Beta Blockers?

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Beta Blockers?

Postby ChrisR » Tue Aug 30, 2011 4:12 pm

Did anyone read the letter to the editor in May's Stroke Journal? A team including Spetzler respond to a study about the efficacy of stains for the treatment of cavernomas, and also suggest beta blockers as potentially useful in shrinking lesions.

I don't have a subscription, so I can't read the whole thing. But a few paragraphs can be found here: http://stroke.ahajournals.org/content/42/5/e373.extract

Is anyone on beta blockers?
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Re: Beta Blockers?

Postby kirkmc » Tue Aug 30, 2011 5:01 pm

I've asked Connie to look into this and get info.

It's been known for a while that propranolol can shrink capillary angiomas, the ones that are like birthmarks on the skin. I hadn't read about any trials for CAs in the brain. I took propranolol for a while for my tremor; it reduced the tremor, but made me very, very tired, and I stopped. And this was at a low dosage.
Two brainstem CAs in the pons. Big Bleed in July 2005, previous, undiagnosed bleeds in 1982 and 1987, and several smaller bleeds in the past few years. I live in a town in the French Alps. http://www.mcelhearn.com
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Re: Beta Blockers?

Postby ChrisR » Tue Aug 30, 2011 5:34 pm

The article makes reference to the use of propranolol to treat a large CA in an infant. If you have a subscription you can read that study at the following link. I don't, so I can't speak to the results. However, the article in Stroke seemed to suggest the treatment was successful.

http://www.ncbi.nlm.nih.gov/pubmed/20413807
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Re: Beta Blockers?

Postby kirkmc » Wed Aug 31, 2011 5:42 am

It's actually a letter, and kind of short, and isn't based on a study, but rather a limited report. Angioma Alliance's scientific advisor will post something here soon.
Two brainstem CAs in the pons. Big Bleed in July 2005, previous, undiagnosed bleeds in 1982 and 1987, and several smaller bleeds in the past few years. I live in a town in the French Alps. http://www.mcelhearn.com
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Re: Beta Blockers?

Postby ChrisR » Wed Aug 31, 2011 10:49 am

Terrific. I knew the stroke journal one was a letter to the editor. Thought maybe the one about shrinking a large infant's cavernoma was an article. I'll have to get a subscription to one of these. Even my university doesn't have access.
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Re: Beta Blockers?

Postby Amy.Akers » Wed Aug 31, 2011 3:21 pm

The original article referenced above is a short one page report describing a single case of an infant with a large brain cavernous angioma who was treated with propranolol. Propranolol is a beta blocker that has been shown to possibly cause regression of skin hemangiomas that often occur in infancy. Using this evidence, the treating physician, and author of this report, treated his CA patient with propranolol and observed that shrinkage of the CA was apparent on MRI. Certainly, this is a favorable outcome that warrants further investigation on the effects of beta blockers on cavernous angiomas. At this point, there is no other published evidence suggesting the CA patients begin taking beta blockers.
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Re: Beta Blockers?

Postby ChrisR » Thu Sep 01, 2011 10:45 am

Thanks Amy,
Did it say that the CA was completely eliminated in the infant?
And in the letter to the editor for which Dr. Robert Spetzler is a co-author, did they expand on the curative potential of beta blockers, or just make reference to the original article?
Really, thanks again Amy.
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Re: Beta Blockers?

Postby kirkmc » Thu Sep 01, 2011 1:16 pm

ChrisR wrote:Thanks Amy,
Did it say that the CA was completely eliminated in the infant?
And in the letter to the editor for which Dr. Robert Spetzler is a co-author, did they expand on the curative potential of beta blockers, or just make reference to the original article?
Really, thanks again Amy.


No, the article mentions "significant shrinkage" in a "giant CCM." It also doesn't say whether this effect is attributed to beta blockers in general or propranolol in particular. They say this:

"The underlying patho- physiological mechanism explaining the action of propranolol in capillary malformations includes: (1) the induction of vasoconstriction; (2) the decrease in the expression of the vascular endothelial growth factor and basic fibroblast growth factor angiogenic factors2; (3) the triggering of an apoptotic process in the capillary endothelial cells; (4) the inhibition of tubulogenesis in the brain endothelial cells; and (5) the suppression of proliferation, migration, and differentiation of endothelial cells."
Two brainstem CAs in the pons. Big Bleed in July 2005, previous, undiagnosed bleeds in 1982 and 1987, and several smaller bleeds in the past few years. I live in a town in the French Alps. http://www.mcelhearn.com
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Re: Beta Blockers?

Postby ChrisR » Thu Sep 01, 2011 2:25 pm

Wow, so in capillary angiomas it not only shrinks them, it kills off cells and prevents new ones from growing?
I guess it's hard to get excited about one infant case, however. Those skin hemagiomas also go away on their own in children, and since cavernomas are dynamic there's really no way to know if the change was due to medication or natural history. Still, my fingers are crossed.
Thanks again both for the breakdown.
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Re: Beta Blockers?

Postby Libby » Thu Sep 01, 2011 5:19 pm

Not to be the downer at the party BUT I have been on propanolol since 87 when I had my first bleed. I have multiples in the brain and in the brainstem. Since then I had a big bleed in 99 and then one every year for the next 6 years. Now I am taking a normal dose, not a theuraputic dose.
multiple ccms in brain including thalamus and in brainstem. 9 bleeds . Large venous angioma and multiple large veins in the brain. Various lymphangiomas and hemangiomas in head.
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