less than 40%. As result, our research intended to increase ZMP by developing transdermal nanostructured lipid carriers (NLCs). NLCs were prepared utilizing combination hot melt emulsification and high-speed stirring in 32 full factorial design. The studied variables liquid type (X1) surfactant (X2). developed evaluated terms particle size (Y1, nm), polydispersity index (Y2, PDI), zeta potential (Y3, mV), entrapment efficacy (Y4, %) amount released after 6 h (Q6h, Y5, %). At 1% Mygliol component Span 20 surfactant, the optimized formula (NLC9) showed minimum (138 ± 7.07 (0.39 0.001), acceptable (-22.1 0.80), maximum efficiency (73 0.10%) (83.22 0.10%). was then incorporated into gel preparation (HPMC) improve stability ease application. Then, pharmacokinetic study conducted on rabbits cross-over calculated parameters higher area under curve (AUC0-24, AUC0-∞ (ng·h/mL)) ZMP-NLCs loaded gel, 1.76-fold comparison orally administered marketed product (Zomig®). A histopathological examination revealed safety nanoparticles. declared results highlight proposed delivery drug bioavailability.

Язык: Английский

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The childhood migraine syndrome

Nature Reviews Neurology, Год журнала: 2021, Номер 17(7), С. 449 - 458

Опубликована: Май 26, 2021

Язык: Английский

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Natural History of Pediatric Cyclic Vomiting Syndrome: Progression to Dysautonomia

Journal of Pediatric Gastroenterology and Nutrition, Год журнала: 2023, Номер 76(6), С. 737 - 742

Опубликована: Фев. 16, 2023

The clinical features of pediatric cyclic vomiting syndrome (CVS) often evolve over time. Many patients develop a constellation chronic symptoms that suggest autonomic nervous system (ANS) dysfunction during adolescence. We aimed to determine the proportion children with CVS who rather than episodic consistent ANS dysfunction.Retrospective chart review ages 0-18 years followed in an outpatient tertiary care center. Patients completed standardized questionnaires at intake and follow-up visits, documenting symptom pattern. Continuous variables are summarized as median [interquartile range (IQR)]. A Mann-Whitney test was used for group comparisons.One hundred subjects were included. total 40% developed (ANS+); 20% confirmed by comprehensive testing, 11% orthostatic vital sign abnormalities, 9% symptoms. (IQR) age onset 14 (10.02, 15) years. presence another disorder gut-brain interaction ( P = 0.018) greater number comorbidities 0.031) more common ANS+ group. missed school days 0.047) seen less frequently emergency department 0.023).Many (40%) dysautonomia These experience comorbid conditions impact on attendance, possibly representing worsened quality life their disease course transitions daily When change time, therapeutic interventions may need be adjusted targeted accordingly.

Язык: Английский

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Cyclic vomiting syndrome: From pathophysiology to treatment

Revista de Gastroenterología de México (English Edition), Год журнала: 2024, Номер 89(3), С. 389 - 403

Опубликована: Июль 1, 2024

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent and unpredictable episodes of intense vomiting, interspersed with periods apparent wellbeing. This disorder, which primarily affects children adolescents but can persist into adulthood, has recently been the subject extensive study analysis in medical literature. The aim present review to examine most important aspects epidemiology, pathophysiology, subtypes, diagnostic criteria, current management CVS. Even though exact etiology remains unknown, genetic factors (polymorphisms), nervous system alterations autonomic dysregulation, environmental (use abuse cannabinoids) are postulated as possible triggers. CVS significant challenges, given that there no specific test for confirming its presence. Thorough evaluation symptoms ruling out other causes required. Management typically involves multidisciplinary approach. Pharmacologic options explored, such antiemetics preventive medications, well behavioral psychologic support therapies. Treatment personalization essential, adapting it individual needs each patient. Despite advances understanding CVS, clinical challenge. impacts quality life those affected their families, underscoring ongoing need research development more effective treatment strategies. El síndrome de vómitos cíclicos (SVC) es un trastorno caracterizado por episodios recurrentes e impredecibles intensos, separados períodos bienestar aparente. Este trastorno, que afecta principalmente niños y adolescentes, aunque puede persistir en la edad adulta, ha sido objeto extenso estudio análisis literatura médica recientemente. propósito esta revisión revisar los aspectos más importantes epidemiología, fisiopatología, subtipos, criterios diagnósticos el manejo actual del SVC. Aunque etiología exacta sigue siendo desconocida, se postulan factores genéticos (polimorfismos), alteraciones sistema nerviosos desregulación autonómica, ambientales (uso abuso cannabinoides) como posibles desencadenantes SVC presenta desafíos significativos términos diagnóstico, ya existe una prueba específica para confirmar su presencia. Se requiere evaluación minuciosa síntomas exclusión otras causas recurrentes. En cuanto al tratamiento, suele adoptar enfoque multidisciplinario. exploran opciones farmacológicas, antieméticos medicamentos preventivos, así terapias conductuales apoyo psicológico. La personalización tratamiento esencial, adaptándolo las necesidades individuales cada paciente. A pesar avances comprensión SVC, desafío clínico significativo. impacta calidad vida afectados sus familias, destacando necesidad continua investigación desarrollo estrategias efectivas.

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Central mechanisms of emesis: A role for GDF15

Neurogastroenterology & Motility, Год журнала: 2024, Номер unknown

Опубликована: Авг. 6, 2024

Nausea and emesis are ubiquitously reported medical conditions often present as treatment side effects along with polymorbidities contributing to detrimental life-threatening outcomes, such poor nutrition, lower quality of life, unfavorable patient prognosis. Growth differentiation factor 15 (GDF15) is a stress response cytokine secreted by wide variety cell types in broad range stressors. Circulating GDF15 levels elevated characterized cachexia malaise. In recent years, has gained scientific translational prominence the discovery that its receptor, GDNF family receptor α-like (GFRAL), expressed exclusively hindbrain. GFRAL activation may results profound anorexia body weight loss, which have attracted interest for pharmacological obesity.

Язык: Английский

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Chronic Nausea and Vomiting

Опубликована: Янв. 1, 2025

Язык: Английский

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