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Ikeda A, Usami K, Danno D, Takeshima T, Tatsuoka Y. [Epileptic seizure and migraine attack: A revisit from the "Borderland of Epilepsy" to clinical implementation of infraslow activity/DC shifts in scalp EEG]. Rinsho Shinkeigaku 2024; 64:383-389. [PMID: 38811205 DOI: 10.5692/clinicalneurol.cn-001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Migraine attacks, especially ones with aura, have symptoms similar to epileptic seizures, and the two may sometimes be difficult to differentiate clinically. However, the characteristic minute-by-minute symptom development and progress within 60 min is useful for diagnosis. Although the details of its pathophysiology remain unsolved, cortical spreading depolarization (CSD) is one of the main pathogenetic factors. In epilepsy, clinical data have shown that ictal DC shifts could reflect impaired homeostasis of extracellular potassium by astrocyte dysfunction. Ictal DC shifts were found to be difficult to detect by scalp EEG, but can be clinically recorded from the seizure focus using wide-band EEG method. The similarity between DC shifts and CSD has been gaining attention from the neurophysiology point of view. The clinical implementation of infraslow activity/DC shifts analysis of scalp EEG is expected to elucidate further the pathophysiology of migraine, which may lie in the borderland of epilepsy.
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Affiliation(s)
- Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
| | - Kiyohide Usami
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
- Department of Clinical Laboratory, Kyoto University Hospital
| | - Daisuke Danno
- Headache Center, Department of Neurology, Tominaga Hospital
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Paungarttner J, Quartana M, Patti L, Sklenárová B, Farham F, Jiménez IH, Soylu MG, Vlad IM, Tasdelen S, Mateu T, Marsico O, Reina F, Tischler V, Lampl C. Migraine - a borderland disease to epilepsy: near it but not of it. J Headache Pain 2024; 25:11. [PMID: 38273253 PMCID: PMC10811828 DOI: 10.1186/s10194-024-01719-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Migraine and epilepsy are two paroxysmal chronic neurological disorders affecting a high number of individuals and being responsible for a high individual and socioeconomic burden. The link between these disorders has been of interest for decades and innovations concerning diagnosing and treatment enable new insights into their relationship. FINDINGS Although appearing to be distinct at first glance, both diseases exhibit a noteworthy comorbidity, shared pathophysiological pathways, and significant overlaps in characteristics like clinical manifestation or prophylactic treatment. This review aims to explore the intricate relationship between these two conditions, shedding light on shared pathophysiological foundations, genetic interdependencies, common and distinct clinical features, clinically overlapping syndromes, and therapeutic similarities. There are several shared pathophysiological mechanisms, like CSD, the likely underlying cause of migraine aura, or neurotransmitters, mainly Glutamate and GABA, which represent important roles in triggering migraine attacks and seizures. The genetic interrelations between the two disorders can be observed by taking a closer look at the group of familial hemiplegic migraines, which are caused by mutations in genes like CACNA1A, ATP1A2, or SCN1A. The intricate relationship is further underlined by the high number of shared clinical features, which can be observed over the entire course of migraine attacks and epileptic seizures. While the variety of the clinical manifestation of an epileptic seizure is naturally higher than that of a migraine attack, a distinction can indeed be difficult in some cases, e.g. in occipital lobe epilepsy. Moreover, triggering factors like sleep deprivation or alcohol consumption play an important role in both diseases. In the period after the seizure or migraine attack, symptoms like speech difficulties, tiredness, and yawning occur. While the actual attack of the disease usually lasts for a limited time, research indicates that individuals suffering from migraine and/or epilepsy are highly affected in their daily life, especially regarding cognitive and social aspects, a burden that is even worsened using antiseizure medication. This medication allows us to reveal further connections, as certain antiepileptics are proven to have beneficial effects on the frequency and severity of migraine and have been used as a preventive drug for both diseases over many years. CONCLUSION Migraine and epilepsy show a high number of similarities in their mechanisms and clinical presentation. A deeper understanding of the intricate relationship will positively advance patient-oriented research and clinical work.
