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Pastorino GMG, Olivieri M, Viggiano A, Meccariello R, Roccella M, Parisi L, Cerulli Irelli E, Di Bonaventura C, Orsini A, Operto FF. Depressive symptoms in children and adolescents with epilepsy and primary headache: a cross-sectional observational study. Front Neurol 2024; 15:1395003. [PMID: 38984036 PMCID: PMC11231184 DOI: 10.3389/fneur.2024.1395003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/03/2024] [Indexed: 07/11/2024] Open
Abstract
Background The primary aims of our cross-sectional observational study were: (i) to determine the prevalence of depressive symptoms in children and adolescents with epilepsy compared to controls and (ii) to explore the difference in depressive symptoms in patients with epilepsy only and those with epilepsy and primary headache as a comorbidity. The secondary objective was to explore parental stress levels. Methods 68 pediatric patients aged 6-18 years (44 with epilepsy only and 24 with epilepsy and headache) and 50 controls were recruited. Depressive profile and parental stress were assessed using Children's Depression Inventory, Second Edition (CDI-2) and Parenting Stress Index-Short Form (PSI-SF). Results The group with epilepsy showed significantly high depressive symptoms and parental stress compared to controls. The patients with headache in comorbidity experienced more depressive symptoms than those with epilepsy only. Conclusion Depressive symptoms are more prevalent in patients who have comorbid epilepsy and primary headache; therefore, the neurological/psychological mechanisms underlying this condition should be further investigated. The simultaneous presence of epilepsy, headache and depressive symptoms impacts the quality of life of patients and their parents, increasing parental stress and family management.
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Affiliation(s)
- Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Miriam Olivieri
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Rosaria Meccariello
- Department of Movement and Well-Being Sciences, Parthenope University of Naples, Naples, Italy
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Lucia Parisi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | | | | | - Alessandro Orsini
- Pediatric Neurology, Azienda Ospedaliero-Universitaria Pisana, Pisa University Hospital, Pisa, Italy
| | - Francesca F. Operto
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Schiller K, Schiller V, Kortas A, Unterholzner G, Raffler S, Schimmel M, Rauchenzauner M. Primary Headache Is Related to Reduced Health-Related Quality of Life in Children with Epilepsy. Healthcare (Basel) 2024; 12:426. [PMID: 38391802 PMCID: PMC10887633 DOI: 10.3390/healthcare12040426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Headache is a frequent comorbidity in patients with epilepsy. Data are sparse regarding the distribution of headache types in children with epilepsy (CWE). We aimed to assess the prevalence of primary headache types and their influence on health-related quality of life (QoL) in CWE. CWE filled out a validated headache questionnaire to assess migraine (MIG), tension-type headache (TTH), trigeminal-autonomic cephalalgia (TAC), or, if the criteria were not fulfilled, non-classifiable headache (NCH). QoL was measured using both patient and parent versions of a validated questionnaire. Of 119 CWE (59 female; 11.5 ± 3.1 y), headache was found in 46 (38.7%). Sixteen (34.8%) patients showed MIG, 9 (19.6%) patients TTH, and 21 (45.7%) patients described NCH. More girls reported headache (χ2 = 5.4, p = 0.02) when compared to boys. Overall, QoL was reduced in patients with headache from both the patients' and parents' points of view (70.8% [39.6; 87.5] vs. 77.0% [46.9; 95.8], p = 0.002; 71,9% [33.3; 87.5] vs. 78,1% [54.2; 95.8], p = 0.003). Headache is common among CWE with MIG as the most prevalent primary headache type and higher rates in female patients. Importantly, patients and their parents perceive a reduced overall QoL when suffering from headache.
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Affiliation(s)
- Katharina Schiller
- Department of Pediatrics, Hospital Group Kaufbeuren-Ostallgäu, 87600 Kaufbeuren, Germany
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, Montreal, QC H3A2B4, Canada
- Department of Pediatrics, Medical University Innsbruck, 6020 Innsbruck, Austria
- Faculty of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Veronika Schiller
- Department of Pediatrics, Hospital Group Kaufbeuren-Ostallgäu, 87600 Kaufbeuren, Germany
| | - Aline Kortas
- Department of Pediatrics, Hospital Group Kaufbeuren-Ostallgäu, 87600 Kaufbeuren, Germany
| | - Gabriele Unterholzner
- Department of Pediatrics, Hospital Group Kaufbeuren-Ostallgäu, 87600 Kaufbeuren, Germany
| | - Sabine Raffler
- Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Mareike Schimmel
- Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Markus Rauchenzauner
- Department of Pediatrics, Hospital Group Kaufbeuren-Ostallgäu, 87600 Kaufbeuren, Germany
- Department of Pediatrics, Medical University Innsbruck, 6020 Innsbruck, Austria
- Faculty of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
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Frattale I, Papetti L, Ursitti F, Sforza G, Monte G, Voci A, Proietti Checchi M, Mazzone L, Valeriani M. Visual Disturbances Spectrum in Pediatric Migraine. J Clin Med 2023; 12:jcm12082780. [PMID: 37109116 PMCID: PMC10143789 DOI: 10.3390/jcm12082780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Migraine is a complex neurological disorder with partially unknown pathophysiological mechanisms. The prevalence in childhood ranges from 7.7% to 17.8%, thus representing the most frequent primary headache. In half of the cases, migraine is accompanied or preceded by various neurological disturbances, among which the visual aura is the best known. In literature, other conditions, such as Alice in Wonderland Syndrome and Visual Snow syndrome, are characterized by visual manifestations and are often associated with migraine. The aim of this narrative review is to describe the spectrum of visual disturbances in pediatric migraine and their pathophysiological mechanisms.
