There is no specific treatment for CADASIL available at the moment. In the long run, we hope that a better understanding of how the underlying genetic abnormality causes CADASIL will allow us to discover how this results in the blood vessel damage, and lead to the development of 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. Therefore although it has not been tested specifically in CADASIL patients most doctors would recommend that patients with CADASIL who have had stroke take a small dose of aspirin (75-300mg/day). An alternative to aspirin is clopidogrel (75mg/day). We avoid warfarin, or taking the combination of aspirin and clopidogrel, unless required for another medical reason, as this can increase the risk of bleeding within the brain in people with CADASIL. In CADASIL patients who have not suffered stroke there is no clear indication for aspirin, although some patients take it when they reach their 40s or 50s.
Recent studies have shown that other risk factors for common stroke, particularly smoking and high blood pressure, are associated with earlier onset of stroke and increased rate of damage on MRI brain scans in CADASIL sufferers. Therefore it is important to address these common stroke risk factors. WE would also recommend an active lifestyle with regular exercise and avoiding being overweight.
If required during attacks of migraine, standard migraine painkillers can be taken. These include drugs such as Migraleve. Initially it was recommended not to take Triptan anti-migraine drugs such as Imigran, but a recent analysis found these were safe in CADASIL and helped migraine attacks in about half of patients. 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 and cognitive behavioural therapy.