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Paungarttner J, Quartana M, Patti L, Sklenárová B, Farham F, Jiménez IH, Soylu MG, Vlad IM, Tasdelen S, Mateu T, Marsico O, Reina F, Tischler V, Lampl C. Migraine - a borderland disease to epilepsy: near it but not of it. J Headache Pain 2024; 25:11. [PMID: 38273253 PMCID: PMC10811828 DOI: 10.1186/s10194-024-01719-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Migraine and epilepsy are two paroxysmal chronic neurological disorders affecting a high number of individuals and being responsible for a high individual and socioeconomic burden. The link between these disorders has been of interest for decades and innovations concerning diagnosing and treatment enable new insights into their relationship. FINDINGS Although appearing to be distinct at first glance, both diseases exhibit a noteworthy comorbidity, shared pathophysiological pathways, and significant overlaps in characteristics like clinical manifestation or prophylactic treatment. This review aims to explore the intricate relationship between these two conditions, shedding light on shared pathophysiological foundations, genetic interdependencies, common and distinct clinical features, clinically overlapping syndromes, and therapeutic similarities. There are several shared pathophysiological mechanisms, like CSD, the likely underlying cause of migraine aura, or neurotransmitters, mainly Glutamate and GABA, which represent important roles in triggering migraine attacks and seizures. The genetic interrelations between the two disorders can be observed by taking a closer look at the group of familial hemiplegic migraines, which are caused by mutations in genes like CACNA1A, ATP1A2, or SCN1A. The intricate relationship is further underlined by the high number of shared clinical features, which can be observed over the entire course of migraine attacks and epileptic seizures. While the variety of the clinical manifestation of an epileptic seizure is naturally higher than that of a migraine attack, a distinction can indeed be difficult in some cases, e.g. in occipital lobe epilepsy. Moreover, triggering factors like sleep deprivation or alcohol consumption play an important role in both diseases. In the period after the seizure or migraine attack, symptoms like speech difficulties, tiredness, and yawning occur. While the actual attack of the disease usually lasts for a limited time, research indicates that individuals suffering from migraine and/or epilepsy are highly affected in their daily life, especially regarding cognitive and social aspects, a burden that is even worsened using antiseizure medication. This medication allows us to reveal further connections, as certain antiepileptics are proven to have beneficial effects on the frequency and severity of migraine and have been used as a preventive drug for both diseases over many years. CONCLUSION Migraine and epilepsy show a high number of similarities in their mechanisms and clinical presentation. A deeper understanding of the intricate relationship will positively advance patient-oriented research and clinical work.
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Affiliation(s)
| | - Martina Quartana
- Department of Sciences for Health Promotion and Mother-and Childcare "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Lucrezia Patti
- Department of Sciences for Health Promotion and Mother-and Childcare "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Barbora Sklenárová
- St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Fatemeh Farham
- Headache Department, Iranian Center of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Gokcen Soylu
- Department of Neurology, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Irina Maria Vlad
- Department of Neurosciences, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Semih Tasdelen
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Teresa Mateu
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Neurology, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospitall", Reggio Calabria, Italy
| | - Federica Reina
- NeuroTeam Life&Science, Spin-off University of Palermo, Palermo, Italy
| | - Viktoria Tischler
- Headache Medical Center Linz, Linz, Austria
- Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria
| | - Christian Lampl
- Headache Medical Center Linz, Linz, Austria.
- Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
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Elshony HS, El Sheikh WM, Melake MS. Association between serum bilirubin and migraine in children and adolescents. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Migraine in children and adolescents is very common and can be associated with equivalents, psychiatric disorders, or abnormal electroencephalogram findings. Neurogenic inflammation is involved in migraine pathogenesis where pro-inflammatory cytokines play a significant role. Recent studies have demonstrated that serum bilirubin can be considered as an antioxidant and cytoprotective agent and that its concentration may be influenced in migraine by neurogenic inflammation. Various studies have observed reduced serum bilirubin in migrainous adults, and few studies investigated the association between serum bilirubin and migraine in children and adolescents.
Objectives
To study the association between serum bilirubin and migraine in children and adolescents.