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Affiliation(s)
- Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Hospital of Rome, Tor Vergata University, 00165 Rome, Italy
| | - Laura Papetti
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Fabiana Ursitti
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Giorgia Sforza
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Gabriele Monte
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandra Voci
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | | | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Hospital of Rome, Tor Vergata University, 00165 Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
- Center for Sensory Motor Interaction, Aalborg University, 9220 Aalborg, Denmark
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Inherited pain hypersensitivity and increased anxiety-like behaviors are associated with genetic epilepsy in Wistar Audiogenic Rats: Short- and long-term effects of acute and chronic seizures on nociception and anxiety. Epilepsy Behav 2023; 141:109160. [PMID: 36907082 DOI: 10.1016/j.yebeh.2023.109160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
Anxiety and pain hypersensitivity are neurobehavioral comorbidities commonly reported by patients with epilepsies, and preclinical models are suitable to investigate the neurobiology of behavioral and neuropathological alterations associated with these epilepsy-related comorbidities. This work aimed to characterize endogenous alterations in nociceptive threshold and anxiety-like behaviors in the Wistar Audiogenic Rat (WAR) model of genetic epilepsy. We also assessed the effects of acute and chronic seizures on anxiety and nociception. WARs from acute and chronic seizure protocols were divided into two groups to assess short- and long-term changes in anxiety (1 day or 15 days after seizures, respectively). To assess anxiety-like behaviors, the laboratory animals were submitted to the open field, light-dark box, and elevated plus maze tests. The von Frey, acetone, and hot plate tests were used to measure the endogenous nociception in seizure-free WARs, and postictal antinociception was recorded at 10, 30, 60, 120, 180 min, and 24 h after seizures. Seizure-free WARs presented increased anxiety-like behaviors and pain hypersensitivity, displaying mechanical and thermal allodynia (to heat and cold stimuli) in comparison to nonepileptic Wistar rats. Potent postictal antinociception that persisted for 120 to 180 min was detected after acute and chronic seizures. Additionally, acute and chronic seizures have magnified the expression of anxiety-like behaviors when assessed at 1 day and 15 days after seizures. Behavioral analysis indicated more severe and persistent anxiogenic-like alterations in WARs submitted to acute seizures. Therefore, WARs presented pain hypersensitivity and increased anxiety-like behaviors endogenously associated with genetic epilepsy. Acute and chronic seizures induced postictal antinociception in response to mechanical and thermal stimuli and increased anxiety-like behaviors when assessed 1 day and 15 days later. These findings support the presence of neurobehavioral alterations in subjects with epilepsy and shed light on the use of genetic models to characterize neuropathological and behavioral alterations associated with epilepsy.
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Yang S, Wu Y, Sun L, You X, Wu Y. Reorganization of brain networks in patients with temporal lobe epilepsy and comorbid headache. Epilepsy Behav 2023; 140:109101. [PMID: 36736237 DOI: 10.1016/j.yebeh.2023.109101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The white matter structural network changes remain poorly understood in patients with temporal lobe epilepsy and comorbid headache (PWH). This study aimed at exploring topological changes in the structural network. METHODS Twenty-five PWH, 32 patients with temporal lobe epilepsy without headache, and 22 healthy controls were recruited in this study. High-resolution structural MRI and diffusion tensor imaging data were acquired from these participants. A graph theory-based approach was employed to characterize the topological properties of the structural network. A network-based statistical analysis was employed to explore abnormal connectivity alterations in PWH. RESULTS Compared with healthy controls, PWH exhibited significantly decreased small-world index, shortest path length, increased clustering coefficient, global efficiency, and local efficiency. Patients with temporal lobe epilepsy and comorbid headache displayed a significantly reduced small-world index, shortest path length, and increased global efficiency when compared with patients with temporal lobe epilepsy without headache. In addition, PWH exhibited abnormal local network parameters, mainly located in the prefrontal, temporal, occipital, and parietal regions. Furthermore, network-based statistical analysis revealed that PWH had abnormal structural connections between the temporoparietal lobe, occipital lobe, insula, cingulate gyrus, and thalamus. CONCLUSION This study reveals the abnormal white matter structural network alterations in PWH, allowing a better insight into the neuroanatomical mechanisms that predispose epileptic patients to comorbid headaches from the network levels.
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Affiliation(s)
- Shengyu Yang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ying Wu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lanfeng Sun
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao You
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuan Wu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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Schiller K, Rauchenzauner M, Avidgor T, Hannan S, Lorenzen C, Kaml M, Walser G, Unterberger I, Filippi V, Broessner G, Luef G. Primary headache types in adult epilepsy patients. Eur J Med Res 2023; 28:49. [PMID: 36707895 PMCID: PMC9881350 DOI: 10.1186/s40001-023-01023-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/29/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Headache is among the most common comorbidities in epilepsy. This study examined the distribution of different primary headache disorders in a large cohort of patients with diagnosed epilepsy. Headache types were analysed with regard to gender, type of epilepsy and antiepileptic drugs (AEDs). METHODS In this prospective single-centre study, 500 patients with epilepsy (250 female, mean age: 45.52 ± 17.26 years) were evaluated with regards to primary headache types using a validated German headache questionnaire categorizing for migraine (MIG), tension-type headache (TTH) or trigeminal autonomic cephalalgias (TAC), their combinations and unclassifiable headache. Data regarding type of epilepsy, seizure-associated headache, AED treatment and seizure freedom were collected. RESULTS Of 500 patients with epilepsy, 163 (32.6%) patients (108 female and 55 male) reported suffering from headaches at least 1 day per month. MIG (without aura, with aura) and TTH were the most frequent headache type (MIG 33.1%, TTH 33.1%). Female epilepsy patients reported headaches significantly more often than male patients (x2 = 8.20, p = 0.0042). In contrast, the type of epilepsy did not significantly affect headache distribution. Of 163 patients with headache, 66 (40.5%) patients reported seizure-associated headache and AEDs were used by 157 patients. Of importance, patients with AED monotherapy suffered from MIG less often when compared to patients on polytherapy (x2 = 4.79, p = 0.028). CONCLUSION MIG and TTH are the most common headache types in epilepsy patients and headache is more frequent among female epilepsy patients. Monotherapy in AEDs might have a beneficial effect on the frequency of headache compared to polytherapy.
