Blepharoclonus, pseudoasterixis, and restless feet

Migraine With Aura Accompanied by Myoclonus: A Case Report

Migraine is a condition characterized by pulsating headaches, often accompanied by photophobia, phonophobia, and/or gastrointestinal symptoms such as nausea and vomiting. Approximately 15% to one-third of migraine patients experience an aura either before or during the headache. To the best of our knowledge, the occurrence of migraine with myoclonus is extremely rare. This report describes a rare case of migraine with aura accompanied by myoclonus. The patient is a 46-year-old man who developed a visual aura followed by vomiting and a throbbing headache on the right side. As the headache intensified, involuntary movements of the left lower extremity appeared. Brain magnetic resonance imaging (MRI) revealed no structural abnormalities or stroke lesions; however, arterial spin labeling MRI showed hypoperfusion in the right cerebral hemisphere. An ophthalmological evaluation was unremarkable. He was diagnosed with migraine with myoclonus, and the intravenous administration of diazepam and sumatriptan resulted in the cessation of the myoclonus and mild relief of the headache. By the day after admission, the myoclonus and visual symptoms had completely disappeared. The headache resolved by the third day of admission.

Comorbidity of Migraine and Restless Legs Syndrome—A Case-Control Study

In order to evaluate a possible association between migraine and restless legs syndrome (RLS), we performed a case-control study on the comorbidity of RLS and migraine. Patients with migraine ( n = 411) and 411 sex- and age-matched control subjects were included. Migraine was diagnosed according to International Headache Society criteria, RLS according to the criteria of the International Restless Legs Syndrome Study Group. Furthermore, all patients had to fill out a self-assessment test performance on depression [Beck's Depression Inventory (BDI)]. RLS frequency was significantly higher in migraine patients than in control subjects (17.3% vs. 5.6%, P < 0.001; odds ratio 3.5, confidence interval 2.2, 5.8). In our sample, there was no significant association between migraine and depression as defined by the BDI score (9.6% in migraine vs. 4.0% in control subjects, P = 0.190). Depression was, however, not significantly more frequent in migraine patients with RLS (13.6%) than in migraine patients without RLS (8.7%). In addition, migraine patients with RLS had a significantly higher BDI score. RLS features did not differ significantly between migraine patients with RLS and control subjects with RLS. There is an association between RLS and migraine and, in addition, a co-association with depression. The underlying mechanism, however, remains undetermined and might be related to a dysfunction of dopaminergic metabolism in migraine.

Extracephalic Yawning Pain

The aim of this study was to report on two patients with recurrent, paroxysmal, extracephalic pain triggered by yawning. Pain with yawning may occur in several conditions (secondary yawning pain) or develop in the absence of precipitating lesions (primary yawning pain). Primary yawning pain is normally of cephalic location. Methods used were clinical neurological examinations, magnetic resonance imaging of the brain, computerized head tomography, electroencephalogram, blink reflex studies and Panorex X-ray views of the skull. The first patient had intense right shoulder pain and brief apnea for 2 years triggered by yawning. The second patient had yawning pain referred to an area of the neck where a thyroid tumour (Hürthle cell carcinoma) was later found. Neither of the two patients could precipitate their pain with imitation of yawning and neither had evidence of Eagle syndrome. Only the second patient had a history of migraine. Yawning pain may have an extratrigeminal and extracephalic distribution. It rarely serves to identify a lesion underlying the area where the pain is perceived.

Asterixis: a study of 103 patients

In 1949, asterixis was first described in patients with hepatic encephalopathy. It was quickly recognized that this phenomenon also occurs in other generalized encephalopathies and sometimes results from structural brain lesions. This paper is a study of asterixis in the general neurology clinic and on the inpatient neurology consultation service. The neurologists recorded the findings on inpatients and clinic patients for 12 consecutive months. Of the 1,109 inpatients with adequate examination, asterixis was documented in 97. Eighteen of the 97 cases were unilateral (18.6%) and 79 cases were bilateral (81.4%). Of the 614 outpatient visits with well documented examination, 6 (1%) individuals had asterixis. Since a small number of patients were examined more than once, the study yielded 103 individuals with adequate data for analysis. Asterixis resulted from varied causes: medications, renal disorder, hepatic dysfunction, pulmonary insufficiency, stroke and other brain lesions (including malignancy, subdural hematoma, and epidural abscess). Asterixis occurred in various patterns: in some cases it was easier to elicit in the upper extremities, in some it was easier to elicit in the lower limbs, and some it was solely or predominantly unilateral. The findings are discussed in light of the literature on asterixis with regard to its varied causes, patterns and presentations. Lastly, asterixis is examined from a historical perspective and the terminology is elucidated.

Comorbidity in perimenstrual migraine

Comorbidity may be defined as the association of two or more diseases in individuals at a frequency greater than that expected statistically by chance. Studying the co-occurrence of two disorders requires a careful statistical analysis before any clear conclusion on causality is reached. Many studies have looked for an association between migraine and many diseases, reporting several sometimes controversial comorbidities in migraine subjects. Although migraine is more common in women than in men, very few studies have analyzed the comorbidity of perimenstrual migraine, a migraine sub-type characterized by attacks of migraine without aura related to menstruation. We review the studies on migraine comorbidities, particularly migraine without aura in women.