Patients and method
Serum samples were collected from 40 migrainous children and adolescents and from 40 controls. Total, direct, and indirect bilirubin concentrations were measured. Headache features, migraine equivalents, psychiatric comorbidity, and electroencephalogram findings were documented in migraineurs.
Results
Serum total, direct, and indirect bilirubin concentrations were significantly lower in migraineurs than controls. This was statistically significant associated with abnormal electroencephalogram findings during headache-free periods and not statistically significant associated with any headache feature, abnormal electroencephalogram findings during headache attacks, or psychiatric comorbidity.
Conclusion
Serum bilirubin concentration is lower in migrainous children and adolescents compared to control, with no association with specific migraine type or features, and thus may be considered a useful marker for neurogenic inflammation in migraine.
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Mascaro Walter S. Taking on enduring distress: Building a concept to lead a program of research. Nurs Forum 2020; 55:678-686. [PMID: 32643164 DOI: 10.1111/nuf.12484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022]
Abstract
Concept building consists of a 10-phase approach using a practice story as the first step in developing a defined concept supported by both scientific and experiential evidence. The purpose of concept building is to guide development of a program of research that informs nursing knowledge and evidence-based practice. Thus, concept building can serve as a teaching strategy for early-stage doctoral students to initiate scholarly inquiry. In this example, the process of concept building occurred as a nurse practitioner in a doctor of philosophy program began to transition ideas that stemmed from practice into phenomenon for scholarly research. The practice story for the concept taking on enduring distress stems from a patient encounter in the nurse practitioner's adolescent headache clinic. Information gained from concept building laid the foundation for an adolescent headache program of research. The purpose of this paper is to demonstrate a step-by-step approach using Liehr and Smith's 10-phase process for concept building and to describe the program of research that followed.
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Affiliation(s)
- Suzy Mascaro Walter
- Department of Family and Community Health, West Virginia University School of Nursing, Morgantown, West Virginia, 26506
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4
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Clinical presentation, diagnosis and polysomnographic findings in children with migraine referred to sleep clinics. Sleep Med 2019; 63:57-63. [PMID: 31606650 DOI: 10.1016/j.sleep.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE An association between migraine and sleep disturbances in children was reported, yet limited clinical data exist. The current study addresses the clinical presentation, polysomnographic (PSG) characteristics, and comorbid sleep diagnoses of children with migraine referred to the sleep clinic. PATIENTS A retrospective review was performed of headache center patients evaluated by the sleep center between 2007 and 2017. Children ≤18 years old, diagnosed with migraine headache, and who had PSG within one year of evaluation in the headache clinic, were included. PSG findings, as well as demographics, were compared to a group of controls aged 5-14 years-old. RESULTS In sum, 185 children with a diagnosis of migraine were included: 39% males, 75% Caucasian, mean age 13.5 ± 3.4, and 57% obese. Additionally, 180 children were included in the control group. The common presenting sleep symptoms were snoring (66%), sleep onset and sleep maintenance problems (25%), and excessive daytime sleepiness (20%). For the sleep diagnosis, 40% had obstructive sleep apnea (OSA), 27% had insomnia, 15% had periodic limb movement disorder (PLMD), and 6% had a central disorder of hypersomnolence. In terms of sleep architecture, children with migraine had significantly higher NREM 2 (p < 0.001) and a lower percentage of NREM3 (p < 0.001) compared to controls after adjustment for demographics and the presence of sleep-disordered breathing. CONCLUSIONS Children referred to the sleep clinic who also had migraine, experience various types of sleep complaints. OSA, insomnia, and PLMD were relatively common in this population. Changes in sleep architecture, specifically increased NREM2 and decreased slow wave sleep compared to the control group, were also observed.
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Abstract
After more than 85 years of development and use in clinical practice, the electroencephalogram (EEG) remains a dependable, inexpensive, and useful diagnostic tool for the investigation of the electrophysiologic activity of the brain. The advent of digital technology has led to greater sophistication and multiple software applications to extend the utility of EEG beyond the confines of the laboratory. Despite the discovery of new waveforms, basic neurophysiologic principles remain essential to the clinical care of patients. Patterns in the interictal EEG make it possible to clarify the differential diagnosis of paroxysmal neurological events, classify seizure type and epilepsy syndromes, and characterize and quantify seizures when ictal recordings are obtained. EEG can also demonstrate cerebral dysfunction when structural imaging is normal to detect focal or lateralized abnormalities in patients with encephalopathy. High-density EEG with electrical source imaging has improved localization in candidates for epilepsy surgery. Quantitative EEG and broadband EEG are advancing our understanding of the functional processes of the brain itself.