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Affiliation(s)
- Katharina Schiller
- Department of Pediatrics and Neonatology, Hospital Ostallgaeu, Kaufbeuren, Germany ,grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada ,grid.5361.10000 0000 8853 2677Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Rauchenzauner
- Department of Pediatrics and Neonatology, Hospital Ostallgaeu, Kaufbeuren, Germany ,grid.5361.10000 0000 8853 2677Department of Pediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - Tamir Avidgor
- grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Sana Hannan
- grid.14709.3b0000 0004 1936 8649Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Carlo Lorenzen
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Manuela Kaml
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gerald Walser
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Iris Unterberger
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Vera Filippi
- grid.5361.10000 0000 8853 2677Department of Neurology, Headache Outpatient Clinic, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gregor Broessner
- grid.5361.10000 0000 8853 2677Department of Neurology, Headache Outpatient Clinic, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
| | - Gerhard Luef
- grid.5361.10000 0000 8853 2677Department of Neurology, Epilepsy Unit, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020 Austria
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7
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Atalar AÇ, Özge A, Türk BG, Ekizoğlu E, Kurt Gök D, Baykan B, Ayta S, Erdoğan FF, Yeni SN, Taşdelen B, Velioğlu SK, Midi İ, Serap S, Ulufer Ç, Sarıca Darol E, Ağan K, Ayç S, Gazioğlu S, Vildan Okudan Z, Görkem Şirin N, Bebek N, Dericioğlu N, Güçlü Altun İ, Destina Yalçın A, Sürmeli R, Osman Erdinç O, Erdal A, İlhan Algın D, Kutlu G, Bek S, Erdal Y, Övünç Özön A, Reyhani A, Güldiken B, Baklan B, Oğuz Genç B, Aykutlu Altindağ E, Karahan G, Koç G, Mısırlı H, Öztura İ, Aslan-Kara K, Merve MÇ, Türkmen N, Bulut O, Ömer K, Kesim Çahin Ö, Ferik S, Mehmet TP, Topaloğlu P, Üstün Özek S, Düzgün Ü, Yayla V, Gömceli Y, Ünlüsoy Acar Z. Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria. Front Neurol 2023; 13:1103541. [PMID: 36703639 PMCID: PMC9872152 DOI: 10.3389/fneur.2022.1103541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
Background Migraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert. Methods In this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis. Results Longer headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone. Conclusion Longer headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs.
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Affiliation(s)
- Arife Çimen Atalar
- Department of Neurology, Istanbul Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye,*Correspondence: Arife Çimen Atalar ✉
| | - Aynur Özge
- Department of Neurology, Algology and Clinical Neurophysiology, Mersin University School of Medicine, Mersin, Türkiye
| | - Bengi Gül Türk
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Esme Ekizoğlu
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Duygu Kurt Gök
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Semih Ayta
- Child Neurology Unit, Department of Pediatrics, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Füsun Ferda Erdoğan
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Seher Naz Yeni
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin University, Mersin, Türkiye
| | | | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Department of Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Türkiye
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Hareem A, Pahlavanzadeh M, Calvo NE, Monjazeb S, Anyanwu C. Case report: An EEG captured case of migralepsy/migraine aura-triggered seizures. Front Neurol 2022; 13:953224. [PMID: 36034309 PMCID: PMC9403508 DOI: 10.3389/fneur.2022.953224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Migraine and epilepsy are common chronic neurological disorders presenting with paroxysmal attacks of transient cerebral dysfunction, followed by subsequent return to baseline between episodes. The term “migralepsy” has been proposed to define migraine-triggered epileptic seizures classified by the ICHD-III as a complication of migraine with an aura. Case A 55-year-old man with a 30-year history of migraine without aura presented with a new onset left parietal pain accompanied by visual disturbances occurring up to 20 times per day. His visual distortions included kaleidoscopic vision, flashes of shadows, and a right superior quadrantanopia lasting 20 min. He described discrete 2-min episodes of scintillating scotomas in his right visual field. Ictal EEG demonstrated a left occipital onset focal aware seizure with his clinical symptoms. The patient was started on valproic Acid and has remained asymptomatic. Discussion The diagnostic criteria as set out by the ICHD-III for migralepsy and other syndromes with migrainous and ictal features remain confusing for practitioners as there is much overlap in clinical manifestations of these entities. EEG should be obtained when ictal features are noted among patients presenting with headache.
