Editing CADASIL (section)

==Treatment==
No specific treatment for CADASIL is available. While most treatments for CADASIL patients' symptoms – including migraine and stroke – are similar to those without CADASIL, these treatments are almost exclusively empiric, as data regarding their benefit to CADASIL patients are limited.<ref name="Andre">{{cite journal|last1=André|first1=Charles|title=CADASIL: pathogenesis, clinical and radiological findings and treatment|journal=Arq. Neuro-Psiquiatr.|date=April 2010|volume=68|issue=2|pages=287–99|pmid=20464302|doi=10.1590/S0004-282X2010000200026|doi-access=free}}</ref> Antiplatelet agents such as [[aspirin]], [[dipyridamole]], or [[clopidogrel]] might help prevent strokes; however, anticoagulation may be inadvisable given the propensity for microhemorrhages.<ref name="auto">{{Cite journal|title = Cerebral microbleeds in CADASIL|journal = Neurology|date = 2001-09-25|issn = 0028-3878|pmid = 11571335|pages = 1066–1070|volume = 57|issue = 6|first1 = S. A.|last1 = Lesnik Oberstein|first2 = R.|last2 = van den Boom|first3 = M. A.|last3 = van Buchem|first4 = H. C.|last4 = van Houwelingen|first5 = E.|last5 = Bakker|first6 = E.|last6 = Vollebregt|first7 = M. D.|last7 = Ferrari|first8 = M. H.|last8 = Breuning|first9 = J.|last9 = Haan|doi=10.1212/wnl.57.6.1066|s2cid = 22934154}}</ref> Control of high blood pressure is particularly important in CADASIL patients.<ref name="Andre" /> Short-term use of atorvastatin, a [[statin]]-type cholesterol-lowering medication, has not been shown to be beneficial in CADASIL patients' cerebral hemodynamic parameters,<ref name="Peters">{{cite journal|last1=Peters|first1=N|title=Effects of short term atorvastatin treatment on cerebral hemodynamics in CADASIL|journal=J Neurol Sci|date=15 September 2007|volume=260|issue=1–2|pages=100–105|doi=10.1016/j.jns.2007.04.015|pmid=17531269|s2cid=6502194}}</ref> although treatment of comorbidities such as high cholesterol is recommended.<ref name="auto1">{{cite book|chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK1500/|title=GeneReviews|first1=Julie|last1=Rutten|first2=Saskia A.J.|last2=Lesnik Oberstein|editor-first1=Roberta A.|editor-last1=Pagon|editor-first2=Margaret P.|editor-last2=Adam|editor-first3=Holly H.|editor-last3=Ardinger|editor-first4=Stephanie E.|editor-last4=Wallace|editor-first5=Anne|editor-last5=Amemiya|editor-first6=Lora J.H.|editor-last6=Bean|editor-first7=Thomas D.|editor-last7=Bird|editor-first8=Nikki|editor-last8=Ledbetter|editor-first9=Heather C.|editor-last9=Mefford|editor-first10=Richard J.H.|editor-last10=Smith|editor-first11=Karen|editor-last11=Stephens|date=1 January 1993|publisher=University of Washington, Seattle|via=PubMed|pmid=20301673|chapter=Cadasil}}</ref> Stopping oral contraceptive pills may be recommended.<ref name="Cambridge">{{Cite web|url=https://www.cambridgestroke.com/faqs.php|title=Questions about cadasil|website=www.cambridgestroke.com}}</ref> Some authors advise against the use of [[triptan]] medications for migraine treatment, given their vasoconstrictive effects,<ref>{{Cite web|url=https://rarediseases.org/rare-diseases/cadasil/|title=CADASIL|first=Lisa|last=Sencen}}</ref> although this sentiment is not universal.<ref name="auto1"/> In this regard, the advent of the "Ditans" such as Lasmiditan, lacking vasoconstrictive effect and the "Gepants" such as Ubrogepant and Rimegepant, are attractive alternatives, albeit not yet field-tested in this condition.   As with other individuals, people with CADASIL should be encouraged to quit smoking.<ref>{{Cite web|url=https://rarediseases.info.nih.gov/diseases/1049/cadasil#diseaseTreatmentSection|title=CADASIL - About the Disease - Genetic and Rare Diseases Information Center|website=rarediseases.info.nih.gov|access-date=2017-04-01|archive-date=2021-10-27|archive-url=https://web.archive.org/web/20211027232618/https://rarediseases.info.nih.gov/diseases/1049/cadasil#diseaseTreatmentSection|url-status=dead}}</ref>

In one small study, around 1/3 of patients with CADASIL were found to have cerebral microhemorrhages (tiny areas of old blood) on [[MRI]].<ref name="auto"/>

L-arginine, a naturally occurring amino acid, has been proposed as a potential therapy for CADASIL,<ref>{{cite journal|last1=Peters|first1=N|title=Enhanced L-arginine-induced vasoreactivity suggests endothelial dysfunction in CADASIL|journal=Journal of Neurology|date=August 2008|volume=255|issue=8|pages=1203–1208|doi=10.1007/s00415-008-0876-9|pmid=18537053|s2cid=42107389}}</ref> but as of 2017 there are no clinical studies supporting its use.<ref name="Cambridge" /> [[Donepezil]], normally used for Alzheimer's Disease, was shown not to improve executive functioning in CADASIL patients.<ref>{{cite journal|title=Donepezil Fails to Improve Cognition in Patients with CADASI... : Neurology Today|journal=Neurology Today|volume=8|issue=7|pages=25|doi=10.1097/01.NT.0000316148.27827.bc|date=2008-04-03|last1=Susman|first1=Ed|s2cid=72564626}}</ref>