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Affiliation(s)
| | - Martina Quartana
- Department of Sciences for Health Promotion and Mother-and Childcare "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Lucrezia Patti
- Department of Sciences for Health Promotion and Mother-and Childcare "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Barbora Sklenárová
- St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Fatemeh Farham
- Headache Department, Iranian Center of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Gokcen Soylu
- Department of Neurology, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Irina Maria Vlad
- Department of Neurosciences, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Semih Tasdelen
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Teresa Mateu
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Neurology, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospitall", Reggio Calabria, Italy
| | - Federica Reina
- NeuroTeam Life&Science, Spin-off University of Palermo, Palermo, Italy
| | - Viktoria Tischler
- Headache Medical Center Linz, Linz, Austria
- Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria
| | - Christian Lampl
- Headache Medical Center Linz, Linz, Austria.
- Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
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Finsterer J. Letter to the Editor: Frequency of Visual Aura in Non-Migraine Headache Strongly Depends on the Underlying Pathophysiology. J Korean Med Sci 2023; 38:e368. [PMID: 37873634 PMCID: PMC10593594 DOI: 10.3346/jkms.2023.38.e368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
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Özge A, Domaç FM, Tekin N, Sünbül EA, Öksüz N, Atalar AÇ, Çallı SY, Fidan YS, Evlice A, Beştepe EE, İzci F, Küsbeci ÖY, Demirel EA, Velioğlu SK, Ungan M. One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases. J Clin Med 2023; 12:5754. [PMID: 37685821 PMCID: PMC10488785 DOI: 10.3390/jcm12175754] [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: 07/27/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Füsun Mayda Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Nil Tekin
- Department of Family Medicine, Izmir Faculty of Medicine, University of Health Sciences, İzmir 35330, Türkiye;
- Department of Family Medicine, Tepecik Education and Research Hospital, University of Health Sciences, İzmir 35330, Türkiye
| | - Esra Aydın Sünbül
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Arife Çimen Atalar
- Neurology Department, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Sümeyye Yasemin Çallı
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Yağmur Sever Fidan
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Ahmet Evlice
- Department of Neurology, School of Medicine, Çukurova University, Adana 01330, Türkiye;
| | - Engin Emrem Beştepe
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Filiz İzci
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Özge Yılmaz Küsbeci
- Neurology Department, Medical Faculty, Izmir University of Economics, Izmir 35330, Türkiye;
| | - Esra Acıman Demirel
- Department of Neurology, Zonguldak Bulent Ecevit University of Medicine, Zonguldak 67100, Türkiye;
| | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Neurology Department, Medical Faculty, Karadeniz Technical University, Trabzon 61080, Türkiye;
| | - Mehmet Ungan
- Department of Family Medicine, Medical Faculty, Ankara University, Ankara 06100, Türkiye;
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Eren OE, Straube A. [Temporary and persistent visual phenomena in neurology]. DER NERVENARZT 2023; 94:344-352. [PMID: 37039876 DOI: 10.1007/s00115-023-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 04/12/2023]
Abstract
Temporary and persistent visual phenomena are a frequent reason for a neurological presentation. The diagnosis can usually be made with the help of a structured anamnesis with determination of the time of onset, the course and symptoms as well as the monocular vs. binocular manifestation. The visual aura in migraine is certainly the most frequent entity to be differentiated. In particular, persistent visual phenomena such as visual snow syndrome, hallucinogen persisting perception disorder and the Charles Bonnet syndrome (CBS) seem to be underdiagnosed in clinical practice for various reasons and are probably not that rare. Instrumental diagnostics are mostly used for exclusion diagnostics and are a component of a complete patient education, but can be indicative for certain questions (CBS, epilepsy). This article presents the most frequent visual phenomena from the neurological practice and their differential diagnoses, guided by a case history.
