臨床神経学

<シンポジウム(1)―10―2>片頭痛の病態研究Update

Cortical spreading depressionと遺伝子研究

古和 久典, 中島 健二

鳥取大学医学部脳神経医科学講座脳神経内科学分野〔〒683―8504 鳥取県米子市西町36―1〕

Cortical spreading depression (CSD) is a slowly propagated wave of depolarization of neurons and glial cells, followed by a subsequent sustained suppression of spontaneous neuronal activity. Functional imaging studies of migraine patients have shown dramatic changes in blood flow and brain activity whose characteristics are similar to those of CSD, implicated in migraine visual aura. Although the trigeminal nerve innervates the meninges and participates in the genesis of migraine headaches, triggering mechanisms remain controversial and poorly understood. It is demonstrated by animal models that CSD activates trigeminovascular afferents and evokes a series of cortical meningeal and brainstem events consistent with the development of headache. Three familial hemiplegic migraine, a rare monogenic subtype of migraine with aura, genes have been identified, which all encode ion transporters, suggesting that disturbances in ion and neurotransmitter balances in the brain are responsible for this migraine type. Additional molecular insight into the pathophysiology of migraine may come from other monogenic syndromes such as CADASIL, RVCL. Several genetic associations with candidate migraine genes like ESR1, MTHFR, and INSR, have been convincingly replicated. The genome-wide association studies may be a successful strategy toward identification of migraine susceptibility genes.
Full Text of this Article in Japanese PDF (190K)

(臨床神経, 52:1006−1008, 2012)
key words:拡延性抑制,チャネル異常,家族性片麻痺性片頭痛,ゲノムワイド関連解析

(受付日:2012年5月23日)