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Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Comprehensive Review. Curr Pain Headache Rep 2021; 25:33. [PMID: 33761013 DOI: 10.1007/s11916-021-00946-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW SMART syndrome is a delayed complication of cranial irradiation that can be misconstrued as tumor recurrence or some other intracranial neurological disease. Recognition of this clinical syndrome is imperative as it can obviate the need for invasive diagnostic testing and can provide reassurance to both the patient and their loved ones. RECENT FINDINGS SMART syndrome is generally considered a reversible clinical syndrome; however, neurological deficits may become permanent. Pathophysiology of SMART syndrome may involve cerebrovascular autoregulation impairment, neuronal dysfunction leading to trigeminovascular system impairment and/or cortical spreading depression, and seizures. In addition to MRI brain with gadolinium, other imaging modalities, such as CT perfusion, MR perfusion, MR spectroscopy, and FDG PET/CT, aid in arriving to the diagnosis sooner. Patients should also undergo electroencephalogram in order to promptly identify and treat seizures. There are currently no clear guidelines on how to effectively treat SMART syndrome, but treatment may involve anti-seizure medication, anti-hypertensives, anti-platelet, and steroid therapy. This review provides a comprehensive understanding of the clinical characteristics of SMART syndrome from presentation to diagnostic evaluation. We also discuss radiographic features and treatment strategies for this rare disease. With increased radiotherapy utilization, prompt clinical recognition of SMART syndrome and further development of a comprehensive diagnostic approach to SMART syndrome utilizing newer radiographic modalities as well as treatment algorithms to effectively treat this clinical condition will be imperative.
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Boyer PN, Devlin M, Boggild M. Rare and rarer: co-occurrence of stroke-like migraine attacks after radiation therapy and Charles Bonnet syndromes. Oxf Med Case Reports 2018; 2018:omy077. [PMID: 30323940 PMCID: PMC6172599 DOI: 10.1093/omcr/omy077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/18/2018] [Accepted: 07/28/2018] [Indexed: 11/18/2022] Open
Abstract
A 30-year-old man presented with new onset severe headache and homonymous hemianopia, with a subsequent seizure, on a background of a right parietal astrocytoma resected at age 5 with adjuvant chemotherapy and radiotherapy. Magnetic resonance imaging of the brain revealed post-surgical and radiotherapy changes only and a clinical diagnosis of Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome was made. Vision subsequently recovered gradually over a 6-week period, however, during the recovery phase he reported well formed hallucinations in the affected hemi-field consisting of small mammals, particularly possums, which gradually became less distinct as vision recovered; a phenomenon which was felt likely to represent the Charles Bonnet syndrome.
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Affiliation(s)
| | - Michael Devlin
- Neurology Department, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| | - Mike Boggild
- Neurology Department, Townsville Hospital and Health Service, Douglas, Queensland, Australia
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Jia W, Saito R, Kanamori M, Iwabuchi N, Iwasaki M, Tominaga T. SMART (stroke-like migraine attacks after radiation therapy) syndrome responded to steroid pulse therapy: Report of a case and review of the literature. eNeurologicalSci 2018; 12:1-4. [PMID: 30003148 PMCID: PMC6040931 DOI: 10.1016/j.ensci.2018.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/22/2018] [Indexed: 01/06/2023] Open
Abstract
This report presents a case of stroke-like migraine attacks after radiation therapy (SMART) syndrome in a 31-year-old man in whom symptoms and radiological findings resolved with steroid pulsed therapy and reviews the literatures with special emphasis on the use of steroids against SMART syndrome. The patient had a past history of left temporal anaplastic astrocytoma and was treated with surgery followed by local 72 Gy radiation therapy and chemotherapy using Nimustine Hydrochloride. Four years after the surgery, he was suffering from subacute progressing symptoms of headache, right hemianopia, right hemiparesis and aphasia from 2 to 4 days before admission to our hospital. At first he was diagnosed as symptomatic epilepsy but after extensive examination, the final diagnosis was SMART syndrome. His symptoms soon improved with steroid pulse therapy. In the literature, steroid pulse therapy is not necessarily a standard of care for SMART syndrome, but it seemed to decrease the need of biopsy. As the lesions of SMART syndrome require differential diagnosis from recurrences, biopsy was performed in some cases. However, lack of benefit and possible detriment is reported with biopsy of SMART lesions. Through this experience we suggest that steroid pulse therapy may provide speedy recovery from symptoms, and it should be considered before other invasive investigations or treatments. Report a case of stroke-like migraine attacks after radiation therapy (SMART) syndrome in a 31-year-old man in whom symptoms and radiological findings resolved with steroid pulsed therapy. Lack of benefit and possible detriment is reported with biopsy of SMART lesions. Steroid pulse therapy is not necessarily a standard of care for SMART syndrome, but it seemed to decrease the need of biopsy. Steroid pulse therapy may provide recovery from symptoms of SMART, and should be considered before invasive investigations.