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Affiliation(s)
- Ozan E Eren
- Neurologie, München Klinik Bogenhausen, München, Deutschland
- Neurologie, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - Andreas Straube
- Neurologie, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland.
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D’Agnano D, Lo Cascio S, Correnti E, Raieli V, Sciruicchio V. A Narrative Review of Visual Hallucinations in Migraine and Epilepsy: Similarities and Differences in Children and Adolescents. Brain Sci 2023; 13:643. [PMID: 37190608 PMCID: PMC10136509 DOI: 10.3390/brainsci13040643] [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: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Since the earliest descriptions of the simple visual hallucinations in migraine patients and in subjects suffering from occipital lobe epilepsy, several important issues have arisen in recognizing epileptic seizures of the occipital lobe, which often present with symptoms mimicking migraine. A detailed quantitative and qualitative clinical scrutiny of timing and characteristics of visual impairment can contribute to avoiding mistakes. Differential diagnosis, in children, might be challenging because of the partial clinical, therapeutic, and pathophysiological overlaps between the two diseases that often coexist. Ictal elementary visual hallucinations are defined by color, shape, size, location, movement, speed of appearance and duration, frequency, and associated symptoms and their progression. The evaluation of the distinctive clinical features of visual aura in migraine and visual hallucinations in occipital epilepsy could contribute to understanding the pathogenetic mechanisms of these two conditions. This paper aims to critically review the available scientific evidence on the main clinical criteria that address diagnosis, as well as similarities and differences in the pathophysiological mechanisms underlying the visual impairment in epilepsy and migraine.
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Affiliation(s)
- Daniela D’Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.MI.S.E. “G. D’Alessandro, University of Palermo, 90100 Palermo, Italy
| | - Edvige Correnti
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
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7
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Ng JKY, Xie PJ, Saber A, Huxtable J. Assessment of photopsia (flashing lights). BMJ 2023; 380:e064767. [PMID: 36690353 DOI: 10.1136/bmj-2021-064767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Evers S, Tassorelli C. Migraine with aura. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:169-186. [PMID: 38043960 DOI: 10.1016/b978-0-12-823356-6.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
This chapter describes the different types of aura including rare aura subtypes such as retinal aura. In addition, aura manifestations not classified in the International Classification of Headache Disorders and auras in headache disorders others than migraine are also described. The differential diagnosis of migraine aura comprises several neurological disorders which should be known to specialists. Migraine aura also has impact on the choice of migraine treatment; recommendations for the treatment of the migraine aura itself are also presented in this chapter.
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Affiliation(s)
- Stefan Evers
- Faculty of Medicine, University of Münster, Münster, Germany; Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany.
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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9
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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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10
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E. Eren O, Wilhelm H, J. Schankin C, Straube A. Visual Phenomena Associated With Migraine and Their Differential Diagnosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:647-653. [PMID: 34636719 PMCID: PMC8762590 DOI: 10.3238/arztebl.m2021.0287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Visual phenomena are of many different kinds; their differential diagnosis is usually possible with directed history-taking. In this review, we describe common visual phenomena that must be distinguished from a migraine aura. METHODS This review is based on publications retrieved by a selective search in PubMed and the Web of Knowledge/Science, with special attention to the current classification of the International Headache Society and the recommendations of the German Migraine and Headache Society. The following search terms were used: "visual phenomena/phenomenon," "migraine aura," and "persistent/complication/ long-lasting/ongoing." RESULTS The most helpful questions for differential diagnosis are whether the symptoms are present in one eye only or in both, whether their onset was sudden or over minutes or days, and whether the phenomenon has occurred only once or repeatedly, or is persistently present. A visual aura associated with migraine must be distinguished, in rare cases, from an isolated epileptic aura, from cerebral/retinal ischemia, or from visual snow. Further differential diagnoses include a persisting perceptual disturbance after hallucinogen use (HPPD, "hallucinogen persisting perception disorder") and the Charles Bonnet syndrome (CBS); the latter arises as a consequence of severely impaired vision. Posterior reversible encephalopathy syndrome (PRES) is rare and generally reveals itself over its further course through the appearance of additional clinical manifestations. Primary ophthalmological causes can usually be readily identified and classified by ophthalmological examination. CONCLUSION Patients with visual phenomena typically consult physicians from various medical specialties. A correct differential diagnosis can be made based on the history if the physician views the symptoms in their overall context to determine the particular disease entity that is responsible.
