Daily Scheduled Opioids as Monotherapy for Prevention of Migraine-Triggered Epilepsy

Dear Editor

As a clinical neurologist with interest in migraine and epilepsy, I am commenting on a recent article published in the Journal by Jand and Palizvan [1]. The authors described an inhibitory role for Pentylenetetrazol-induced seizures in certain strain of mice after treating the animals with sumatriptan at various doses, comparing those results with the effect of varying doses of sodium valproate in alleviating epileptic symptoms. Although the respected authors seem to be familiar with the relationship of migraine and epilepsy in general, they do not seem cognizant of the fact that the two conditions bespeak of identical entities as to their pathogenetic mechanisms. Thus, in a recent article entitled “a report of three patients in whom the surgical closure of terminal branches of the external carotid arteries for treatment of migraine resulted in significantly reduced frequency of epileptic attacks,” Shevel showed that the two conditions are one and the same etiopathogenically [2]. Similarly, data in a recent analysis of the subject Wilner and colleagues pointed to the effectiveness of an empirically-derived method for preventing occurrences of epilepsy employing daily scheduled opioid, acknowledging the primacy of migraines in generating the fits in patients with migralepsy [3] [4]. The role of dynorphin as an endogenous anticonvulsant was thoroughly reviewed by Simonato and Romuladi in 1996 [5].

• References

• 1 Jand A, Palizvan MR. Sumatriptan, an Antimigraine Drug, Inhibits Pentylenetetrazol-induced Seizures in NMRI Mice. Drug Res (Stuttg) 2017; 67: 179-182
• 2 Shevel EI. A report of three patients in whom the surgical closure of terminal branches of the external carotid arteries for treatment of migraine resulted in significantly reduced frequency of epileptic attacks. S Afr Med J. 2016; 106: 1084-1085
• 3 Wilner AN, Sharma BK, Thompson AR. et al. Analgesic opioid use in a health-insured epilepsy population during 2012. Epilepsy Behav. 2016; 57 Pt A 126-132
• 4 Wilner AN, Sharma BK, Thompson AR. et al. Analgesic opioid use in a health-insured epilepsy population during 2012: Response to Derakhshan. Epilepsy Behav. 2016; 60: 239
• 5 Simonato M, Romualdi P. Dynorphin and epilepsy. Prog Neurobiol. 1996; 50: 557-583