Jactatio extra-capitis and migraine suppression

Sleep often terminates migraine headaches, and sleep disorders occur with greater prevalence in individuals with chronic or recurrent headaches. Rhythmic head, limb or body movements are common in children before falling asleep, but they very rarely persist into adolescence and adulthood, or appear de novo later in life as sleep-related rhythmic movement disorders. A 22-year-old female with migraine without aura and history of early childhood pre-dormital body rocking (jactatio) discovered that unilateral slow rhythmic movements of her right foot greatly facilitated falling sound asleep while reclining. Sleep served every time to terminate her migraine attack. Rhythmic movements may serve on occasion as a therapeutic hypnotic maneuver in migraine sufferers.

Possible joint origin of restless leg syndrome (RLS) and migraine

Sleep disorders have been described in migraine patients. Among sleep disorders RLS has been reported in up to one-third of migraineurs. Adverse effects of anti migraine therapy by dopamine antagonists can not fully explain this association. Therefore we present the hypothesis that RLS and migraine may have a joint origin. The hypothesis is supported by: (1) the same genetic origin for migraine without aura and RLS in single Italian family on chromosome 14q21; this gene codes survival motor neuron-interacting protein 1 (SIP1) which can play role in both diseases. (2) Correlation of both RLS and migraine with fibromyalgia. (3) Alteration of cortical excitability in both migraine and RLS.

Eyelid movements in health and disease. The supranuclear impairment of the palpebral motility

The eyelid movements are mediated mainly by the orbicularis oculi (OO) and the levator palpebrae superioris (LPS) muscles. Dissociated upper lid functions exhibit different counterbalanced action of these muscles, and in blinking they show a strictly reciprocal innervation. The disturbance of this close LPS-OO relationship likely leads to many of the central lid movement disorders. Three groups of supranuclear motor impairment of lid movements are considered: the disorders of the lid-eye movements' coordination, the disturbances of blinking and lid "postural" maintenance, and the alteration of voluntary lid movements. Nuclei of the posterior commissure control the inhibitory modulation of LPS motor-neuronal activity and they are involved in the lid-eye coordination disorders such as lid retraction, which is observed in the Parinaud's syndrome and also in parkinsonism and progressive supranuclear palsy. Spontaneous (SB) and reflex blinking consist of two components: the inhibition of the basal tonic LPS activity, which keeps the eyes open, and the concurrent activation of the OO muscles. LPS inhibition precedes and outlasts the OO activation. This normal configuration is impaired in parkinsonism and blepharospasm (BSP). SB shows a highly interindividual rate variation (among 10-20 per minute in adults) and abnormal blink rates occur in neurological diseases related to dopaminergic transmission impairments. Lid postural abnormalities include involuntary eyelid closure, which is usually associated with inability to open the eyes. Two major disorders share these two aspects: BSP and blepharocolysis (BCO). BSP consists of an involuntary overactivity of the OO, with LPS co-contraction activity, and is expressed as frequent and prolonged blinks, clonic bursts, prolonged tonic contraction or a blend of all of them. BCO (commonly named "so-called lid opening apraxia") is an overinhibition of the LPS with no evidence of ongoing OO activity. BSP and BCO occur in many instances of idiopathic dystonias and basal ganglia diseases and, less frequently, in rostral brainstem lesions. Both may coincide in the same patient. Voluntary lid movement disorders comprise the impairment of Bell's phenomenon, the voluntary eyelid closure palsy and the so-called cerebral ptosis, all related to lesions of frontal cortical areas and/or the corticospinal system.

Restless legs syndrome and drug-induced akathisia in headache patients

The purpose of the research presented in this article was to characterize restless leg syndrome (RLS) in a headache population and correlate treatment induced risks with dopamine blockers. Fifty patients with severe headache who were admitted to an outpatient infusion center were enrolled. The diagnosis of RLS was established using the International Restless Leg Syndrome Study Group criteria. Patients were screened for baseline akathisia using an akathisia scale and reexamined for akathisia after receiving intravenous infusion with one of four dopamine receptor blocking agents as treatment for their headaches. A change from baseline to post-infusion assessment of two points on a global assessment of akathisia was considered positive for drug-induced akathisia. Our results indicated that 41 (82%) of patients had episodic or chronic migraine. The rest had new daily persistent headache, cluster, or posttraumatic headache. Seventeen subjects (34%) met the criteria for RLS. Nineteen (38%) of the subjects developed drug-induced akathisia. Thirteen (76.5%) of the subjects with RLS developed akathisia compared with only 6 of the 33 (18.2%) without RLS (P<.0001). Finally, we concluded that headache patients with RLS are at a greatly increased risk of developing drug-induced akathisia when treated with intravenous dopamine receptor blocking agents.