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To the Editor:
I enjoyed the article by Drs. Yu and Horowitz1 and learned a new treatment for hemiplegic migraine. The rationale for using verapamil was based on both the demonstrations that familial hemiplegic migraine has gene mutations within the P/Q-type neuronal calcium channel alpha1A subunit and the assumption that sporadic hemiplegic migraine has similar calcium channel dysfunction. Based on these assumptions, they gave verapamil intravenously and orally. Their findings suggest that neuronal calcium-channel dysfunction may underlie the pathogenesis of familial and sporadic hemiplegic migraines and that verapamil is an effective therapy for both disorders. However, I believe that their conclusion is untenable for the following reasons:
Their patients were treated as having homogeneous disorders with P/Q-type calcium channel</O: P</O: P defect without DNA analysis.
They lumped the group based on the pharmacologic response to verapamil assuming that they are targeting the P/Q-type calcium channel dysfunction when verapamil …
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