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Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic College of Medicine and Health Sciences, Jacksonville, FL, United States.
| | - William O Tatum
- Department of Neurology, Mayo Clinic College of Medicine and Health Sciences, Jacksonville, FL, United States
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Jancic J, Djuric V, Hencic B, van den Anker JN, Samardzic J. Comorbidity of Migraine and Epilepsy in Pediatrics: A Review. J Child Neurol 2018; 33:801-808. [PMID: 30095015 DOI: 10.1177/0883073818788942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Migraine and epilepsy are classified as chronic paroxysmal neurologic disorders sharing many clinical features, as well as possible treatment options. This review highlights the similarities between migraine and epilepsy in pediatrics, focusing on epidemiologic, pathophysiological, genetic, clinical, and pharmacologic aspects. Despite the fact that several syndromes share symptoms of both migraine and epilepsy, further research is needed to clarify the pathophysiological and genetic basis of their comorbidity. Drugs used for prophylactic therapy of migraine and epilepsy have similar pharmacologic properties. The role of epileptic pharmacotherapy in the prophylaxis of migraine is assessed, including the use of conventional antiepileptic drugs, calcium channel blockers, and nonpharmacologic methods such as dietary therapy, supplements, and vagal nerve stimulation. Further randomized, controlled clinical trials assessing pharmacologic and nonpharmacologic methods for the treatment of both disorders are essential, in order to initiate new therapeutic approaches.
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Affiliation(s)
- Jasna Jancic
- 1 Clinic of Neurology and Psychiatry for Children and Youth, Medical Faculty, University of Belgrade, Serbia
| | - Vesna Djuric
- 2 Medical Faculty, University of Belgrade, Serbia
| | - Boris Hencic
- 2 Medical Faculty, University of Belgrade, Serbia
| | - John N van den Anker
- 3 Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,4 Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA.,5 Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Janko Samardzic
- 3 Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,6 Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty, University of Belgrade, Serbia
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Salem H, Vivas D, Cao F, Kazimi IF, Teixeira AL, Zeni CP. ADHD is associated with migraine: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2018; 27:267-277. [PMID: 28905127 DOI: 10.1007/s00787-017-1045-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
An association between primary headaches and attention-deficit/hyperactivity disorder (ADHD) has long been suggested. Moreover, headache is regarded as a common side effect of stimulants, the most effective treatment for ADHD. So far, no systematic review has evaluated the potential association between ADHD and headache. We performed a systematic review of the literature and a meta-analysis of all reported studies on ADHD and primary headaches. Our analysis showed a positive association between ADHD and migraine (OR 1.322, 95% CI 1.018-1717, p value 0.036), but not with tension-type headache. There is a significant association between migraine and ADHD. The mechanisms underlying this association remain to be elucidated, warranting further studies.
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Affiliation(s)
- Haitham Salem
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - David Vivas
- Pediatric Mood Disorders/ADHD Across Lifespan Programs, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Road, Suite 3128, Houston, TX, 77054, USA
| | - Fei Cao
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Iram F Kazimi
- Pediatric Mood Disorders/ADHD Across Lifespan Programs, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Road, Suite 3128, Houston, TX, 77054, USA
| | - Antonio L Teixeira
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Cristian P Zeni
- Pediatric Mood Disorders/ADHD Across Lifespan Programs, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Road, Suite 3128, Houston, TX, 77054, USA.