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Affiliation(s)
- Wenting Jia
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Naoya Iwabuchi
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Cianchetti C, Avanzini G, Dainese F, Guidetti V. The complex interrelations between two paroxysmal disorders: headache and epilepsy. Neurol Sci 2017; 38:941-948. [DOI: 10.1007/s10072-017-2926-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/16/2017] [Indexed: 01/03/2023]
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Kingston WS, Schwedt TJ. The Relationship Between Headaches with Epileptic and Non-epileptic Seizures: a Narrative Review. Curr Pain Headache Rep 2017; 21:17. [DOI: 10.1007/s11916-017-0617-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Bompaire F, Zinchenko L, Lahutte M, Mokhtari K, Psimaras D, Gaultier C, Monjour A, Delattre JY, Ricard D. SMART syndrome: Classic transient symptoms leading to an unusual unfavorable outcome. Rev Neurol (Paris) 2017; 173:67-73. [DOI: 10.1016/j.neurol.2016.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/30/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
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Ramanathan RS, Sreedher G, Malhotra K, Guduru Z, Agarwal D, Flaherty M, Leichliter T, Rana S. Unusual case of recurrent SMART (stroke-like migraine attacks after radiation therapy) syndrome. Ann Indian Acad Neurol 2016; 19:399-401. [PMID: 27570398 PMCID: PMC4980969 DOI: 10.4103/0972-2327.168634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication of cerebral radiation therapy. A 53-year-old female initially presented with headache, confusion and left homonymous hemianopia. Her medical history was notable for cerebellar hemangioblastoma, which was treated with radiation in 1987. Her initial brain MRI (magnetic resonance imaging) revealed cortical enhancement in the right temporo-parieto-occipital region. She improved spontaneously in 2 weeks and follow-up scan at 4 weeks revealed no residual enhancement or encephalomalacia. She presented 6 weeks later with aphasia. Her MRI brain revealed similar contrast-enhancing cortical lesion but on the left side. Repeat CSF studies was again negative other than elevated protein. She was treated conservatively and recovered completely within a week. Before diagnosing SMART syndrome, it is important to rule out tumor recurrence, encephalitis, posterior reversible encephalopathy syndrome (PRES) and stroke. Typically the condition is self-limiting, and gradually resolves.
