“Comorbidity” between epilepsy and headache/migrai

Authors: Pasquale Striano Vincenzo Belcastro Alberto Verrotti Pasquale Parisi

Publish Date: 2011/10

Volume: 12, Issue: 5, Pages: 577-

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Abstract

We read with interest the paper by Toldo and coworkers addressing the important issue of comorbidity between epilepsy and headache/migraine 1 In fact although these are both chronic disorders with episodic attacks and their association has been long recognized the common molecular mechanisms remain so far elusive 2–4 Indeed recent data suggest shared genetic substrates and phenotypicgenotypic correlations with mutations in some ion transporters genes including CACNA1A ATP1A2 SCN1A 3 4 In their latest study Toldo et al evaluated the distribution of five polymorphisms of SCN1A the gene encoding the asubunit of the neuronal voltagegated sodium channel Nav11 in children and adolescents with headache and epilepsy compared to controls They concluded that SCN1A is not involved in the pathogenesis of comorbidity between headache/migraine and epilepsy 1Despite this negative study neuronal hyperexcitability and increased susceptibility to cortical spreading depression remain important molecular mechanisms in the pathophysiology of this association In the coming decade it is possible that International efforts to collect large wellphenotyped samples and the current technical possibilities of massive genotyping will shed light on the genetic mechanisms involved in with headache/migraine and epilepsy On the other hand the role of additional non genetic factors influencing the excitation threshold eg mitochondrial dysfunction disturbance in neurotransmitters metabolism or inflammatory factorsalone or in combinationcan not be excluded a priori 3 4 Indeed any of these triggering factors irrespective of their nature genetically determined or not could potentially lead to a paroxysmal and transient cortical excitability change leading to prolonged neuronal depolarization seizure or spreading depression headache/migraine 2 3Among the potential practical implications arising from these observations there is the urgent need for a revision of either International Classifications of Epilepsy and Headache disorders 2 3 5 Finally insight into the molecular mechanisms involved in the association between headache/migraine and epilepsy is crucial to identify drug targets for improving patients’ treatmentBy submitting a comment you agree to abide by our Terms and Community Guidelines If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines

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