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Affiliation(s)
- Ozan E. Eren
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Andreas Straube
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
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11
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Bauer PR, Tolner EA, Keezer MR, Ferrari MD, Sander JW. Headache in people with epilepsy. Nat Rev Neurol 2021; 17:529-544. [PMID: 34312533 DOI: 10.1038/s41582-021-00516-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Epidemiological estimates indicate that individuals with epilepsy are more likely to experience headaches, including migraine, than individuals without epilepsy. Headaches can be temporally unrelated to seizures, or can occur before, during or after an episode; seizures and migraine attacks are mostly not temporally linked. The pathophysiological links between headaches (including migraine) and epilepsy are complex and have not yet been fully elucidated. Correct diagnoses and appropriate treatment of headaches in individuals with epilepsy is essential, as headaches can contribute substantially to disease burden. Here, we review the insights that have been made into the associations between headache and epilepsy over the past 5 years, including information on the pathophysiological mechanisms and genetic variants that link the two disorders. We also discuss the current best practice for the management of headaches co-occurring with epilepsy and highlight future challenges for this area of research.
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Affiliation(s)
- Prisca R Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark R Keezer
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.,NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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12
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Chiang MC, Dumitrascu OM, Chhabra N, Chiang CC. Migraine with Visual aura and the Risk of Stroke- a Narrative Review. J Stroke Cerebrovasc Dis 2021; 30:106067. [PMID: 34461446 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Patients with migraine with visual aura (MwvA) often present to eye care providers for evaluation. A thorough ophthalmological history and examination is needed to exclude ophthalmologic disorders. Additionally, it has been increasingly recognized that MwvA is associated with ischemic stroke (IS). The aim of this narrative review is to provide a comprehensive overview of the differential diagnosis of MwvA and its association with IS. MATERIALS AND METHODS We conducted a PubMed search using key words including "migraine aura", "visual aura without headache", "late onset migraine accompaniment", "migraine and stroke", "migraine and atrial fibrillation", and "migraine and patent foramen ovale (PFO)". We narratively summarized the main findings of the identified studies in sections including age of onset and frequency of migraine with aura, stroke subtypes, and the role of cardioembolism in the migraine-stroke association. RESULTS AND CONCLUSION For women younger than 50 years, MwvA is associated with an increased risk of IS, and the risk further increases in patients who also smoke and use oral contraceptives. Age of onset of MwvA 50 years or greater is associated with IS that occurs in late life. Studies reported that increased frequency of aura is associated with an increased risk of IS in women. MwvA is associated with an increased risk of cardioembolic stroke and a higher incidence of atrial fibrillation compared to migraine without aura. Most studies that assessed the migraine-stroke association were based on patients with MwvA. The risks of stroke associated with other types of migraine aura or aura without headache, as well as such association in men require further investigation. More data is needed to determine the absolute risk of stroke when evaluating MwvA in situations including smoking and low dose estrogen use, new or late onset (>50 years) MwvA, to facilitate the development of practice guidelines for stroke prevention in specific clinical scenarios.
