Serum Calcitonin Gene-Related Peptide Is Elevated in Patients With Migraine and Ophthalmoplegia.

BACKGROUND: There is ongoing debate about whether the oculomotor (III), trochlear (IV), or abducens (VI) nerve paresis in patients with migraine is directly attributable to migraine (ophthalmoplegic migraine [OM]) or is due to an inflammatory neuropathy (recurrent painful ophthalmoplegic neuropathy [RPON]). As migraine is associated with elevated serum calcitonin gene-related peptide (CGRP) levels, we studied serum CGRP levels among patients with OM/RPON to determine whether they are elevated during and between attacks. This is the first study assessing CGRP levels in the serum of patients with OM/RPON. METHODS: The aim of this case-control study was to assess serum CGRP levels in patients with ophthalmoplegia and a headache consistent with migraine according to ICHD-3 criteria. Serum CGRP levels were measured during the ictal and interictal phases in 15 patients with OM/RPON and compared with age-matched and sex-matched controls without migraine (12 patients). RESULTS: The median serum CGRP levels were significantly elevated ( P = 0.021) during the ictal phase (37.2 [36.4, 43.6] ng/L) compared with controls (32.5 [30.1, 37.3] ng/L). Serum CGRP levels during the attack correlated with the total duration of ophthalmoplegia. A CGRP level of 35.5 ng/L in the ictal phase of the attack had a sensitivity of 86.7% and specificity of 75.0% in diagnosing a patient with OM/RPON. CONCLUSIONS: Elevated serum CGRP levels during the ictal phase of OM/RPON favor migraine as the underlying cause of episodic headache with ophthalmoplegia.

Evaluation of enalapril affecting the renin-angiotensin system in normal and stress-induced rats based on urinary metabolites of amines and cortisol.

INTRODUCTION: The renin-angiotensin system is distributed centrally as well as peripherally, which works in association with SNS and HPA in stress. Angiotensin is considered one of the principal hormones for bringing out stress-related changes. To find the influence of enalapril on the neuromediator of CNS and periphery, the present work was carried out. The assessment of the transmitter levels was done by estimating major urinary stress metabolites like vanillylmandelic acid, 5-hydroxyindoleacetic acid, 6-ß-hydroxycortisol and homovanillic acid in normal and stress-induced conditions and also in the absence and presence of enalapril treatment in rats. MATERIALS AND METHODS: Groups of rats were subjected to a forced swim stress one hour after daily treatment of enalapril. The 24 h urinary excretion of vanillylmandelic acid, 5-hydroxyindoleacetic acid, 6-ß-hydroxycortisol and homovanillic acid was determined in all groups under normal and stressed-induced conditions. RESULTS: Daily administration of enalapril at doses of 3, 10 and 30 mg/kg/body weight inhibited the stress-induced urinary biochemical changes. However, treatment with enalapril in normal conditions increased the excretion of all selected metabolites. CONCLUSION: It can be speculated that enalapril prevented stress-induced increases of adrenergic, serotonergic and cortical mechanisms.