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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.
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Randomized trial evidence supports the use of tricyclic antidepressants, such as amitriptyline, for tension headache prophylaxis and are often tried first.
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Although neither intravenous valproate or levetiracetam is approved by the FDA for status epilepticus, both were equivalent to fosphenytoin in a randomized trial.
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Dabigatran showed similar efficacy to warfarin in one randomized trial and may be an acceptable alternative.
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INTRACRANIAL & SPINAL MASS LESIONS
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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.
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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.
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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.
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DISORDERS OF NEUROMUSCULAR TRANSMISSION
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Eculizumab is FDA-approved for acetylcholine receptor antibody positive myasthenia in patients who have disease refractory to at least two alternate immunosuppressive therapies.