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Affiliation(s)
- Meng-Chun Chiang
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan.
| | | | - Nikita Chhabra
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
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Hosokawa K, Usami K, Kajikawa S, Shimotake A, Tatsuoka Y, Ikeda A, Takahashi R. [Migraine with multiple visual symptoms and out-of-body experience may mimic epilepsy]. Rinsho Shinkeigaku 2021; 61:530-536. [PMID: 34275950 DOI: 10.5692/clinicalneurol.cn-001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The patient was an 18-year-old man who had suffered from various visual symptoms as follows since he was 17 years old: 1) a diagonal line appeared in his visual field, shifting his upper field of view to the right and his lower field of view to the left; 2) his whole vision seemed distorted with ripples; and 3) black spots covered parts of his visual field and moved up and down. These visual symptoms were followed by out-of-body experience (OBE), which he felt as seeing his own body apart from his left back. Headache attacks followed these symptoms. On brain MRI, bilateral occipital atrophy was suspected. An electroencephalogram showed intermittent irregular delta in the bilateral occipital area. No epileptiform discharges were observed. We finally diagnosed him as having migraine with multiple visual auras and OBE. He was very well treated with a small dose of valproic acid which he tolerated well. OBE rarely occurs in migraine and should be distinguished from epilepsy.
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Affiliation(s)
- Kyoko Hosokawa
- Department of Neurology, Kyoto University Graduate School of Medicine
| | - Kiyohide Usami
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
| | - Shunsuke Kajikawa
- Department of Neurology, Kyoto University Graduate School of Medicine
| | - Akihiro Shimotake
- Department of Neurology, Kyoto University Graduate School of Medicine
| | | | - Akio Ikeda
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine
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Demarquay G, Rheims S. Relationships between migraine and epilepsy: Pathophysiological mechanisms and clinical implications. Rev Neurol (Paris) 2021; 177:791-800. [PMID: 34340811 DOI: 10.1016/j.neurol.2021.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
Migraine and epilepsy are distinct neurological diseases with specific clinical features and underlying pathophysiological mechanisms. However, numerous studies have highlighted the complex and multifaceted relationships between the two conditions. The relationships between headache and epilepsy manifest themselves in different ways. Firstly, the clinical diagnosis of these disorders may be challenging in view of possible overlapping. While post-ictal headache is a frequent condition, ictal epileptic headache is a rare but challenging diagnosis. Both situations raise the question of the pathophysiological mechanism of headache triggered by seizures. Migraine aura and epilepsy can also exhibit overlapping symptoms leading to their misdiagnosis, in particular in the case of visual aura. Secondly, migraine with aura and epilepsy can occur as a co-morbid condition, particularly in familial hemiplegic migraine (FHM). From a pathophysiological perspective, the identification of genetic mutations in FHM has brought significant advances in the understanding of dysfunctions of neuronal networks leading to hyperexcitability. The purpose of this review is to present clinical situations encompassing headache and epilepsy that can be challenging in neurological practice and to discuss the underlying pathophysiological mechanism of such interactions.
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Affiliation(s)
- G Demarquay
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292 and Lyon 1 University, Lyon, France.
| | - S Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center (CRNL), INSERM U1028, CNRS UMR5292 and Lyon 1 University, Lyon, France
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Birk D, Noachtar S, Kaufmann E. Kopfschmerz bei Parietal- und Okzipitallappenepilepsien. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021; 34:86-92. [DOI: 10.1007/s10309-020-00381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 08/30/2023]
Abstract
ZusammenfassungEpilepsiepatienten leiden überdurchschnittlich häufig unter Kopfschmerzen. Dies gilt insbesondere für Patienten mit idiopathisch generalisierten und parietookzipitalen Epilepsien. Die Häufigkeit des gemeinsamen Auftretens von Kopfschmerzen und Epilepsie überschreitet dabei die rechnerische Koinzidenz, sodass von einer Komorbidität beider Syndrome auszugehen ist. Bestärkt wird diese Hypothese durch überlappende genetische Veränderungen sowie gemeinsame pathophysiologische Mechanismen. Bis zu 62 % der Patienten mit z. B. Parietal- und Okzipitallappenepilepsie (POLE) geben Kopfschmerzen an. Diese treten v. a. nach dem Anfall (postiktal) auf und manifestieren sich am häufigsten als Migräne-ähnlicher Kopfschmerz oder Spannungskopfschmerz. Seltener kommt es zu Kopfschmerzen vor (periiktal), während (iktal) oder zwischen (interiktal) epileptischen Anfällen. Bei transienten neurologischen Ausfallsymptomen mit begleitenden Kopfschmerzen ist differenzialdiagnostisch neben der Migräne an vaskuläre Ereignisse wie Synkopen oder eine transiente ischämische Attacke zu denken.
