USE OF A CALCIUM-CHANNEL BLOCKER (NICARDIPINE HCL) IN THE TREATMENT OF CHILDHOOD MOYAMOYA DISEASE

Moyamoya disease is a cerebrovascular disease characterized radiologic ally by progressive narrowing and occlusion of the arteries contributi ng to the circle of Willis and its branches. There is formation of an exuberant collateral network of blood vessels at the base of the brain , which is thought to arise in response to chronic ischemia. Clinicall y, the course is variable, with patients having repeated transient isc hemic attacks, strokes, migraine, and seizures. Effective treatment is not available. The etiology and pathophysiology of moyamoya disease a re largely unknown. Two patients with arteriographically proven moyamo ya disease were identified. Both patients were symptomatic before age 5 years. Despite successful encephaloduroarteriosynangiosis revascular ization procedures, they continued to experience an inexorable downhil l course. A calcium channel blocker (nicardipine HCl) was introduced i n order to prevent further symptoms. After the introduction of nicardi pine, no further strokes occurred in either patient. There were no fur ther episodes of transient ischemic attacks, seizures, or headache in one patient and decreased frequency in the other. In patients with moy amoya disease, nicardipine may have a beneficial effect on cerebral he modynamics and may prevent ischemic sequelae by optimizing existing co llateral circulation.