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.
The most important thing is to control other risk factors for common stroke. Many studies have shown these risk factors accelerate the damage caused by the CADASIL gene. For example, people with the CADASIL gene who smoke have stroke about 10 years earlier, while those with high blood pressure have about double the risk of stroke. It is important to address these in midlife, before symptoms of CADASIL occur. We recommend an active lifestyle with regular exercise and avoiding being overweight, as well as monitoring of blood pressure and monitoring for diabetes.
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). In CADASIL patients who have not suffered stroke, there is no clear indication for aspirin. 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.
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 are safe in CADASIL and helped migraine attacks in about half of patients. 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 (CBT).