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Affiliation(s)
- Anam Hareem
- Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- *Correspondence: Anam Hareem
| | | | - Nicholas E. Calvo
- Department of Neurology, The University of Utah, Salt Lake City, UT, United States
| | - Sanaz Monjazeb
- Department of Neurology, University of Southern California, Los Angeles, CA, United States
| | - Chinekwu Anyanwu
- Department of Neurology, Virginia Tech Carilion, Roanoke, VA, United States
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Bidirectional Relations Among Depression, Migraine, and Epilepsy: Do They Have an Impact on Their Response to Treatment? Curr Top Behav Neurosci 2021; 55:251-265. [PMID: 34964936 DOI: 10.1007/7854_2021_286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The evaluation and treatment of patients with epilepsy is not limited to the type of epilepsy, but it must incorporate the common comorbid neurologic, psychiatric, and medical disorders, as the latter can bare an impact on the course and response to treatment of the seizure disorder and vice versa. In this article we review the bidirectional relations among epilepsy and two of its most common comorbidities, mood disorders and migraine and examine the implications of these relations on the selection of therapies of these three disorders and their response to treatment. We also review the most salient common pathogenic mechanisms that may explain such relations.
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Sforza G, Ruscitto C, Moavero R, Ursitti F, Ferilli MAN, Tarantino S, Balestri M, Vigevano F, Valeriani M, Papetti L. Case Report: Migralepsy: The Two-Faced Janus of Neurology. Front Neurol 2021; 12:711858. [PMID: 34707554 PMCID: PMC8542981 DOI: 10.3389/fneur.2021.711858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/06/2021] [Indexed: 12/01/2022] Open
Abstract
We report three cases of pediatric patients suffering from migraine aura triggered seizures. This entity, also called migralepsy, still does not have a unique definition today. Migraine and epilepsy are both episodic neurological disorders with periods of interictal well-being; this is indicative of similar pathophysiological mechanisms, such as increased neuronal excitation and ion channel dysfunction. The purpose of this paper is to discuss the clinical and instrumental features of migralepsy through the description of three clinical cases in which the symptoms of the usual migraine aura developed into a generalized tonic–clonic or focal seizure.
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Affiliation(s)
- Giorgia Sforza
- Pediatric Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Fabiana Ursitti
- Pediatric Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Michela Ada Noris Ferilli
- Pediatric Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Samuela Tarantino
- Pediatric Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Martina Balestri
- Child Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Federico Vigevano
- Child Neurology Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Massimiliano Valeriani
- Pediatric Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Laura Papetti
- Pediatric Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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11
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Güven B, Çilliler AE. Headache in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav 2021; 121:108081. [PMID: 34062448 DOI: 10.1016/j.yebeh.2021.108081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE It is remarkable that epilepsy and migraine are similar diseases with many parallel clinical features, as well as sharing common pathophysiological mechanisms. However, the pathogenetic role of hippocampal sclerosis (HS) in epilepsy and headache coexistence has not been clarified. In this study, we aimed to investigate the frequency of headache/migraine and the relationship between headache and HS lateralizations in patients with mesial temporal lobe epilepsy (MTLE), accompanied by HS. METHODS Consecutive patients with mesial temporal lobe epilepsy with hippocampal sclerosis (HS-MTLE) followed up in epilepsy outpatient clinic were included in this study, with their demographic and clinical characteristics, HS lateralization, and side (unilateral-right-left, bilateral), which were recorded. Using the questionnaires, the type of headache [migraine, tension headache (TTH)] was determined. Patients in whom migraine and TTH could not be completely separated were recruited for the unclassified group. The temporal relationship of headache and seizures (peri-ictal and/or interictal), pain lateralization, and side (unilateral-right-left, bilateral, unilateral + bilateral) were likewise determined. RESULTS There were 56 patients (30 females, 26 males; mean age 36.9 ± 12.1 years; mean epilepsy duration 19.3 ± 12.5 years) included in the study. Thirty-one patients (55.4%) stated they had a headache: of these, eighteen (32.1%) had migraine and 9 (16.1%) had TTH. Migraine accounted for 58.1% of headaches and TTHs was 29%. Headache was unilateral in 15 patients, and bilateral or bilateral + unilateral in 16 patients. Of patients with migraine, pain was unilateral in 10, and bilateral or bilateral + unilateral in 8. HS was right-sided in 24 patients, left-sided in 30 patients, and bilateral in 2 patients. In patients with right-sided HS, it was an ipsilateral headache; bilateral headache was found to be more common in patients with left-sided HS (p = 0.029). No relationship was found between the lateralization of the headache and the side of HS in patients with migraine. CONCLUSION The results of our study showed that approximately half the patients with HS-MTLE did have a headache, with one third noting migraine type headache; this highlighted that HS may play a pathogenetic role in the development of headache, especially migraine, in patients with epilepsy. Further comprehensive studies will enable us to understand whether accompanying headache, especially migraine attacks in patients with epilepsy, can be determinant for HS-MTLE, as well as if it has a lateralizing value for HS.
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Affiliation(s)
- Bülent Güven
- Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Neurology, University of Health Sciences, Turkey.
| | - Aslı Ece Çilliler
- Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Neurology, University of Health Sciences, Turkey.
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12
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Abstract
There is increasing recognition that epilepsy can be associated with a broad spectrum of comorbidities. While epileptic seizures are an essential element of epilepsy in children, there is a spectrum of neurological, mental health and cognitive disorders that add to the disease burden of childhood epilepsy resulting in a decreased quality of life. The most common comorbid conditions in childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disorders, attention deficits, cognitive impairment, and migraine. While epilepsy can result in comorbidities, many of the comorbidities of childhood have a bi-directional association, with the comorbid condition increasing risk for epilepsy and epilepsy increasing the risk for the comorbid condition. The bidirectional feature of epilepsy and the comorbidities suggest a common underlying pathological basis for both the seizures and comorbid condition. While recognition of the comorbid conditions of pediatric epilepsies is increasing, there has been a lag in the development of effective therapies partly out of concern that drugs used to treat the comorbid conditions could increase seizure susceptibility. There is now some evidence that most drugs used for comorbid conditions are safe and do not lower seizure threshold. Unfortunately, the evidence showing drugs are effective in treating many of the childhood comorbidities of epilepsy is quite limited. There is a great need for randomized, placebo-controlled drug trials for efficacy and safety in the treatment of comorbidities of childhood epilepsy.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Stafford Hall, 118C, Burlington, VT, 05405, USA.