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Messina A, Bitetti I, Precenzano F, Iacono D, Messina G, Roccella M, Parisi L, Salerno M, Valenzano A, Maltese A, Salerno M, Sessa F, Albano GD, Marotta R, Villano I, Marsala G, Zammit C, Lavano F, Monda M, Cibelli G, Lavano SM, Gallai B, Toraldo R, Monda V, Carotenuto M. Non-Rapid Eye Movement Sleep Parasomnias and Migraine: A Role of Orexinergic Projections. Front Neurol 2018. [PMID: 29541053 PMCID: PMC5835506 DOI: 10.3389/fneur.2018.00095] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Sleep and migraine share a common pathophysiological substrate, although the underlying mechanisms are unknown. The serotonergic and orexinergic systems are both involved in the regulation of sleep/wake cycle, and numerous studies show that both are involved in the migraine etiopathogenesis. These two systems are anatomically and functionally interconnected. Our hypothesis is that in migraine a dysfunction of orexinergic projections on the median raphe (MR) nuclei, interfering with serotonergic regulation, may cause Non-Rapid Eye Movement parasomnias, such as somnambulism. Hypothesis/theory Acting on the serotonergic neurons of the raphe nuclei, the dysfunction of orexinergic neurons would lead to a higher release of serotonin. The activation of serotonergic receptors located on the walls of large cerebral vessels would lead to abnormal vasodilatation and consequently increase transmural pressure. This process could activate the trigeminal nerve terminals that innervate vascular walls. As a consequence, there is activation of sensory nerve endings at the level of hard vessels in the meninges, with release of pro-inflammatory peptides (e.g., substance P and CGRP). Within this hypothetical frame, the released serotonin could also interact with trigeminovascular afferents to activate and/or facilitate the release of the neuropeptide at the level of the trigeminal ganglion. The dysregulation of the physiological negative feedback of serotonin on the orexinergic neurons, in turn, would contribute to an alteration of the whole system, altering the sleep–wake cycle. Conclusion Serotonergic neurons of the MR nuclei receive an excitatory input from hypothalamic orexin/hypocretin neurons and reciprocally inhibit orexin/hypocretin neurons through the serotonin 1A receptor (or 5-HT1A receptor). Considering this complex system, if there is an alteration it may facilitate the pathophysiological mechanisms involved in the migraine, while it may produce at the same time an alteration of the sleep–wake rhythm, causing sleep disorders such as sleepwalking. Understanding the complex mechanisms underlying migraine and sleep disorders and how these mechanisms can interact with each other, it would be crucial to pave the way for new therapeutic strategies.
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Affiliation(s)
- Antonietta Messina
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ilaria Bitetti
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Diego Iacono
- Neurodevelopmental Research Lab, Biomedical Research Institute of New Jersey (BRInj), Cedar Knolls NJ, United States.,Neuroscience Research, MidAtlantic Neonatology Associates, Atlantic Health System, Morristown NJ, United States.,Neuropathology Research, MidAtlantic Neonatology Associates (MANA) and Biomedical Research Institute of New Jersey (BRInj), Morristown, NJ, United States
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Margherita Salerno
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Agata Maltese
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Monica Salerno
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Rosa Marotta
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Marsala
- Struttura Complessa di Farmacia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Christian Zammit
- Anatomy Department, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Francesco Lavano
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Beatrice Gallai
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Roberto Toraldo
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Le K, Yu D, Wang J, Ali AI, Guo Y. Is topiramate effective for migraine prevention in patients less than 18 years of age? A meta-analysis of randomized controlled trials. J Headache Pain 2017; 18:69. [PMID: 28721545 PMCID: PMC5515721 DOI: 10.1186/s10194-017-0776-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
Background Mainly based on evidence of success in adults, various medications are commonly used to prevent pediatric migraines. Topiramate has been approved for migraine prevention in children as young as 12 years of age. In this meta-analysis, we aimed to assess the currently published data pertaining to the efficacy of topiramate for migraine prevention in patients less than 18 years of age. Methods We searched PubMed/Medline, Embase and the Cochrane Library (from inception to April 2017) for randomized controlled trials (RCTs) published in English. Two independent investigators performed data extraction and quality evaluation using the Cochrane Collaboration’s tool. The data extracted were analyzed by Review Manager 5.3 software. Results A total of four RCTs matching the inclusion criteria were included, with an aggregate of 465 patients. Of these patients, 329 were included in the topiramate group, and 136 were included in the placebo group. This meta-analysis revealed that compared with placebo, topiramate failed to decrease the number of patients experiencing a ≥ 50% relative reduction in headache frequency (n = 465, RR = 1.26, 95% CI = [0.94,1.67], Z = 1.55, P = 0.12) or the number of headache days (n = 465, MD = −0.77, 95% CI = [−2.31,0.76], Z = 0.99, P = 0.32) but did reduce PedMIDAS scores (n = 205, MD = −9.02, 95% CI = [−17.34, −0.70], Z = 2.13, P = 0.03). Higher rates of side effects and adverse events in the topiramate group than in the placebo group were observed in the included trials. Conclusions Topiramate may not achieve a more effective clinical trial endpoint than placebo in the prevention of migraines in patients less than 18 years of age, and topiramate may lead to more side effects or adverse events in the included patients.
