Saturday, 23 November 2013

Hemiphegic Migraine Headaches - The Types

Hemiphegic Migraine Headaches
Hemiphegic Migraine headache is defined as a severe and rare condition of of migraine with aura. Headache pain of a migraine may precede with temporary chemical imbalances, as the levels of the serotonin, dopamine or norepinephrine in the brain have become too low or too high, affecting transmit messages. Hemiphegic Migraine headache occurs 5 to 90 minutes before the onset of the headache, but sometime through the duration of the headache.
Types of Hemiphegic Migraine Headaches
A. Familial
of which with the above but includes involvement of  the family history of the diseases as the result of gene nutation, familial hemiphegic migraine headache is classified into 3 different types, CACNA1A (FHM1) gene, the ATP1A2 (FHM2) and the SCN1A (FHM3), depending to the specific gene mutation.
Type I: Familial hemiplegic migraine type 1 CACNA1A (FHM1)
Familial hemiplegic migraine type 1 is defined as a condition of mutation of gene CACNA1A of that affects the Voltage-dependent calcium channels mediate the entry of calcium ions into excitable cells, and their functions in regulating muscle contraction, hormone or neurotransmitter release, etc. CACNA1A mutations can give significant symptoms other than (hemiplegic) migraine as reason for presentation.
Familial hemiplegic migraine type 1 is accounted approximately half of  hemiplegic migraine of all cases. There are evidences that the risk is up to 90% of a loss of motor control presented with patient of Familial hemiplegic migraine type 1 as the result of the death of cells in the cerebellum.

Type II: Familial hemiplegic migraine type 2 ATP1A2 (FHM2)
Familial hemiplegic migraine type 2 (FHM2) is defined as a condition of an autosomal dominant form of migraine with aura as a result of mutations of the α2-subunit of the Na,K-ATPase, an isoform almost exclusively expressed in astrocytes in the adult brain. There are report that FHM2 and FHM1 mutations share the cortical spreading depression as a key migraine trigger(7)

Type III: Familial hemiplegic migraine type 3 SCN1A (FHM3)
The SCN1A gene is located on chromosome (2q24) and codes for a sodium channel protein type 1 and considered a high resistant molecule when compared to FHM1 and FHM2because of it is associated with
recurrent seizures. According to "Familial hemiplegic Migraine Type 3, FHM3 - SCN1A" (8), SCN1A mutations follow an autosomal dominant pattern of inheritance with incomplete penetrance. New mutations are possible. Others show that if one parent is affected, their children will have a 1 in 2 chance of inheriting the condition.

B. Sporadic
of which with above symptoms and same types of gene mutation but no family history of the diseases, according to "Sporadic hemiplegic migraine and epilepsy associated with CACNA1A gene mutation" (9), there is evidence that sporadic case of FHM1 linked to S218L CACNA1A gene mutation with the triad of prolonged hemiplegic migraine, cerebellar symptoms, and epileptic seizures. Sporadic cases are more difficult to diagnose and often require several investigations to rule out more ominous possibilities(10)

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