Divalproex Extended‐Release in Adolescent Migraine Prophylaxis: Results of a Randomized, Double‐Blind, Placebo‐Controlled Study

Apostol, George; Cady, Roger; Laforet, Genevieve; Robieson, Weining; Olson, Evelyn; Abi-Saab, Walid; Saltarelli, Mario

doi:10.1111/j.1526-4610.2008.01081.x

Cited by 58 publications

(65 citation statements)

References 36 publications

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“…This study shows that the reduction of migraine days achieved by effective migraine prophylaxis is a least partly maintained after termination of prophylaxis at 6 months. Prophylactic treatment with oxcarbazepine [12], divalproex sodium in adolescents [13], and estrogen in menstrual migraine [14] were not effective in migraine prophylaxis.…”

Section: Epilepsy: Evidence-based Medicine and Epidemiological Updatementioning

confidence: 90%

Teaching Sessions

Holst

2009

Neuroepidemiology

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Alzheimer's disease (AD), vascular dementias (VaD), Lewy body dementias, and frontotemporal dementia all have a complex presentation and challenges in the diagnostic criteria make none of these 'causes' truly correct. It is more instructive to see these entities on a continuum of neuropathological conditions.By example, the DSM-IV criteria do not do justice to the variety of syndromes seen in AD. The specific wordings of the criteria leave much room for interpretation. These criteria require impairment of function; if memory impairment or another symptom is not severe enough to demonstrate functional impairment in activities of daily living, the diagnosis should not be dementia. Diagnostic criteria disregard mixed cases and are mostly useful for research criteria only, not epidemiological field work. Clearly, it is difficult regarding who to count.Nevertheless, the non-genetic risk factors based on epidemiological studies showed that in AD, age is the single most important factor. The prevalence increases with age, at about two-fold for every 5 years in patients aged >65 years; this means by 85 years of age, the prevalence is ~20%, at 90, at ~40%. Beyond 90 years, there is little data. When genetic considerations are taken into account, these data may be relevant to finding individuals who are "coded" to survive.What happens to an individual when they are young can also affect their risk of dementia later in life. Head trauma with concomitant short-duration coma (3-4 days) seems to confer a small increased risk. This injury may cause a low-level effect that may remain active over decades; however, the underlying processes are not understood.Another risk factor is a low education level. Several studies have demonstrated that higher education (versus no schooling) confers a protection of 10 to 1, i.e. 90% of schooled individuals did not develop dementia compared to their unschooled agematched counterparts. Occupational attainment showed a similar protective effect, although whether this is due to higher education can not be ruled out. These data emphasize from a social level, the impact that non-genetic risk factors have from a young age on the future burden of dementia.Younger individuals (<65 years) with symptoms matching the DSM-IV criteria have a higher likelihood to have a strong genetic component. In early-onset AD, autosomal dominant inheritance (3 generations affected, e.g. PSEN1) is possible, whereas in lateonset AD, APOE genetic testing may be useful; however, AD is genetically heterogeneous. The APOE ε4 may indicate that the dementia is of vascular origin as it only advances the onset, it doesn't change the risk. For patients aged >65 years, genetic explanations are much less likely. Moreover, genetic analysis should not be considered deterministic; it simply offers the patient, family and doctor a chance to be more careful and proactive about prevention.The risk factors of coronary artery disease, smoking, hyperhomocysteinemia, diabetes mellitus, hypertension, high dietary saturated fat and cholesterol...

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Section: Epilepsy: Evidence-based Medicine and Epidemiological Updatementioning

confidence: 90%

Teaching Sessions

Holst

2009

Neuroepidemiology

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“…88 A single unpowered randomized controlled trial examined the risk of individual adverse effects and found no significant differences with divalproex versus placebo based on sparse data. 69 Upper respiratory tract infections were more common with larger doses of divalproex. 69 The results differed depending on the statistical model used.…”

Section: Efficacy and Safety Of Antiepileptic Drugsmentioning

confidence: 99%

“…69 Upper respiratory tract infections were more common with larger doses of divalproex. 69 The results differed depending on the statistical model used. Viral infections were more common with larger doses of divalproex in the models that obtained arcsine-transformed risk differences.…”

Section: Efficacy and Safety Of Antiepileptic Drugsmentioning

confidence: 99%

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Episodic Migraines in Children

et al. 2013

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The authors conducted a systematic literature review of preventive pharmacological treatments for episodic childhood migraines searching several databases through May 20, 2012. Episodic migraine prevention was examined in 24 publications of randomized controlled trials that enrolled 1578 children in 16 nonrandomized studies. Single randomized controlled trials provided low-strength evidence that propranolol would result in complete cessation of migraine attacks in 713 per 1000 children treated (95% confidence interval, 452-974); trazodone and nimodipine decreased migraine days, while topiramate, divalproex, and clonidine were no more effective than placebo in preventing migraines. Migraine prevention with multidisciplinary drug management was not sustained at 6 months. Divalproex resulted in treatment discontinuation due to adverse effects, and topiramate increased the risk of paresthesia, upper respiratory tract infection, and weight loss. Long-term preventive benefits and improvement in disability and quality of life are unknown. No studies examined quality of life or provided evidence for individualized treatment decisions.

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“…Hepatotoxicity, thrombocytopenia, increased appetite, and tremor may occur, though it tends to be well tolerated. Open-label trials in children have shown some promise; however, one double-blind, placebo-controlled trial failed to demonstrate superiority over placebo [8][9][10]. Gabapentin is often used due to safety and tolerability and may help to treat comorbid pain conditions.…”

Section: Migraine Without Auramentioning

confidence: 99%