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The International Journal of the Royal Society of Thailand
Volume XI - 2019

Currently, many wearable devices are in the market or in the development
phase such as wrist watch and implants. They use artificial intelligence for
monitoring, predicting seizure and providing warning to patients and related

personnel. Some device may be used at night for nocturnal seizure monitoring to
prevent sudden death in epilepsy.

5. Migraine headache
Migraine is the most common neurological disease worldwide. Due to
frequent headache attack and related disabilities, the patients have significantly
lower quality of life when compared to unaffected individuals. Acute headache is

treated by analgesics such as paracetamol, NSAIDs. In patients with frequent or
severe attack or unresponsive to analgesics, prophylactic medication is indicated.
Unfortunately, prophylaxis is underutilized and the headache will become more
chronic.

For the past several decades, calcitonin gene related peptide (CGRP) is
found to be elevated during migraine attack and in asymptomatic period. The
development of oral CGRP inhibitor or antagonist has been unfruitful in the past
decade. Luckily, the advance in biotechnology for monoclonal antibody has led
to production of antibodies to CGRP receptor antibody or antibody against CGRP
molecule itself.

Nowadays, the research in these antibodies focus on prophylactic use
in severe chronic or refractory migraine cases (McAllister P ,2017). They clearly
provide significant improvement in reducing migraine severity, frequency of
the attacks and disability.

Three antibodies which were approved by the US FDA were erenumab,
galcanezumab and fremenezumab (McAllister 2017; Sacco et al., 2019; American
Headache society, 2019). Many professional organizations and migraine specialists
have endorsed the usage in these patient groups according to the labelling.
Additional research in another severe type of headache such as cluster headache
also showed promising result (Goadsby et al., 2019).

Conclusion

Advance in precision medicine in neurology is promising. Many inherited
diseases which were untreatable have become treatable and their outcome were
clearly improved. New technologies provide more accurate diagnosis and better

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