PO-25 | Antiepileptic medication in PRRT2 familial hemiplegic migraine: a case report
L. Bartole, A. Granato, G. Garascia, P. Manganotti | Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
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Background: Antiepileptic medications (AEMs) are known to reduce cortical excitability and have demonstrated efficacy in decreasing the frequency of migraines, particularly in cases of chronic migraine and migraine with aura. Hemiplegic migraine represents a distinct subtype characterized by transient hemiparesis during aura episodes. Familial hemiplegic migraine (FHM) is an autosomal dominant disorder associated with genetic mutations linked to mutations in the genes CACNA1A, ATP1A2, and SCN1A. More recently, mutations in PRRT2 have also been implicated. Aim of the study is the description of the long-term efficacy of AEMs in a PRRT2 case.
Methods: We conducted a retrospective analysis of a 31-year-old man with a lifelong history of migraine from early childhood, who later developed progressive sensory-motor hemiparesis.
Results: Firstly, the patient suffered from migraine without aura but at 15 y.o. he started having initially right-sided hemiparesis which later evolved in a transient ipsilateral sensorimotor hemiparesis which became persistent at 27, with a deficit lasting several months. The patient underwent EEG and neuroimaging with no abnormal results. A heterozygous deletion of the entire PRRT2 gene was identified with Multiplex ligation-dependent probe amplification, the same result was found in two close relatives (sister and mother), whom exhibited similar clinical features. Lamotrigine was the first AEMs choice but after few months he developed suicidal ideation so he was switched to Valproic Acid (VA) 300 mg bid. The aura symptoms resolved in less than a month and the patient never presented again the sensorimotor hemiparesis in over three years. No side effects were described except a non-significant increase in liver enzymes.
Conclusion: VA has been shown to be effective and well tolerated in the long-term treatment of FHM due to PRRT2 deletion.
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