• Reduced Frequency of Prolonged...

*Result*: Reduced Frequency of Prolonged Sporadic Hemiplegic Migraine Attacks Following Fremanezumab Treatment-A Case Report.

Title:
Reduced Frequency of Prolonged Sporadic Hemiplegic Migraine Attacks Following Fremanezumab Treatment-A Case Report.
Authors:
Hotz JF; Department of Neurology, St. John of God Hospital, Vienna, Austria.; Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria., Kaindl L; Department of Neurology, St. John of God Hospital, Vienna, Austria., Krebs S; Department of Neurology, St. John of God Hospital, Vienna, Austria., Vigl M; Department of Neurology, St. John of God Hospital, Vienna, Austria., Ferrari J; Department of Neurology, St. John of God Hospital, Vienna, Austria., Neumann C; Department of Radiology, St. John's Hospital, Vienna, Austria., Han R; Department of Radiology, St. John's Hospital, Vienna, Austria., Ritscher L; Department of Neurology, St. John of God Hospital, Vienna, Austria., Sykora M; Department of Neurology, St. John of God Hospital, Vienna, Austria.; Medical Faculty, Sigmund Freud University Vienna, Vienna, Austria., Gallmetzer P; Department of Neurology, St. John of God Hospital, Vienna, Austria.
Source:
European journal of neurology [Eur J Neurol] 2026 Feb; Vol. 33 (2), pp. e70514.
Publication Type:
Case Reports; Journal Article
Language:
English
Journal Info:
Publisher: Wiley Country of Publication: England NLM ID: 9506311 Publication Model: Print Cited Medium: Internet ISSN: 1468-1331 (Electronic) Linking ISSN: 13515101 NLM ISO Abbreviation: Eur J Neurol Subsets: MEDLINE
Imprint Name(s):
Publication: <2014- > : Oxford : Wiley
Original Publication: Oxford ; New York : Rapid Communications, [1994-
MeSH Terms:
Antibodies, Monoclonal*/therapeutic use , Migraine with Aura*/drug therapy, Humans ; Male ; Middle Aged
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Contributed Indexing:
Keywords: calcitonin gene‐related peptide receptor antagonists; headache; humans; migraine disorders; migraine with aura
Substance Nomenclature:
0 (Antibodies, Monoclonal)
0 (fremanezumab)
SCR Disease Name:
Migraine, Sporadic Hemiplegic
Entry Date(s):
Date Created: 20260127 Date Completed: 20260127 Latest Revision: 20260201
Update Code:
20260201
PubMed Central ID:
PMC12836861
DOI:
10.1111/ene.70514
PMID:
41589756
Database:
MEDLINE

*Further Information*

*Introduction: Hemiplegic migraine (HM) is a rare subtype of migraine with aura, characterized by transient, unilateral motor weakness. Due to its rarity, treatment strategies are lacking. Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway have emerged as a potential therapeutic option.
Case Report: A 64-year-old man was admitted to an Austrian stroke unit with acute aphasia, right-sided hemiplegia, and reduced consciousness. MRI showed no ischemia or hemorrhage. Cerebrospinal fluid analysis revealed pleocytosis (146 cells/μL) without signs of infection. By Day 4, the patient showed improving hemiparesis and new-onset hemicranial headache. Aphasia resolved by Day 14 and hemiparesis by Day 21. The patient's history included non-Hodgkin lymphoma with cerebral relapse, treated with whole-brain irradiation and stem cell transplantation in 2007, and a history of migraine with aura. Differential diagnoses such as SMART syndrome and HaNDL were considered, but the improvement of symptoms following headache onset and the prior migraine history supported the diagnosis of sporadic hemiplegic migraine (SHM). Genetic testing revealed no mutations associated with familial HM. Initial treatment with lamotrigine was followed by monthly fremanezumab (225 mg). No further HM attacks occurred over 6 months of follow-up.
Conclusion: This case illustrates the diagnostic complexity of SHM and adds to the growing body of anecdotal observations suggesting that CGRP monoclonal antibodies may be a promising preventive treatment for patients with HM. Further studies are needed to evaluate their efficacy in this rare migraine subtype.
(© 2026 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)*