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13
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14
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Parisi P, Paolino MC, Raucci U, Della Vecchia N, Belcastro V, Villa MP, Striano P. Ictal Epileptic Headache: When Terminology Is Not a Moot Question. Front Neurol 2019; 10:785. [PMID: 31396147 PMCID: PMC6664028 DOI: 10.3389/fneur.2019.00785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
The relationship between headache and epilepsy is complex and despite the nature of this association is not yet clear. In the last few years, it has been progressively introduced the concept of the “ictal epileptic headache” that was included in the recently revised International Classification of Headaches Disorders 3rd edition (ICHD-3-revised). The diagnostic criteria for ictal epileptic headache (IEH) suggested in 2012 were quite restrictive thus leading to the underestimation of this phenomenon. However, these criteria have not yet been included into the ICHD-3 revision published in 2018, thus creating confusion among both, physicians and experts in this field. Here, we highlight the importance to strictly apply the original IEH criteria explaining the reasons through the analysis of the clinical, historical, epidemiological and pathophysiological characteristics of the IEH itself. In addition, we discuss the issues related to the neurophysiopathological link between headache and epilepsy as well as to the classification of these epileptic events as “autonomic seizure.”
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Affiliation(s)
- Pasquale Parisi
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Vincenzo Belcastro
- Neurology Unit, Department of Neuroscience, Sant'Anna Hospital, Como, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy.,Paediatric Neurology and Muscular Diseases Unit, G. Gaslini' Institute, Genova, Italy
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15
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Emergence delirium in children is related to epileptiform discharges during anaesthesia induction. Eur J Anaesthesiol 2018; 35:929-936. [DOI: 10.1097/eja.0000000000000867] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Kanner AM, Ribot R, Mazarati A. Bidirectional relations among common psychiatric and neurologic comorbidities and epilepsy: Do they have an impact on the course of the seizure disorder? Epilepsia Open 2018; 3:210-219. [PMID: 30564780 PMCID: PMC6293067 DOI: 10.1002/epi4.12278] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 01/13/2023] Open
Abstract
The treatment of epilepsy is not limited to the achievement of a seizure‐free state. It must also incorporate the management of common psychiatric and neurologic comorbidities, affecting on average between 30 and 50% of patients with epilepsy, which have a significant impact on their lives at various levels, including quality of life and the prognosis of the seizure disorder. Mood and anxiety disorders are the most frequent psychiatric comorbidities, whereas stroke and migraine are among the more common neurologic comorbidities, migraine among the younger patients and stroke among the older patients. Not only do these psychiatric and neurologic comorbidities each have a bidirectional relation with epilepsy, but primary mood disorders have a bidirectional relation with these 2 neurologic disorders. Furthermore, depression and migraine have been each associated with a more severe epilepsy course, whereas depression has been associated with a more severe course of stroke and migraines. The purpose of this article is to review the clinical implications of the complex relations among epilepsy and these 3 comorbid disorders, and to identify any clinical and/or experimental evidence that may suggest that having more than one of these comorbid disorders may increase the risk of and course of epilepsy.
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Affiliation(s)
- Andres M Kanner
- Comprehensive Epilepsy Center and Epilepsy Division Department of Neurology Miller School of Medicine University of Miami Miami Florida U.S.A
| | - Ramses Ribot
- Comprehensive Epilepsy Center and Epilepsy Division Department of Neurology Miller School of Medicine University of Miami Miami Florida U.S.A
| | - Andrey Mazarati
- Department of Pediatrics and Children's Discovery and Innovation Institute D. Geffen School of Medicine at UCLA Los Angeles California U.S.A
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17
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Parisi P, Belcastro V, Verrotti A, Striano P, Kasteleijn-Nolst Trenitè DGA. "Ictal epileptic headache" and the revised International Headache Classification (ICHD-3) published in Cephalalgia 2018, vol. 38(1) 1-211: Not just a matter of definition! Epilepsy Behav 2018; 87:243-245. [PMID: 30115602 DOI: 10.1016/j.yebeh.2018.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Pasquale Parisi
- Child Neurology, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy.
| | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, University of Genoa, "G. Gaslini" Institute, Genova, Italy
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18
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Does pain sensitivity increase during ictal period? Evidence from absence epileptic WAG/Rij rats. Epilepsy Behav 2018; 87:14-17. [PMID: 30153651 DOI: 10.1016/j.yebeh.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The hyperexcitable brain provides a common ground for comorbidity of pain syndromes and epilepsy. There are controversial reports about pain sensitivity during the ictal period. We analyzed the pain sensitivity during the ictal period in the genetic absence epilepsy animal model, Wistar Albino Glaxo/Rijswijk (WAG/Rij) rats. METHODS The ictal and interictal pain sensitivities of symptomatic WAG/Rij rats (8 months old, n = 19) were determined and compared with those of age-matched control Wistar rats (n = 19). Pain sensitivity was assessed by applying heat stimulation to hind paws and measuring the paw-withdrawal latency using a thermal plantar analgesia meter in awake and freely moving animals. All measurements were made during the interictal and ictal periods and confirmed by simultaneous electroencephalography (EEG) through intracranially implanted electrodes. RESULTS The nociceptive stimulus-induced withdrawal latency during the ictal period in absence epilepsy WAG/Rij rats was significantly shorter when compared with that during the interictal period (p = 0.007) and when compared with that in the control Wistar rats (p = 0.001). CONCLUSION Our data indicate higher pain sensitivity during the ictal period in absence epilepsy rats. Considering the fact that subjects are less responsive during spike-wave discharges, there is a decrease in the level of consciousness and/or responsiveness ictally during all generalized genetic seizures, this increased pain sensitivity is rather surprising during the ictal period. Although the mechanism remains unknown, this novel finding deserves further investigation.
