Lasmiditan, a 5-HT1F receptor agonist that is FDA-approved for migraine headaches, lacks the vasoconstrictive properties of triptans and can be given safely to patients with cardiovascular risk factors.
Randomized trial evidence supports the use of tricyclic antidepressants, such as amitriptyline, for tension headache prophylaxis and are often tried first.
Although neither intravenous valproate or levetiracetam is approved by the FDA for status epilepticus, both were equivalent to fosphenytoin in a randomized trial.
Dabigatran showed similar efficacy to warfarin in one randomized trial and may be an acceptable alternative.
INTRACRANIAL & SPINAL MASS LESIONS
In patients with glioblastoma with methylated methylguanine- DNA methyltransferase (MGMT) promoter, combination therapy with lomustine and temozolomide improved median survival from 31 to 48 months in a randomized controlled trial.
The only approved therapy for NMO-IgG positive neuromyelitis optica cases is eculizumab, which reduced the annualized relapse rate from 35% to 2% compared with placebo.
Inebilizumab, a humanized anti-CD19 antibody that depletes B cells, also reduced relapse rate in a neuromyelitis optica randomized trial but is not yet approved.
DISORDERS OF NEUROMUSCULAR TRANSMISSION
Eculizumab is FDA-approved for acetylcholine receptor antibody positive myasthenia in patients who have disease refractory to at least two alternate immunosuppressive therapies.