ROLE OF ANTICARDIOLIPIN ANTIBODIES IN YOUNG PERSONS WITH MIGRAINE ANDTRANSIENT FOCAL NEUROLOGIC EVENTS - A PROSPECTIVE-STUDY

Anticardiolipin antibodies (aCL) are a risk factor for cerebral ischem ia. In migraine, the association is controversial, with widely varying results in different small series. The controversy in part may be due to the inherent difficulty in distinguishing the transient focal neur ologic events (TFNE) of migraine from TIA. To assess the frequency of aCL in migraine, we prospectively evaluated consecutive adults under 6 0 years of age with migraine without aura and with recent TFNE (<24-ho ur duration) clinically suggestive of either migraine with aura or TIA . We concomitantly enrolled persons with no CNS disease. Each person w as interviewed and had blood drawn for solid-phase ELISA with IgG and IgM aCL isotyping. Neuroradiologic studies were reviewed. Patients wit h TFNE were followed every 6 months for the duration of the 3-year stu dy. The frequency of aCL positivity (IgG >20, IgG >40, IgM >7.5) for t he 645 patients with TFNE (8.8, 3.1, 4.2%), the 518 persons in the TFN E subgroup with migraine with aura (8.9, 3.3, 4.1%), the 497 persons w ith migraine without aura (7.0, 2.0, 3.6%), and the 366 control subjec ts (9.3, 3.6, 3.9%) did not differ significantly between groups. In TF NE patients with elevated aCL titer, the association was positive with diabetes mellitus, TFNE duration <15 minutes, and diplopia and was ne gative with hemiparesis, tinnitus, and family history of stroke. Findi ngs on imaging consistent with cerebral ischemia were more frequent in aCL-positive persons. The short-term risk of stroke was uniformly low . In young persons, aCL is not associated with migraine or with TFNE, although diabetes mellitus, negative family history of stroke, and bri ef duration of symptoms (including diplopia) may predict immunoreactiv ity. Imaging studies suggest an ischemic etiology of TFNE in this coho rt.