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19
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Koch S, Rupp L, Prager C, Mörgeli R, Kramer S, Wernecke KD, Fahlenkamp A, Spies C. Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane. Clin Neurophysiol 2018; 129:1642-1648. [DOI: 10.1016/j.clinph.2018.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
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20
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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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21
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Velioglu SK, Gedikli O, Yıldırım M, Ayar A. Epilepsy may cause increased pain sensitivity: Evidence from absence epileptic WAG/Rij rats. Epilepsy Behav 2017; 75:146-150. [PMID: 28866333 DOI: 10.1016/j.yebeh.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The comorbidity of epilepsy and pain disorders as well as effectiveness of certain therapeutic approaches in both conditions attracted attention to epilepsy-pain interactions. This lead to the discovery of significantly shared pathophysiological mechanisms although many aspects remain largely unknown. To test the hypothesis that epilepsy may be associated with altered pain sensitivity, we analyzed interictal pain sensitivity using epilepsy prone WAG/Rij rats, a genetic model exhibiting age-related-onset absence epilepsy. METHODS Two series of experiments were conducted. In experiment I, pain sensitivity of symptomatic WAG/Rij rats were compared with age-matched control Wistar rats. In experiment II, pain sensitivity of WAG/Rij rats were monitored longitudinally when they were presymptomatic (at 2months) and symptomatic (after maturation, at 8months), and compared with age-matched control Wistar rats. Pain sensitivity was assessed by applying heat stimuli to hind paws and measuring the paw-withdrawal latency using thermal plantar analgesia meter in awake and freely moving animals. All pain measurements were made during the interictal period, confirmed by simultaneous electroencephalography through intracranially implanted electrodes. RESULTS In experiment I, the interictal pain withdrawal latency of symptomatic WAG/Rij rats was significantly shorter than control Wistar rats (P<0.01). In experiment II, WAG/Rij rats had significantly shorter latency of withdrawal response than control Wistar rats, both at presymptomatic (P<0.05) and symptomatic stage (P<0.0001). Matured (8months old) control Wistar rats demonstrated significantly increased withdrawal latency compared to the 2months animals (P<0.01), but the WAG/Rij rats did not (P>0.5). CONCLUSION Epileptic WAG/Rij rats present significantly increased pain sensitivity when compared to control Wistar rats, suggesting comorbidity of epilepsy and pain.
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Affiliation(s)
- Sibel K Velioglu
- Karadeniz Technical University, Faculty of Medicine, Neurology Department, Clinical Neurophysiology Unit, Trabzon, Turkey.
| | - Oznur Gedikli
- Karadeniz Technical University, Faculty of Medicine, Physiology Department, Trabzon, Turkey
| | - Mehmet Yıldırım
- University of Health Sciences, Faculty of Medicine, Medical Physiology Department, Istanbul, Turkey
| | - Ahmet Ayar
- Karadeniz Technical University, Faculty of Medicine, Physiology Department, Trabzon, Turkey
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22
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Chen SP, Ayata C. Novel Therapeutic Targets Against Spreading Depression. Headache 2017; 57:1340-1358. [PMID: 28842982 DOI: 10.1111/head.13154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
Migraine is among the most prevalent and disabling neurological diseases in the world. Cortical spreading depression (SD) is an intense wave of neuronal and glial depolarization underlying migraine aura, and a headache trigger, which has been used as an experimental platform for drug screening in migraine. Here, we provide an overview of novel therapeutic targets that show promise to suppress SD, such as acid-sensing ion channels, casein kinase Iδ, P2X7-pannexin 1 complex, and neuromodulation, and outline the experimental models and essential quality measures for rigorous and reproducible efficacy testing.
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Affiliation(s)
- Shih-Pin Chen
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Cenk Ayata
- Neurovascular Research Lab, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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23
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Çilliler AE, Güven H, Çomoğlu SS. Epilepsy and headaches: Further evidence of a link. Epilepsy Behav 2017; 70:161-165. [PMID: 28427026 DOI: 10.1016/j.yebeh.2017.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/01/2017] [Accepted: 03/05/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Epilepsy and primary headaches are two of the most common neurologic conditions that share some common clinical characteristics, and can affect individuals of all age groups around the world. In recent years, the underlying pathophysiologic mechanisms potentially common to both headaches and epileptic seizures have been the subject of scrutiny. The objective of this study was to determine the frequencies and types of headaches in patients with epilepsy, and evaluate any temporal relationship with epileptic seizures. METHOD Demographic data, epilepsy durations, seizure frequencies, seizure types and antiepileptic medications used were captured of 349 patients who were followed up at our epilepsy outpatient clinic. Patients who experienced headaches were grouped based on the type of headaches and on whether their headaches occurred in the preictal, postictal or interictal period. RESULT Three hundred forty-nine patients (190 females, 159 males) were enrolled in the study. The patients' average age was 30.9±13.1 years, and average epilepsy duration was 13.5±10.9 years. The types of epileptic seizures were partial in 19.8% of patients, generalized in 57.9%, and secondary generalized in 20.3% of patients. Some 43.6% of the patients did not experience headaches, and 26.9% had migraine and 17.2% tension-type headaches. Headaches could not be classified in 12.3% of patients. The headaches occurred preictally in 9.6%, postictally in 41.6% and interictally in 8.6% of patients. The ratio of headaches was lower in male patients compared with females, and females experienced migraine-type headaches more frequently compared with males (p=0.006). Migraine-type headaches were less frequent a mong patients who experienced less than one seizure per year, but more frequent (p=0.017) among those who experienced more than one seizure per month, but less than one seizure per week. Migraine-type headaches were significantly more frequent (p=0.015) among patients receiving polytherapy compared with patients receiving monotherapy. CONCLUSION The results of this study suggest that headaches, particularly migraine-type headaches, were frequently experienced by patients with epilepsy, postictal headaches were more common, and the frequency of migraine attacks could be linked with seizure frequency and the type of treatment.