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Affiliation(s)
- Ramnath Santosh Ramanathan
- Department of Neurology, Neurology Chief Resident, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Gayathri Sreedher
- Pediatric Neuro-Radiology, Akron Childrens Hospital, Akron, Ohio, United States
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Zain Guduru
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Deeksha Agarwal
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Mary Flaherty
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Timothy Leichliter
- Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Sandeep Rana
- Associate Professor of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
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Black DF, Bartleson JD, Bell ML, Lachance DH. SMART: Stroke-Like Migraine Attacks After Radiation Therapy. Cephalalgia 2016; 26:1137-42. [PMID: 16919065 DOI: 10.1111/j.1468-2982.2006.01184.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe two adults with stroke-like migraine attacks after radiation therapy (SMART syndrome), propose revised diagnostic criteria, and review the previously reported patients. ‘SMART’ is an acronym for a newly recognized syndrome which occurs as a delayed consequence of cerebral irradiation and consists of prolonged, unilateral, migrainous neurological symptoms with transient, dramatic cortical gadolinium enhancement of the affected cerebral hemisphere and is sometimes punctuated by generalized seizures and ipsilateral EEG slowing. Although the neurological symptoms can last for weeks, full recovery occurs. An appropriate evaluation should exclude alternative explanations.
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Affiliation(s)
- D F Black
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, MN 55905, USA.
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Zheng Q, Yang L, Tan LM, Qin LX, Wang CY, Zhang HN. Stroke-like Migraine Attacks after Radiation Therapy Syndrome. Chin Med J (Engl) 2015; 128:2097-101. [PMID: 26228225 PMCID: PMC4717966 DOI: 10.4103/0366-6999.161393] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To summarize the clinical presentation, pathogenesis, neuroimaging, treatment, and outcome of stroke-like migraine attacks after radiation therapy (SMART) syndrome, and to propose diagnostic criteria for this disorder. DATA SOURCES We searched the PubMed database for articles in English published from 1995 to 2015 using the terms of "stroke-like AND migraine AND radiation." Reference lists of the identified articles and reviews were used to retrieve additional articles. STUDY SELECTION Data and articles related to late-onset effects of cerebral radiation were selected and reviewed. RESULTS SMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies. The recovery, which ranges from hours to days to weeks, can be partial or complete. We propose the following diagnostic criteria for SMART: (1) Remote history of therapeutic external beam cranial irradiation for malignancy; (2) prolonged, reversible clinical manifestations mostly years after irradiation, which may include migraine, seizures, hemiparesis, hemisensory deficits, visuospatial defect, aphasia, confusion and so on; (3) reversible, transient, unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region; (4) eventual complete or partial recovery, the length of duration of recovery ranging from hours to days to weeks; (5) no evidence of residual or recurrent tumor; (6) not attributable to another disease. To date, no specific treatment has been identified for this syndrome. CONCLUSIONS SMART is an extremely rare delayed complication of brain irradiation. However, improvements in cancer survival rates have resulted in a rise in its frequency. Hence, awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.
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Affiliation(s)
- Qian Zheng
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Li-Ming Tan
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Li-Xia Qin
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Chun-Yu Wang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Hai-Nan Zhang
- Department of Neurology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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Surgically Induced SMART Syndrome: Case Report and Review of the Literature. World Neurosurg 2014; 82:240.e7-12. [DOI: 10.1016/j.wneu.2013.01.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 08/27/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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Armstrong AE, Gillan E, DiMario FJ. SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients. J Child Neurol 2014; 29:336-41. [PMID: 23364656 DOI: 10.1177/0883073812474843] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
SMART syndrome (stroke-like migraine attacks after radiation therapy) is a rare condition that involves complex migraines with focal neurologic findings in patients following cranial irradiation for central nervous system malignancies. Little is known about the mechanisms behind the disorder, making successful treatment challenging. We report 2 new cases of SMART syndrome in pediatric patients as well as review all documented cases of the syndrome. Each of our 2 pediatric patients suffered multiple episodes. Attacks were characterized by severe headache, visual disturbance, aphasia, and weakness. Recovery occurred over several days to weeks. The data from all documented reports of SMART syndrome indicate a greater prevalence for male gender. An age-dependent pattern of onset was also observed, with a greater variability of syndrome onset in patients who received cranial irradiation at a younger age. SMART appears to be a reversible, recurrent long-term complication of radiation therapy with possible age- and gender-related influences.
