Abstract：
Hemiplegic migraine (HM) is a subtype of migraine with aura that includes motor weakness; such headaches can be excruciating. The presence of not only headache but also aura symptoms of HM increase the burden on patients, and the treatment of HM is sometimes challenging. Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway are novel migraine preventive treatments that have shown promising efficacy in patients with migraine; however, there have been no reports regarding their efficacy in HM to date. Six patients with HM were treated with galcanezumab in a tertiary-care headache center. After 3 months of treatment, the number of monthly days with headache of at least moderate severity was reduced in three patients. The number of days each month with weakness was also reduced in four patients. Furthermore, the Patient\'s Global Impression of Change and change in Migraine Disability Assessment total score, were improved in five of the six patients after the treatment; however, the change from baseline in days with bothersome symptoms did not show any specific trends in our patients. Notably, no adverse events were reported during the treatments. The mechanism underlying the improvement in aura symptoms in our patients is not clear; however, we speculate that a small amount of CGRP mAbs have a direct mode of action in the central nervous system; alternatively, blocking the CGRP pathway in the periphery may secondarily inhibit cortical spreading depression. While prudence must be practiced, galcanezumab was still generally effective in HM and well tolerated. Further prospective clinical studies will more clearly elucidate the effects of CGRP mAbs in patients with HM.
摘要：
偏瘫偏头痛（HM）是一种具有先兆的偏头痛亚型，包括运动无力；这种头痛可能令人痛苦。不仅头痛，而且HM先兆症状的存在增加了患者的负担，并且HM的治疗有时是具有挑战性的。针对降钙素基因相关肽（CGRP）途径的单克隆抗体（mAb）是一种新型的偏头痛预防性治疗方法，在偏头痛患者中显示出有希望的疗效；然而，迄今为止,尚无关于其在HM中疗效的报道.6例HM患者在三级治疗头痛中心接受galcanezumab治疗。治疗3个月后,3例患者每月出现至少中度头痛的天数减少.4名患者每月虚弱的天数也减少了。此外，患者对偏头痛残疾评估总分变化和变化的总体印象，治疗后六名患者中有五名有所改善；然而，在我们的患者中,出现烦人症状的天数与基线相比的变化未显示出任何具体趋势.值得注意的是,治疗期间未报告不良事件.我们的患者先兆症状改善的潜在机制尚不清楚；然而，我们推测少量CGRPmAb在中枢神经系统中具有直接的作用方式；或者，阻断外周CGRP途径可能其次抑制皮质扩散抑制。虽然必须谨慎行事，galcanezumab在HM中仍然普遍有效并且耐受性良好.进一步的前瞻性临床研究将更清楚地阐明CGRPmAb在HM患者中的作用。