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Affiliation(s)
- Asli Ece Çilliler
- Dişkapi Yildirim Beyazit Training and Research Hospital Neurology Department, Ankara, Turkey.
| | - Hayat Güven
- Dişkapi Yildirim Beyazit Training and Research Hospital Neurology Department, Ankara, Turkey
| | - Selim Selçuk Çomoğlu
- Dişkapi Yildirim Beyazit Training and Research Hospital Neurology Department, Ankara, Turkey
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24
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Eidlitz-Markus T, Zolden S, Haimi-Cohen Y, Zeharia A. Comparison of comorbidities of migraine and tension headache in a pediatric headache clinic. Cephalalgia 2016; 37:1135-1144. [PMID: 27586882 DOI: 10.1177/0333102416665870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective To compare comorbidities between migraine and tension headache in patients treated in a tertiary pediatric headache clinic. Methods Files of patients with migraine or tension headache attending a pediatric headache clinic were retrospectively reviewed for the presence of organic comorbidities. Additionally, patients were screened with the self-report Strengths and Difficulties Questionnaire to identify nonorganic comorbidities. If necessary, patients were referred to a pediatric psychiatrist, psychologist or social worker for further evaluation. Results The study cohort comprised 401 patients: 200 with migraine and 201 with tension headache. The main organic comorbidities were atopic disease, asthma, and first-reported iron-deficiency anemia; all occurred with statistical significance more often with migraine than with tension headache (Familial Mediterranean fever was six times more frequent in the migraine group than in the tension headache group, but the difference was not statistically significant. Nonorganic comorbidities (psychiatric, social stressors) were associated significantly more often with tension headache than with migraine (48.3% versus 33%; p = 0.03). Conclusions Children and adolescents with migraine or tension headache treated in a dedicated clinic have high rates of organic and nonorganic comorbidities. In this setting, patients with migraine have significantly more organic comorbidities, and patients with tension headache, significantly more nonorganic comorbidities.
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Affiliation(s)
- Tal Eidlitz-Markus
- 1 Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirit Zolden
- 1 Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Haimi-Cohen
- 1 Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Zeharia
- 1 Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Cefalee del bambino. Neurologia 2016. [DOI: 10.1016/s1634-7072(16)78792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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26
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Jakobsen LA, Karshenas A, Bach FW, Gazerani P. Alterations in pain responsiveness and serum biomarkers in juvenile myoclonic epilepsy: an age- and gender-matched controlled pilot study. FUTURE NEUROLOGY 2016. [DOI: 10.2217/fnl.16.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Serum levels of several biomarkers along with sensory responsiveness were investigated in juvenile myoclonic epilepsy patients in comparison with healthy controls. Methods: Ten epileptic patients (36.1 ± 3.4 years) and ten gender- and age-matched healthy controls were recruited. Mechanical sensitivity, cold pressor tolerance and serum levels of BDNF, CGRP, PGE2, S100B and TNF-α were investigated. Results: Mechanical sensitivity to pinprick was lower in patients (p < 0.05) while cold pain tolerance threshold was higher. Serum level of BDNF was higher in patients compared with controls (p < 0.01). The same pattern was evident for CGRP (p < 0.05). Serum level of PGE2 was lower in patients (p < 0.01). Conclusion: Juvenile myoclonic epilepsy patients had an altered serum biomarker pattern and sensory perception in comparison with controls.
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Affiliation(s)
- Lydia Anja Jakobsen
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Ali Karshenas
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Parisa Gazerani
- SMI® & Laboratory for Cancer Biology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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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: 16] [Impact Index Per Article: 2.0] [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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28
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Fanella M, Morano A, Fattouch J, Albini M, Casciato S, Manfredi M, Giallonardo AT, Di Bonaventura C. Ictal epileptic headache revealing non convulsive status epilepticus in a case of eyelid myoclonia with absences. J Headache Pain 2015; 16:105. [PMID: 26644029 PMCID: PMC4671982 DOI: 10.1186/s10194-015-0587-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/28/2015] [Indexed: 02/07/2023] Open
Abstract
Epileptic seizures and headache attacks are two common neurologic phenomena characterized by paroxysmal alteration of brain functions followed by complete restauration of the baseline condition. Headache and epilepsy are related in numerous ways, and they often co-occur. Although the link between these two diseases is not completely clear, several clinical, physiopathological and therapeutic features overlap. Headache is reported in association with epileptic seizures as a pre-ictal, ictal or post-ictal phenomenon. We present the case of a 40 year-old woman affected by eyelid myoclonia with absences (EMA) with a history of prolonged headache attacks. A video-EEG recording performed during one of these episodes showed subcontinuous epileptic activity consisting of generalized spike-and-wave discharges (GSWDs), clinically associated with tensive headache. Our work represents one of the few well EEG-documented cases of ictal epileptic headache in idiopathic generalized epilepsy (IGE).
