A. Word-finding difficulty
B. Renal stones
E. Acute myopia
The answer is D. All of the listed side effects are noted with topiramate (Topamax), with paresthesias being the most common side effect noted in adult patients. Oligohidrosis (decreased sweating) and elevated body temperature have been reported in patients on topiramate, primarily young children. Symptomatic hyperthermia is primarily associated with increased environmental temperature and/or exercise, and generally can be prevented with adequate hydration. The risk of hyperthermia is increased when topiramate is combined with other drugs, such as carbonic anhydrase inhibitors and anticholinergic medications, which also predispose patients to heat-related disorders. The other topiramate side effects listed are not more prevalent in children. (Cerminara, Seri, Bombardieri, et al., Pediatr Neurol 2006)
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leu-koencephalopathy (CADASIL) has been associated with mutations of which gene?
The answer is D. Patients with CADASIL have a mutation in the NOTCH3 gene, which encodes for a receptor involved in the functioning of vascular smooth muscle cells in small arteries and arterioles. Familial hemiplegic migraine is a genetically heterogeneous migraine disorder associated with mutations in the CACNA1A (FHM1), ATP1A2 (FHM2), and SCN1A (FHM3) genes. TREX1 is involved in the cellular response to oxidative stress, and has been identified as the causal gene for autosomal dominant retinal vasculopathy with cerebral leu-kodystrophy (RVCL). Migraine and Raynaud’s phenomenon have been associated with RVCL. (Stam, van den Maagdenberg, Haan, et al., Curr Opin Neurol 2008)
Which of the following is associated with cutaneous allodynia?
A. Female gender
C. Increased body mass index
D. Increased headache frequency
E. All of the above
The answer is E. Cutaneous allodynia is a painful skin sensation or discomfort induced by a non-noxious stimulus, that is a frequent complaint during prolonged migraine attacks. Cutaneous allodynia is experienced with sunburned skin where even the lightest touch is perceived as painful, a helpful analogy when explaining the phenomenon to those who have never experienced it. It is usually noted initially on the face ipsilateral to the migraine pain but can spread to the opposite side and involve the extremities as well. The Allodynia Symptom Checklist (ASC) was used to measure allodynia, as well as headache features, disability, and comorbidities in over 16, 000 individuals who responded to a mail survey. Cutaneous allodynia was more common and more severe in patients with transformed migraine or migraine, as compared with other primary headache types. Among migraineurs, CA was associated with female gender, increased headache frequency, increased BMI, increased disability, and depression. However, a recently published report of twenty-five non-allodynic patients and 38 allodynic migraineurs studied with a 90-item self-report psychological symptom inventory, found no significant difference between the two groups in any area of the personality profile. (Bin, Ashina, Burstein, et al., Neurology 2008; Lovati C, DAmico D, Brambilla A, Mariani C, Bussone G. Personality profile and allodynic migraine. Neurol Sci. 2008 May;29 Suppl l:S152-4)
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