Latest clinical recommendations on valproate use for migraine prophylaxis in women of childbearing age: overview from European Medicines Agency and European Headache Federation

Vatzaki, E.; Straus, Sabine M. J. M.; Dogné, Jean‐Michel; Burgos, Juan Garcia; Girard, Thomas; Martelletti, Paolo

doi:10.1186/s10194-018-0898-3

Cited by 19 publications

(17 citation statements)

References 18 publications

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“…According to European Medicines Agency [4] recommendations, subscribed by the European Headache Federation, valproic acid should be avoided in women in childbearing age. In our sample, 90.1% of responders followed that recommendation.…”

Section: Discussionmentioning

confidence: 99%

“…The Spanish Headache Study Group guidelines [3] recommended topiramate and beta-blockers as the first choice of preventive therapy in Episodic Migraine, followed by flunarizine, Lisinopril and candesartan. Valproic acid is recommended only in a tertiary referral centre and is currently contraindicated in women of childbearing age [4]. On the other hand, the first oral preventive option in Chronic Migraine is topiramate, followed by amitriptyline and in a third level flunarizine and beta-blockers.…”

Section: Introductionmentioning

confidence: 99%

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Real world preventative drug management of migraine among Spanish neurologists

et al. 2019

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BackgroundMany different preventatives have showed efficacy in the treatment of migraine. National guidelines differ in their recommendations and patients’ characteristics are usually taken into account in their selection. In Spain, real life use of preventive therapies seems to be heterogeneous. We aimed to evaluate differences in clinical practice and adherence to national guidelines among Spanish neurologists.MethodsObservational descriptive study. A survey was conducted among neurologists ascribed to the Spanish Society of Neurology. Participants were differentiated in accordance with their dedication to headache disorders. We analysed socio-demographic parameters and evaluated 43 questions considering migraine management as well as therapeutic choices regarding migraine sub-types and finally, neurologists’ personal perception.ResultsOne hundred fifty-five neurologists participated from 17 different regions, 43.4% of them female and 53.3% under 40 years of age. 34.9% confirmed headache disorders as their main interest.The first choice for preventive therapy in chronic migraine among participants was topiramate (57%) followed by amytriptiline (17.9%) and beta-blockers (14.6%). However in episodic migraine, the preferred options were beta-blockers (47.7%), topiramate (21.5%) and amytriptiline (13.4%). Regarding perceived efficacy, topiramate was considered the best option in chronic migraine (42.7%) followed by onabotulinumtoxinA (25.5%) and amitryptiline (22.4%). Where episodic migraine was concerned, surveyed neurologists perceived topiramate (43.7%) and beta-blockers (30.3%) as the best options. When we evaluated the duration of treatment use with a view to adequate therapeutic response, 43.5% of neurologists preferred 3 months duration and 39.5% were in favour of 6 months duration in episodic migraine. However, considering the preferred duration of treatment use in chronic migraine, 20.4% recommended 3 months, 42.1% preferred 6 months and 12.5% and 22.4% opted for 9 and 12 months respectively. When considering onabotulinumtoxinA therapy, the number of prior therapeutic failures was zero in 7.2% of neurologists, one in 5.9%, two in 44.1%, three in 30.9% and four or more in 11.9%. Following an initial treatment failure with onabotulinumtoxinA, 49% of subjects decided against a second treatment. The number of OnabotA procedures before considering it as ineffective was two in 18.9% of neurologists, three in 70.8% and four in 10.4%.ConclusionsThe initial management of migraine among Spanish Neurologists is in line with most guidelines, where first choice preventative drugs are concerned. The Management of episodic migraine differed from chronic migraine, both in terms of neurologist preference and in their perceived efficacy.Electronic supplementary materialThe online version of this article (10.1186/s10194-019-0971-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real world preventative drug management of migraine among Spanish neurologists

et al. 2019

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“…Otherwise, it is an important FDA-approved drug component with several beneficial effects and of great interest for the treatment of different types of cancers [56]. As a medication, it is mostly used to treat seizure disorders, mental/mood conditions, such as manic phase of bipolar disorder [57], and to prevent migraine headaches [58].…”

Section: Discussionmentioning

confidence: 99%

Similar Population of CD133+ and DDX4+ VSEL-Like Stem Cells Sorted from Human Embryonic Stem Cell, Ovarian, and Ovarian Cancer Ascites Cell Cultures: The Real Embryonic Stem Cells?

Virant‐Klun

Škerl

Novaković

et al. 2019

Cells

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A population of small stem cells with diameters of up to 5 μm resembling very small embryonic-like stem cells (VSELs) were sorted from human embryonic stem cell (hESC) cultures using magnetic-activated cell sorting (MACS) based on the expression of a stem-cell-related marker prominin-1 (CD133). These VSEL-like stem cells had nuclei that almost filled the whole cell volume and expressed stem-cell-related markers (CD133, SSEA-4) and markers of germinal lineage (DDX4/VASA, PRDM14). They were comparable to similar populations of small stem cells sorted from cell cultures of normal ovaries and were the predominant cells in ascites of recurrent ovarian cancer. The sorted populations of CD133+ VSEL-like stem cells were quiescent in vitro, except for ascites, and were highly activated after exposure to valproic acid and follicle-stimulating hormone (FSH), indicating a new tool to study these cells in vitro. These VSEL-like stem cells spontaneously formed clusters resembling tumour-like structures or grew into larger, oocyte-like cells and were differentiated in vitro into adipogenic, osteogenic and neural lineages after sorting. We propose the population of VSEL-like stem cells from hESC cultures as potential original embryonic stem cells, which are present in the human embryo, persist in adult human ovaries from the embryonic period of life and are involved in cancer manifestation.

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“…In our study group, 42.3% patients received valproic acid/divalproex sodium for prophylaxis. It should be very careful in female patients with child-bearing potential [ 19 ].…”

Section: Discussionmentioning

confidence: 99%