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Affiliation(s)
- Kai Le
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Dafan Yu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Jiamin Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Abdoulaye Idriss Ali
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Yijing Guo
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China.
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Melamed S, Romantseva L. Occipital Epilepsy, the Great Mimicker: Case Report and Review for the Pediatrician. Hosp Pediatr 2017; 7:415-418. [PMID: 28655752 DOI: 10.1542/hpeds.2016-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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11
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Affiliation(s)
- Yun-Jin Lee
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
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12
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Kang PB, Bale JF, Mintz M, Joshi SM, Gilbert DL, Radabaugh C, Ruch-Ross H. The child neurology clinical workforce in 2015: Report of the AAP/CNS Joint Taskforce. Neurology 2016; 87:1384-92. [PMID: 27566740 DOI: 10.1212/wnl.0000000000003147] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/09/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES More than a decade has passed since the last major workforce survey of child neurologists in the United States; thus, a reassessment of the child neurology workforce is needed, along with an inaugural assessment of a new related field, neurodevelopmental disabilities. METHODS The American Academy of Pediatrics and the Child Neurology Society conducted an electronic survey in 2015 of child neurologists and neurodevelopmental disabilities specialists. RESULTS The majority of respondents participate in maintenance of certification, practice in academic medical centers, and offer subspecialty care. EEG reading and epilepsy care are common subspecialty practice areas, although many child neurologists have not had formal training in this field. In keeping with broader trends, medical school debts are substantially higher than in the past and will often take many years to pay off. Although a broad majority would choose these fields again, there are widespread dissatisfactions with compensation and benefits given the length of training and the complexity of care provided, and frustrations with mounting regulatory and administrative stresses that interfere with clinical practice. CONCLUSIONS Although not unique to child neurology and neurodevelopmental disabilities, such issues may present barriers for the recruitment of trainees into these fields. Creative approaches to enhance the recruitment of the next generation of child neurologists and neurodevelopmental disabilities specialists will benefit society, especially in light of all the exciting new treatments under development for an array of chronic childhood neurologic disorders.
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Affiliation(s)
- Peter B Kang
- From the Division of Pediatric Neurology (P.B.K.), Department of Pediatrics, University of Florida College of Medicine, Gainesville; Division of Pediatric Neurology (J.F.B.), University of Utah School of Medicine, Salt Lake City; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey (M.M.), Voorhees; Division of Pediatric Neurology (S.M.J.), Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor; Division of Pediatric Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center, OH; and American Academy of Pediatrics Division of Workforce and Medical Education Policy (C.R., H.R.-R.), Elk Grove Village, IL.
