Sa. Hosain et al., USE OF A CALCIUM-CHANNEL BLOCKER (NICARDIPINE HCL) IN THE TREATMENT OF CHILDHOOD MOYAMOYA DISEASE, Journal of child neurology, 9(4), 1994, pp. 378-380
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.