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Affiliation(s)
- Amy E Armstrong
- 1University of Connecticut School of Medicine, Farmington, CT, USA
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13
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Cianchetti C, Pruna D, Ledda M. Epileptic seizures and headache/migraine: A review of types of association and terminology. Seizure 2013; 22:679-85. [DOI: 10.1016/j.seizure.2013.05.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/23/2013] [Accepted: 05/25/2013] [Indexed: 01/09/2023] Open
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Papetti L, Nicita F, Parisi P, Spalice A, Villa MP, Kasteleijn-Nolst Trenité DGA. "Headache and epilepsy"--how are they connected? Epilepsy Behav 2013; 26:386-93. [PMID: 23122969 DOI: 10.1016/j.yebeh.2012.09.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 12/15/2022]
Abstract
The relationship between headache and seizures is a complicated one, since these two conditions are related in numerous ways. Although the nature of this association is unclear, several plausible explanations exist: the two disorders coexist by chance; headache is part (or even the sole ictal phenomenon) of seizures or the post-ictal state; both disorders share a common underlying etiology; and epilepsy mimics the symptoms of migraine (as in benign childhood epilepsy). Seizures and headaches as well as their respective primary syndromes (epilepsy and headache/migraine) share several pathophysiological mechanisms. These mechanisms especially involve neurotransmitter and ion channel dysfunctions. Also, photosensitivity seems to play a role in the connection. In order to improve the care for patients with a clinical connection between migraine and epilepsy, it is necessary to try to understand more accurately the exact pathophysiological point of connection between these two conditions. Both experimental and clinical measures are required to better understand this relationship. The development of animal models, molecular studies defining more precise genotype/phenotype correlations, and multicenter clinical studies with revision of clinical criteria for headache/epilepsy-related disorders represent the start for planning future translational research. In this paper, we review the relationship between migraine and epilepsy in terms of epidemiology and pathophysiology with regard to translational research and clinical correlations and classification.
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Affiliation(s)
- Laura Papetti
- Department of Pediatrics, Child Neurology Division, Sapienza University of Rome, Italy
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Truntzer P, Monjour A, Gaultier C, Ahle G, Guillerme F, Boutenbat G, Stilhart B, Salze P, Atlani D. SMART Syndrome : à propos d’un cas d’une complication rare après radiothérapie cérébrale et revue de la littérature. Cancer Radiother 2012; 16:295-301. [DOI: 10.1016/j.canrad.2012.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 03/26/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
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Kerklaan JP, Lycklama á Nijeholt GJ, Wiggenraad RGJ, Berghuis B, Postma TJ, Taphoorn MJB. SMART syndrome: a late reversible complication after radiation therapy for brain tumours. J Neurol 2011; 258:1098-104. [PMID: 21373901 PMCID: PMC3101343 DOI: 10.1007/s00415-010-5892-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 12/18/2010] [Accepted: 12/20/2010] [Indexed: 12/01/2022]
Abstract
With intensified treatment leading to longer survival, complications of therapy for brain tumours are more frequently observed. Regarding radiation therapy, progressive and irreversible white matter disease with cognitive decline is most feared. We report on four patients with reversible clinical and radiological features occurring years after radiation for brain tumours, suggestive for the so called SMART syndrome (stroke-like migraine attacks after radiation therapy). All four patients (males, age 36-60 years) had been treated with focal brain radiation for a primary brain tumour or with whole-brain radiation therapy for brain metastases. Ranging from 2 to 10 years following radiation therapy patients presented with headache and focal neurological deficits, suggestive for tumour recurrence. Two patients also presented with focal seizures. MRI demonstrated typical cortical swelling and contrast enhancement, primarily in the parieto-occipital region. On follow-up both clinical and MRI features improved spontaneously. Three patients eventually proved to have tumour recurrence. The clinical and radiological picture of these patients is compatible with the SMART syndrome, a rare complication of radiation therapy which is probably under recognized in brain tumour patients. The pathophysiology of the SMART syndrome is poorly understood but bears similarities with the posterior reversible encephalopathy syndrome (PRES). These four cases underline that the SMART syndrome should be considered in patients formerly treated with radiation therapy for brain tumours, who present with new neurologic deficits. Before the diagnosis of SMART syndrome can be established other causes, such as local tumour recurrence, leptomeningeal disease or ischemic disease should be ruled out.