| | - James F Bale
- From the Division of Pediatric Neurology (P.B.K.), Department of Pediatrics, University of Florida College of Medicine, Gainesville; Division of Pediatric Neurology (J.F.B.), University of Utah School of Medicine, Salt Lake City; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey (M.M.), Voorhees; Division of Pediatric Neurology (S.M.J.), Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor; Division of Pediatric Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center, OH; and American Academy of Pediatrics Division of Workforce and Medical Education Policy (C.R., H.R.-R.), Elk Grove Village, IL
| | - Mark Mintz
- From the Division of Pediatric Neurology (P.B.K.), Department of Pediatrics, University of Florida College of Medicine, Gainesville; Division of Pediatric Neurology (J.F.B.), University of Utah School of Medicine, Salt Lake City; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey (M.M.), Voorhees; Division of Pediatric Neurology (S.M.J.), Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor; Division of Pediatric Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center, OH; and American Academy of Pediatrics Division of Workforce and Medical Education Policy (C.R., H.R.-R.), Elk Grove Village, IL
| | - Sucheta M Joshi
- From the Division of Pediatric Neurology (P.B.K.), Department of Pediatrics, University of Florida College of Medicine, Gainesville; Division of Pediatric Neurology (J.F.B.), University of Utah School of Medicine, Salt Lake City; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey (M.M.), Voorhees; Division of Pediatric Neurology (S.M.J.), Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor; Division of Pediatric Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center, OH; and American Academy of Pediatrics Division of Workforce and Medical Education Policy (C.R., H.R.-R.), Elk Grove Village, IL
| | - Donald L Gilbert
- From the Division of Pediatric Neurology (P.B.K.), Department of Pediatrics, University of Florida College of Medicine, Gainesville; Division of Pediatric Neurology (J.F.B.), University of Utah School of Medicine, Salt Lake City; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey (M.M.), Voorhees; Division of Pediatric Neurology (S.M.J.), Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor; Division of Pediatric Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center, OH; and American Academy of Pediatrics Division of Workforce and Medical Education Policy (C.R., H.R.-R.), Elk Grove Village, IL
| | - Carrie Radabaugh
- From the Division of Pediatric Neurology (P.B.K.), Department of Pediatrics, University of Florida College of Medicine, Gainesville; Division of Pediatric Neurology (J.F.B.), University of Utah School of Medicine, Salt Lake City; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey (M.M.), Voorhees; Division of Pediatric Neurology (S.M.J.), Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor; Division of Pediatric Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center, OH; and American Academy of Pediatrics Division of Workforce and Medical Education Policy (C.R., H.R.-R.), Elk Grove Village, IL
| | - Holly Ruch-Ross
- From the Division of Pediatric Neurology (P.B.K.), Department of Pediatrics, University of Florida College of Medicine, Gainesville; Division of Pediatric Neurology (J.F.B.), University of Utah School of Medicine, Salt Lake City; The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey (M.M.), Voorhees; Division of Pediatric Neurology (S.M.J.), Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor; Division of Pediatric Neurology (D.L.G.), Cincinnati Children's Hospital Medical Center, OH; and American Academy of Pediatrics Division of Workforce and Medical Education Policy (C.R., H.R.-R.), Elk Grove Village, IL
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Abstract
Comorbid conditions frequently occur in pediatric headaches and may significantly affect their management. Comorbidities that have been associated with pediatric headaches include attention-deficit or hyperactivity disorder, autism, developmental disabilities, depression, anxiety, epilepsy, obesity, infantile colic, atopic disorders, inflammatory bowel disease, and irritable bowel syndrome. The goal of this article is to review these comorbidities associated with pediatric headache, thereby empowering child neurologists to identify common triggers and tailor management strategies that address headache and its comorbidities.
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Sowell MK, Youssef PE. The Comorbidity of Migraine and Epilepsy in Children and Adolescents. Semin Pediatr Neurol 2016; 23:83-91. [PMID: 27017028 DOI: 10.1016/j.spen.2016.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Migraine and epilepsy share a number of clinical attributes, including pathophysiology and clinical expression. Both are paroxysmal in nature and thus constitute episodic disorders, yet either may be chronic and/or recurrent. Epileptic seizures and migraine headaches may be mistaken one for the other and may even overlap. In particular, occipital lobe seizures may be misdiagnosed as migraine auras. In this article, we review the relationship between migraine and epilepsy, including the known genetic contributions to both conditions, prodromal, ictal, and postictal headache and shared pathophysiology and treatment options. We describe clinical conditions in which both migraine and epilepsy are prominent features. Lastly, we discuss electronecephaographic abnormalities that have been known to occur in individuals with migraine.
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Affiliation(s)
- Michael K Sowell
- Department of Neurology, University of Louisville School of Medicine, Louisville, KY.
