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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 53, Num. 2, 2005, pp. 243-243
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Neurology India, Vol. 53, No. 2, April-June, 2005, pp. 243
Letter To Editor
Authors’ Reply
Bhattacharyya Kalyan B.
Department of Neurology, Calcutta National Medical College and Hospital, Calcutta
Correspondence Address: Department of Neurology, Calcutta National
Medical College and Hospital, Calcutta, kalyanbrb@rediffmail.com
Date of Acceptance: 27-May-2005
Code Number: ni05081
Related article: ni05080
Sir,
We thank the author for his interest in our case report. We could not
use propranolol, since there was history of bronchial asthma and sodium
valproate
or divalproex sodium are known to increase body weight. Moreover, we
are somewhat reluctant in using sodium valproate or its congener in women
for the known side effect of alopecia and the development of polycystic
ovarian disease, which has recently been reported in various publications[1],[2] and
alopecia is certainly not cosmetically acceptable to the female subjects.
Constipation, dry mouth, and somnolence associated with amitryptiline
(and also gain in weight) dissuaded us from using this agent.
We are afraid, we cannot possibly agree with the author that flunarizine is a second line drug for the prophylactic management of migraine. Various studies recommend its usage as one of the first orders,[3],[4],[5] and in this particular case, where propranolol could not be administered and where we were hesitant to use sodium valproate or its congener, for the reasons mentioned above, topiramate was the readily available option with us. However, because of limited works available on the use of topiramate (when we came across the patient) and this agent being also being designated by various workers as a second-line drug, even in recent times,[6] we felt that one first-line drug should better be prescribed and flunarazine was the obvious choice. We restricted its dosage to the lowest possible limit, since it is known to cause troublesome somnolence and leads to weight gain. These were the compelling reasons for administering two drugs simultaneously in this case, deviating from the conventional system of usage.
REFERENCES
| 1. | Isojarvi JI, Tapanainen JS. Valproate, hyperandrogenism, and polycystic ovaries: a report of 3 cases. and polycystic ovaries: Arch Neurol 2000;57:1064-8. Back to cited text no. 1 |
| 2. | Ribacoba Montero R, Martinez-Faedo C, Salas-Puig J. Polycystic ovary syndrome and valproic acid. Rev Neurol. 2003;37:975-82. Back to cited text no. 2 |
| 3. | Evers S, Pothmann R, Uberall M, Naumann E, Gerber WD. Treatment of idiopathic headache in childhood - recommendations of the German Migraine and Headache Society (DMKG). Schmerz 2002;16:48-56. Back to cited text no. 3 |
| 4. | Limmroth V, Michel MC. The prevention of migraine: a critical review with special emphasis on beta-adrenoceptor blockers. Br J Clin Pharmacol 2001;52:237-43. Back to cited text no. 4 |
| 5. | Shimell CJ, Fritz VU, Levien SL. A comparative trial of flunarizine and propranolol in the prevention of migraine. S Afr Med J 1990 20;77:75-7. Back to cited text no. 5 |
| 6. | Geraud G, Lanteri-Minet M, Lucas C, Valade D; French Society for the Study of Migraine Headache (SFEMC). French guidelines for the diagnosis and management of migraine in adults and children. Clin Ther 2004;26:1305-18. Back to cited text no. 6 |
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