There is no specific treatment for CADASIL available at the moment. In the long run, we hope that now that we know the underlying genetic abnormality, we will be able to discover how this results in the blood vessel damage, and therefore design drugs to prevent this damage. However, this is likely to be a number of years away. Aspirin has been shown to reduce the risk of recurrent stroke by about 20% for common stroke. Although it has not been tested specifically in CADASIL patients most doctors would recommend that patients with CADASIL take a small dose of aspirin per day (75-300mg). Occasionally we also use other drugs to reduce blood clotting, such as Dipyridamole (Persantin) and Clopidogrel (Plavix). We would avoid warfarin, unless required for another medical reason, as this could increase the risk of bleeding within the brain.
Recent studies have shown that other risk factors for common stroke such as smoking and high blood pressure are associated with earlier onset of stroke or increased rate of change on MRI in CADASIL sufferers. Therefore we feel that it is important to prevent any other damage to the blood vessels. For this reason, it is important not to smoke, and that blood pressure and cholesterol are checked, and treated if abnormal. It is also advisable not to take the combined oral contraceptive pill or HRT as these can increase the risk of blood clotting and could increase stroke risk.
If required during attacks of migraine, standard migraine painkillers can be taken. These include drugs such as Migraleve. However, it is probably not advisable to take some of the newer anti-migraine drugs such as Imigran, which act by reducing the blood flow to the brain. If migraine attacks are frequent then normal migraine prevention therapies seem effective.
It is important to look for, and treat when necessary, depression in patients with CADASIL. This can be treated with standard anti-depressant drugs.