Use of a calcium channel blocker (nicardipine HCl) in the treatment of childhood moyamoya disease.
Moyamoya disease is a cerebrovascular disease characterized radiologically by progressive narrowing and occlusion of the arteries contributing to the circle of Willis and its branches. There is formation of an exuberant collateral network of blood vessels at the base of the brain, which is thought to arise in response to chronic ischemia. Clinically, the course is variable, with patients having repeated transient ischemic attacks, strokes, migraine, and seizures. Effective treatment is not available. The etiology and pathophysiology of moyamoya disease are largely unknown. Two patients with arteriographically proven moyamoya disease were identified. Both patients were symptomatic before age 5 years. Despite successful encephaloduroarteriosynangiosis revascularization procedures, they continued to experience an inexorable downhill course. A calcium channel blocker (nicardipine HCl) was introduced in order to prevent further symptoms. After the introduction of nicardipine, no further strokes occurred in either patient. There were no further episodes of transient ischemic attacks, seizures, or headache in one patient and decreased frequency in the other. In patients with moyamoya disease, nicardipine may have a beneficial effect on cerebral hemodynamics and may prevent ischemic sequelae by optimizing existing collateral circulation.
Hosain
S A
SA
Department of Pediatric Neurology, New York University Medical Center, NY 10016.
Hughes
J T
JT
Forem
S L
SL
Wisoff
J
J
Fish
I
I
D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy; D002533:Cerebral Angiography / Q000187:drug effects*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy; D002548:Cerebral Revascularization; D002648:Child; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009529:Nicardipine / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy
D009529:Nicardipine