Flunarizine for Headache Prophylaxis in Children With Sturge-Weber Syndrome

Gallop, Felicity; Fosi, Tangunu; Prabhakar, P; Aylett, Sarah

doi:10.1016/j.pediatrneurol.2018.11.012

Cited by 15 publications

(13 citation statements)

References 53 publications

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“…Considering the side effects of flunarizine, there are cases that reported mood instability, weight gain, sedation, and seizures, albeit rarely. [ 32 ] We had to stop flunarizine due to sedation in only 2 of our patients. We think the reason we saw few side effects is that we started treatment with the lowest dose.…”

Section: Discussionmentioning

confidence: 99%

Can flunarizine be used routinely as the first option for childhood headache treatment?: Flunarizine and childhood headache

Çıraklı

2022

Medicine

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The prevalence of headache in childhood increases due to environmental factors. Various risk factors in children whose playgrounds are restricted outside and therefore remain inactive. So diagnosis and treatment can be challenging. The aim of this study was to evaluate the experience of flunarizine in childhood headache with a focus on efficacy and success. We conducted a retrospective observational study of 185 pediatric patients at the tertiary pediatric emergency and pediatric neurology unit between May 2018 and May 2020. Patients with headache for >15 days of a month for at least 3 months were included in the study, whether or not receiving treatment. Also, all patients who had an adequate follow-up period were included in the study. All patients were evaluated by history, physical–neurological examination, blood tests, blood pressure, eye examination, and cranial magnetic resonance imaging. All data were evaluated statistically. Ninety-eight (53%) of 185 cases were female and 87 (47%) were male. Average age was 11.4 years (min–max, 4–17). There was family history in 51.3% of the cases. The most frequent applicants were in the autumn season (43%), when schools were opened. Organic causes were hypertension in 1 case, brain tumor in 1 case, and papilledema due to idiopathic intracranial hypertension in 2 cases. The other cases were asked to make a 1-month pain chart and grading according to the visual analog scale. In this process, it was stated that painkillers could be used if needed. At the end of the first month, these patients were reevaluated. Flunarizine treatment was initiated in 95 patients who had to use painkillers for >4 times and who described ≥6 pain score according to the visual analog scale. The treatment was discontinued due to sleepiness and weakness in 2 patients. At the end of the third month, a 50% reduction in headache was observed in 82 cases (86.3%). We used flunarizine as the first choice in all patients and we achieved a high rate of treatment success. Flunarizine can be considered as an alternative option for headache management in terms of low side effects, easy accessibility, and compliance with treatment.

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Section: Discussionmentioning

confidence: 99%

Can flunarizine be used routinely as the first option for childhood headache treatment?: Flunarizine and childhood headache

Çıraklı

2022

Medicine

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“…Some features of this subgroup that are commonly found in the druginduced DTN literature include the prevalence of female sex predominance, affected younger population (compared to general data), low CNZ/FNZ doses associated with DTN, and short MD onset. The presentation in descending order of frequency was blepharospasm, oromandibular, and cervical; even worsening of a previous DTN was observed in a child with Sturge-Weber syndrome, when FNZ 5 mg was prescribed [126].…”

Section: Dystonia (Dtn)mentioning

confidence: 99%

Cinnarizine- and flunarizine-associated movement disorder: a literature review

Rissardo

Caprara

2020

Egypt J Neurol Psychiatry Neurosurg

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Introduction: Cinnarizine (CNZ) and flunarizine (FNZ) belong to the calcium channel blockers class of medication. Main text: The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of CNZ/FNZ-associated movement disorder (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. One hundred and seventeen reports containing 1920 individuals who developed a CNZ/FNZ-associated MD were identified. The MD encountered were 1251 parkinsonism, 23 dyskinesias, 11 akathisia, 16 dystonia, and 5 myoclonus, and in the group not clearly defined, 592 extrapyramidal symptoms, 19 tremors, 2 bradykinesia, and 1 myokymia. The predominant sex was female with a percentage of 72.69% (466/641). The mean age was 74.49 (SD, 7.88) years. The mean CNZ dose was 148.19 mg (SD, 42.51) and for the FNZ dose, 11.22 mg (5.39). The mean MD onset and recovery were 1.83 years (SD, 1.35) and 3.71 months (SD, 1.26). In the subgroup of subjects that had improvement of the symptoms, the complete recovery was achieved within 6 months of the drug withdrawal in almost all subjects (99%). The most common management was drug withdrawal. A complete recovery was observed in 93.77% of the patients (437/466). Conclusions: CNZ/FNZ-associated MD was extensively reported in the literature. Parkinsonism was the most well described. Myoclonus (MCL) was the poorest described MD with missing data about the neurological examination and electrodiagnostic studies. The knowledge of this disorder probably can contribute to the understanding of the other drug-induced MDs.

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“…For headache symptoms, recent research has supported the use of abortive and prophylactic therapies in SWS. 139,140 Many patients with SWS commonly use abortive medications for headache treatment 42 as opposed to prophylactic medications. Triptan use for headache prophylaxis was effective and safe in 22% of 74 patients with migraine headaches.…”

Section: Neurologic Treatmentmentioning

confidence: 99%

Sturge–Weber syndrome: Updates in pathogenesis, diagnosis, and treatment

Valery,

Comi

2023

Annals of the Child Neurology Society

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We summarize the current knowledge of Sturge–Weber syndrome (SWS) including genetic involvement, difficulties in diagnosis, symptoms caused by the vascular malformations, treatments, and future areas of research. PubMed searches were completed between October and December of 2022 including the following search terms: Sturge–Weber neuroimaging, Sturge–Weber ocular involvement, Sturge–Weber G‐protein alpha q subunit (GNAQ), Sturge–Weber presymptomatic treatment, and Sturge–Weber quantitative EEG. Clinically relevant articles and case reports were reviewed and summarized, with emphasis placed on reports from the last 20 years. Literature suggests that early identification of brain involvement is essential for optimal medical care. Infants with a port‐wine birthmark on the forehead, temple, or eyelids are at risk for SWS brain and eye involvement. Neuroimaging findings include leptomeningeal enhancements, cortical calcifications, and brain atrophy, and diagnosis requires magnetic resonance imaging with and without contrast. Before 1 year of age, neuroimaging has low sensitivity and may underestimate the extent of involvement; imaging after 1 year of age is needed to exclude brain involvement. The most common underlying cause for SWS is a somatic mosaic mutation in GNAQ. Neurological symptoms include seizures, stroke or stroke‐like episodes, headaches, and cognitive deficits. Recommended treatment for SWS brain involvement includes aggressive seizure control with antiepileptic medications; low‐dose aspirin is also frequently but not universally utilized. Current literature suggests that children with SWS may benefit from presymptomatic treatment; further study of this approach is ongoing. SWS is a rare neurovascular disorder usually signaled by a facial port‐wine birthmark. Early diagnosis and appropriate treatment may improve outcomes.

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Flunarizine for Headache Prophylaxis in Children With Sturge-Weber Syndrome

Cited by 15 publications

References 53 publications

Can flunarizine be used routinely as the first option for childhood headache treatment?: Flunarizine and childhood headache

Can flunarizine be used routinely as the first option for childhood headache treatment?: Flunarizine and childhood headache

Cinnarizine- and flunarizine-associated movement disorder: a literature review

Sturge–Weber syndrome: Updates in pathogenesis, diagnosis, and treatment

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