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Affiliation(s)
- Joost P Kerklaan
- Department of Neurology, Medical Centre Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands,
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Verrotti A, Coppola G, Di Fonzo A, Tozzi E, Spalice A, Aloisi P, Bruschi R, Iannetti P, Villa MP, Parisi P. Should "migralepsy" be considered an obsolete concept? A multicenter retrospective clinical/EEG study and review of the literature. Epilepsy Behav 2011; 21:52-9. [PMID: 21497557 DOI: 10.1016/j.yebeh.2011.03.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/28/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
Abstract
The few reports that have been published on the current International Classification of Headache Disorders, Second Edition (ICHD-II), criteria for migralepsy and hemicrania epileptica have highlighted the considerable confusion regarding this "hot topic" within both headache and epilepsy classifications (ICHD-II and International League Against Epilepsy [ILAE]). Indeed, the ICHD-II describes a migraine-triggered seizure as a rare event in which a seizure occurs during migraine aura; on the other hand, hemicrania epileptica is described as an "ictal headache" that occurs "synchronously" with a partial seizure. To confuse matters even further, neither the term migralepsy nor the term hemicrania epileptica is included in the currently used ILAE classification. On the basis of both a review of "migralepsy" cases in the literature and 16 additional retrospective multicenter cases, we suggest that the term migraine-triggered seizure or migralepsy be deleted from the ICHD-II classification until unequivocal evidence is provided of its existence, and that the term ictal epileptic headache be introduced into the ILAE classification.
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Affiliation(s)
- Alberto Verrotti
- Child Neurology and Department of Pediatrics, University of Chieti, Chieti, Italy
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Belcastro V, Striano P, Pierguidi L, Calabresi P, Tambasco N. Ictal Epileptic Headache Mimicking Status Migrainosus: EEG and DWI-MRI Findings. Headache 2011; 51:160-2. [DOI: 10.1111/j.1526-4610.2010.01709.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Bradshaw J, Chen L, Saling M, Fitt G, Hughes A, Dowd A. Neurocognitive recovery in SMART syndrome: A case report. Cephalalgia 2010; 31:372-6. [DOI: 10.1177/0333102410388436] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Stroke-like migraine attacks after radiation therapy, or SMART syndrome, is characterised by migraine-like headache with or without aura, transient neurological dysfunction, including seizures, and gyriform enhancement on magnetic resonance imaging (MRI) which resolves over a period of weeks. Detailed neuropsychological characterisation in SMART syndrome is lacking and there are no published data on the course and pattern of neurocognitive recovery. Results: The acute clinical presentation was one of unstable, fluctuating neurocognitive disturbances, complicated by seizure activity, followed by a longer term lag in the recovery of focal neuropsychological deficits which, we believe, was due to the more slowly resolving cerebral effects of SMART. Conclusions: To our knowledge, this is the first case of SMART syndrome in which neuropsychological functioning has been comprehensively and serially examined. This case is also unique due to the development of complex partial seizures. We suggest that epileptiform activity during clinical seizures should not be regarded as inconsistent with a diagnosis of SMART, provided that the seizures do not explain the onset of the other clinical and radiological features.