| | - Paul E Youssef
- Division of Child and Adolescent Neurology, Mayo Clinic Rochester, Rochester, MN
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Prophylactic Drug Treatment of Migraine in Children and Adolescents: An Update. Curr Pain Headache Rep 2015; 20:1. [DOI: 10.1007/s11916-015-0536-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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16
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Song M, Heo GE, Ding Y. SemPathFinder: Semantic path analysis for discovering publicly unknown knowledge. J Informetr 2015. [DOI: 10.1016/j.joi.2015.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Nye BL, Thadani VM. Migraine and epilepsy: review of the literature. Headache 2015; 55:359-80. [PMID: 25754865 DOI: 10.1111/head.12536] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 01/03/2023]
Abstract
Migraine and epilepsy are disorders that are common, paroxysmal, and chronic. In many ways they are clearly different diseases, yet there are some pathophysiological overlaps, and overlaps in clinical symptomatology, particularly with regard to visual and other sensory disturbances, pain, and alterations of consciousness. Epidemiological studies have revealed that the two diseases are comorbid in a number of individuals. Both are now recognized as originating from electrical disturbances in the brain, although their wider manifestations involve the recruitment of multiple pathogenic mechanisms. An initial excess of neuronal activity in migraine leads to cortical spreading depression and aura, with the subsequent recruitment of the trigeminal nucleus leading to central sensitization and pain. In epilepsy, neuronal overactivity leads to the recruitment of larger populations of neurons firing in a rhythmic manner that constitutes an epileptic seizure. Migraine aura and headaches may act as a trigger for epileptic seizures. Epilepsy is not infrequently accompanied by preictal, ictal, and postictal headaches that often have migrainous features. Genetic links are also apparent between the two disorders, and are particularly evident in the familial hemiplegic migraine syndromes where different mutations can produce either migraine, epilepsy, or both. Also, various medications are found to be effective for both migraine and epilepsy, again pointing to a commonality and overlap between the two disorders.
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Affiliation(s)
- Barbara L Nye
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Spiri D, Rinaldi VE, Titomanlio L. Pediatric migraine and episodic syndromes that may be associated with migraine. Ital J Pediatr 2014; 40:92. [PMID: 25928129 PMCID: PMC4239406 DOI: 10.1186/s13052-014-0092-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/07/2014] [Indexed: 01/03/2023] Open
Abstract
Importance Migraine is a common disorder and a frequent cause of medical consultation in children. Many childhood episodic syndromes have been described as common precursors of migraine. Objective To review current knowledge on migraine and childhood episodic syndromes, and to discuss future directions for research and clinical practice. Findings For most children it is difficult to describe a headache and fully verbalize symptoms such as photophobia and phonophobia that must be inferred from behaviour. Classical migraine features are rare before the age of 6 years, but some migraine-related syndromes have been described. Benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of childhood, cyclic vomiting syndrome and abdominal migraine are currently classified as childhood episodic syndromes, and therefore common precursors of migraine. A strong association between infantile colic and migraine has recently been reported. There are similarities between children with episodic syndromes and children with migraine, regarding social and demographic factors, precipitating and relieving factors, and accompanying gastrointestinal, neurologic, and vasomotor features. The real pathophysiological mechanisms of migraine are not fully understood. Current data obtained through molecular and functional studies provide a complex model in which vascular and neurologic events cooperate in the pathogenesis of migraine attacks. Genetic factors causing disturbances in neuronal ion channels, make a migraineur more sensitive to multiple trigger factors that activate the nociception cascade. The expanding knowledge on migraine genetics and pathophysiology may be applicable to childhood episodic syndromes. Migraine preventive strategies are particularly important in children, and could be beneficial in childhood episodic syndromes. Nonspecific analgesics like ibuprofen and acetaminophen are widely used in pediatrics to control pain and have been found to be effective also in the treatment of acute migraine attacks. Triptans are the specific fist-line drugs for acute migraine treatment. Conclusions and relevance Migraine phenotype differs somewhat in the developing brain, and childhood episodic syndromes may arise before typical migraine headache. Diagnosing pediatric migraine may be difficult because of children’s language and cognitive abilities. The risk of underestimating migraine in pediatric age is high. An adequate diagnosis is important to maintain a good quality of life and to avoid inappropriate therapy.
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Affiliation(s)
- Daniele Spiri
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy.
| | - Victoria Elisa Rinaldi
- Department of Pediatrics, Università degli Studi di Perugia, Perugia, Italy. .,Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France.
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France. .,Pediatric Migraine and Neurovascular Diseases Unit, APHP-Hospital Robert Debré, Paris, France. .,Pediatric Emergency Department, Robert Debré University Hospital, 48, Bld Sérurier, Paris, 75019, France.
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