How does it progress?
The symptoms of CADASIL gradually increase in intensity as the degeneration of the arteries continues. It is not rapidly progressive and the average life expectancy can reach into the 70’s but this can be variable.
Management of CADASIL
Unfortunately, there is no proven treatment or cure for CADASIL. Treatment is mainly aimed at relieving and managing the symptoms, maintaining quality of life and being stroke-free. Migraines should be treated with standard migraine painkillers such as Migraleve with the vital exception of those drugs known as Triptans who work by restricting blood flow which is more likely to cause strokes. Some of those drugs are Imitrex, Imigran, Sumatriptan and Rizatriptan. Other drugs are known as Antiplatelets work by preventing blood cells called platelets from clumping together and forming clots. Two of these that have shown some benefit are Aspirin and Clopidogrel.
There are some medications that are in use to prevent migraines however always consult your clinician about their use. Some of those are Valproic Acid, Topiramate, Gabapentin, Propranolol and tricyclic antidepressants. Acetazolamide, which dilates blood vessels has also been used.
Never use thrombolytic agents (clot-dissolving medication) as it increases bleeding in the brain for those with CADASIL.
Standard anti-depressant drugs can be used to treat depression and in fact, we recommend this in conjunction with cognitive behaviour therapy.
A randomised trial with Aricept (Donepezil), a drug used for Alzheimer’s did not prove effective however some people may benefit due to improved concentration and attention.
More study needs to be undertaken as to the proven benefits and safety of these drugs and other options.
Never take any drug without first consulting your clinician.
Your personal health plays a significant role in how you can treat CADASIL. Smoking is a proven risk factor for strokes so please give it up. Birth control pills are also known risk factors. Maintain a healthy lifestyle as possible with regular exercise and be in charge of those factors such as high blood pressure, diabetes and high cholesterol that increase your risk of stroke. Wherever possible take advantage of supportive therapies such as physical, speech or any that are available through your allied and community health systems.
Diabetes, Hypertension and excessive build-up of cholesterol in the blood (Hypercholesterolaemia) need to be carefully monitored as they are all risk factors in CADASIL.