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Affiliation(s)
- Jennifer Bradshaw
- University of Melbourne, Melbourne, Australia
- Austin Health, Melbourne, Australia
| | | | - Michael Saling
- University of Melbourne, Melbourne, Australia
- Austin Health, Melbourne, Australia
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Sances G, Guaschino E, Perucca P, Allena M, Ghiotto N, Manni R. Migralepsy: A call for a revision of the definition. Epilepsia 2009; 50:2487-96. [DOI: 10.1111/j.1528-1167.2009.02265.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maggioni F, Mampreso E, Ruffatti S, Viaro F, Lunardelli V, Zanchin G. Migralepsy: Is the Current Definition Too Narrow? Headache 2008; 48:1129-32. [DOI: 10.1111/j.1526-4610.2008.01091.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Merlino G, Valente M, D'Anna S, Gigli GL. Seizures With Prolonged EEG Abnormalities During an Attack of Migraine Without Aura. Headache 2007; 47:919-22. [PMID: 17578546 DOI: 10.1111/j.1526-4610.2007.00829.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The term "migralepsy" indicates a particular condition in which seizures occur during a migraine attack. Several cases of seizures associated with migraine with aura and characterized by transient MRI abnormalities have been published. We report the case of a patient who presented 2 generalized seizures during an attack of migraine without aura and with a transient, diffuse, irregular, high voltage slow activity without clear epileptiform abnormalities in subsequent EEG recordings.
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Affiliation(s)
- Andrew H Ahn
- Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA.
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Mateo I, Foncea N, Vicente I, Gómez Beldarrain M, Garcia-Monco JC. Migraine-Associated Seizures With Recurrent and Reversible Magnetic Resonance Imaging Abnormalities. Headache 2004; 44:265-70. [PMID: 15012667 DOI: 10.1111/j.1526-4610.2004.04059.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Migraine and epilepsy are highly comorbid, but the nature of their association remains unclear. Exceptionally, reversible brain magnetic resonance imaging (MRI) abnormalities following migraine and seizures have been reported. There are no descriptions, however, of patients with recurrent brain MRI changes. We report a patient with repeated episodes of migraine-with-aura-associated seizures (migralepsy) and recurrent and reversible brain MRI abnormalities. Location of the abnormalities was always consistent with the neurologic deficits. The possibility that transient brain MRI abnormalities in a patient with migraine with aura followed by seizures may be due to migralepsy should be borne in mind to avoid misdiagnosis and potentially aggressive procedures.
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Affiliation(s)
- Ignacio Mateo
- Neurology Service, Galdakao Hospital, Vizcaya, Spain
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Sand T. Electroencephalography in migraine: a review with focus on quantitative electroencephalography and the migraine vs. epilepsy relationship. Cephalalgia 2003; 23 Suppl 1:5-11. [PMID: 12699455 DOI: 10.1046/j.1468-2982.2003.00570.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
EEG-studies in migraine in the last decade has contributed modestly to the understanding of headache pathogenesis. Headache patient groups seem to have increased EEG responses to photic stimulation, but a useful biological marker for migraine in single patients has not been found. In future EEG and QEEG studies we recommend to use follow-up designs and record several EEGs across the migraine cycle. It is also important to use a blinded study design in order to avoid selection bias. A clinical EEG should be performed in patients with acute headache attacks when either epilepsy, basilar migraine, migraine with prolonged aura or alternating hemiplegia is suspected. Unequivocal epileptiform abnormalities usually suggest a diagnosis of epilepsy. In children with occipital spike-wave activity the probable diagnosis is childhood epilepsy with occipital paroxysms (CEOP). The final diagnosis of either an epilepsy syndrome or migraine must be mainly based on a clinical judgement [corrected].
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Affiliation(s)
- T Sand
- Department of Clinical Neuroscience, Norwegian University of Science and Technology, Clinical Neurophysiology Laboratory, Trondheim, Norway.
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ter Berg HW. Migraine-associated seizure: a case of reversible MRI abnormalities and persistent nondominant hemisphere syndrome. Headache 2001; 41:326-8. [PMID: 11264699 DOI: 10.1046/j.1526-4610.2001.111006326.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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