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Affiliation(s)
- Martina Fanella
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Alessandra Morano
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Sara Casciato
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
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Abstract
Migraine and epilepsy are both common episodic disorders that share many clinical features and underlying pathophysiological mechanisms. The comorbidity of these two conditions is well known. However, the temporal association between migraine and epilepsy is a controversial issue, since these two conditions may occur in numerous ways. Four types of association between headache and epileptic seizure are recognized: pre-ictal headache, headache as the expression of an epileptic manifestation, post-ictal headache, and inter-ictal headache. The classification of epilepsy by the International League Against Epilepsy did not refer to the epileptic headache. On the other hand, the International Classification of Headache Disorders, 3rd edition (ICHD-3) defines three entities: migraine aura-triggered seizure which sometimes referred to as migralepsy, hemicrania epileptica, and post-ictal headache. However, ICHD-3 mentions that there is a complex and bidirectional association between migraine and epilepsy. Most of the previous reports of migralepsy corresponded to occipital seizures that mimic migraine with aura. The term migralepsy has recently been criticized. Migraine and epilepsy share several pathophysiological mechanisms which involve neurotransmitters and iron channel dysfunctions. There is the hypothesis of a shared genetic susceptibility to migraine and epilepsy. Strong support of a shared genetic basis comes from familial hemiplegic migraine.
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Affiliation(s)
- Sadatoshi Tsuji
- Department of Medical Technology and Sciences, School of Health Sciences at Fukuoka, International University of Health and Welfare
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Guidetti V, Antonelli A, Donazzan S, Faedda N, Natalucci G, Simeoni S. P015. Externalizing behaviours in children with headache and epilepsy: a case-control study. J Headache Pain 2015; 16:A144. [PMID: 28132244 PMCID: PMC4759330 DOI: 10.1186/1129-2377-16-s1-a144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Vincenzo Guidetti
- Department of Pediatrics and Child Neuropsychiatry, University "La Sapienza", Rome, Italy.
| | - Azzurra Antonelli
- Department of Pediatrics and Child Neuropsychiatry, University "La Sapienza", Rome, Italy
| | - Sonia Donazzan
- Department of Pediatrics and Child Neuropsychiatry, University "La Sapienza", Rome, Italy
| | - Noemi Faedda
- Department of Pediatrics and Child Neuropsychiatry, University "La Sapienza", Rome, Italy
| | - Giulia Natalucci
- Department of Pediatrics and Child Neuropsychiatry, University "La Sapienza", Rome, Italy
| | - Susanna Simeoni
- Department of Pediatrics and Child Neuropsychiatry, University "La Sapienza", Rome, Italy
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Mainieri G, Cevoli S, Giannini G, Zummo L, Leta C, Broli M, Ferri L, Santucci M, Posar A, Avoni P, Cortelli P, Tinuper P, Bisulli F. Headache in epilepsy: prevalence and clinical features. J Headache Pain 2015; 16:556. [PMID: 26245188 PMCID: PMC4540713 DOI: 10.1186/s10194-015-0556-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Headache and epilepsy are two relatively common neurological disorders and their relationship is still a matter of debate. Our aim was to estimate the prevalence and clinical features of inter-ictal (inter-IH) and peri-ictal headache (peri-IH) in patients with epilepsy. METHODS All patients aged ≥ 17 years referring to our tertiary Epilepsy Centre were consecutively recruited from March to May 2011 and from March to July 2012. They underwent a semi-structured interview including the International Classification Headache Disorders (ICHD-II) criteria to diagnose the lifetime occurrence of headache.χ(2)-test, t-test and Mann-Whitney test were used to compare clinical variables in patients with and without inter-IH and peri-IH. RESULTS Out of 388 enrolled patients 48.5 % had inter-IH: migraine in 26.3 %, tension-type headache (TTH) in 19.1 %, other primary headaches in 3.1 %. Peri-IH was observed in 23.7 %: pre-ictally in 6.7 %, ictally in 0.8 % and post-ictally in 19.1 %. Comparing patients with inter-ictal migraine (102), inter-ictal TTH (74) and without inter-IH (200), we found that pre-ictal headache (pre-IH) was significantly represented only in migraineurs (OR 3.54, 95 % CI 1.88-6.66, P < 0.001). Post-ictal headache (post-IH) was significantly associated with both migraineurs (OR 2.60, 95 % CI 1.85-3.64, P < 0.001) and TTH patients (OR 2.05, 95 % CI 1.41-2.98, P < 0.001). Moreover, post-IH was significantly associated with antiepileptic polytherapy (P < 0.001), high seizure frequency (P = 0.002) and tonic-clonic seizures (P = 0.043). CONCLUSIONS Migraine was the most represented type of headache in patients with epilepsy. Migraineurs are more prone to develop pre-IH, while patients with any inter-IH (migraine or TTH) are predisposed to manifest a post-IH after seizures.
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Affiliation(s)
- G Mainieri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, AUSL di Bologna, Bologna, Italy,
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Rodriguez-Sainz A, Pinedo-Brochado A, Sánchez-Menoyo JL, Ruiz-Ojeda J, Escalza-Cortina I, Garcia-Monco JC. Migraine, Stroke and Epilepsy: Underlying and Interrelated Causes, Diagnosis and Treatment. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:322-34. [DOI: 10.1007/s11936-013-0236-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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