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Abstract
Illusions and hallucinations are commonly encountered in both daily life and clinical practice. In this chapter, we review definitions and possible underlying mechanisms of these phenomena and then review what is known about specific conditions that are associated with them, including ophthalmic causes, migraine, epilepsy, Parkinson's disease, and schizophrenia. We then discuss specific syndromes including the Charles Bonnet syndrome, visual snow syndrome, Alice in Wonderland syndrome, and peduncular hallucinosis. The scientific study of illusions and hallucinations has contributed significantly to our understanding of how eye and brain process vision and contribute to perception. Important concepts are the distinction between topologic and hodologic mechanisms underlying hallucinations and the involvement of attentional networks. This chapter examines the various ways in which pathological illusions and hallucinations might arise in relation to the phenomenology and known pathology of the various conditions associated with them.
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Affiliation(s)
- Clare L Fraser
- Department of Ophthalmology, Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - Christian J Lueck
- Department of Neurology, Canberra Hospital, and Australian National University Medical School, Canberra, Australia
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Neuro-Ophthalmic Symptoms of Primary Headache Disorders: Why the Patient With Headache May Present to Neuro-Ophthalmology. J Neuroophthalmol 2020; 39:200-207. [PMID: 31022065 DOI: 10.1097/wno.0000000000000790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Primary headache disorders can cause many ophthalmic symptoms that lead many patients to present for neuro-ophthalmic evaluation. Neuro-ophthalmologists frequently encounter these patients in clinical practice. EVIDENCE ACQUISITION A literature review was completed in PubMed using the following terms paired with "migraine" and "headache:" dry eye, eye pain, monocular diplopia, binocular diplopia, photophobia, visual field defect, tunnel vision, floaters, amaurosis fugax, transient visual obscuration, autonomic symptoms, anisocoria, visual snow, Alice in Wonderland syndrome, and palinopsia. RESULTS Patients with migraine experience a wide range of visual disturbances including aura and more complex perceptual abnormalities such as Alice in Wonderland syndrome and visual snow. Visual disturbances may consist of positive and/or negative phenomena and may be binocular or monocular. Migraine and other primary headache disorders can be associated with photophobia, eye pain, dry eye, autonomic features, and anisocoria. CONCLUSIONS Patients with primary headache disorders may experience a wide range of visual and ophthalmic symptoms. An understanding of the typical features of these disorders allows providers to help patients find appropriate treatment without unnecessary testing and to recognize when atypical presentations require additional evaluation.
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Ostroumova TM, Ostroumova OD, Akimova ES, Kochetkov AI. [Drug-induced seizures: prevalence, risk factors, treatment and prevention]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:86-97. [PMID: 31851178 DOI: 10.17116/jnevro201911911186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a growing interest to the problem of drug-induced epileptic seizures (ES) due to their relatively high prevalence, poor prognosis, a large number of different drugs associated with the development of drug-induced ES, and low awareness among general practitioners. Drug-induced ES are most often associated with the use of antidepressants, antipsychotics, antiepileptic drugs (overdose or as a result of discontinuation), antibiotics, immunosuppressants and immunomodulators, antitumor agents, analgesics, central nervous system stimulators, anesthetics etc. The prevalence of drug-induced ES varies with different drugs. It is estimated that about 6.1% of the first occurring ES are drug-induced. Risk factors for drug-induced ES include a history of epilepsy or ES, cancer, blood-brain barrier dysfunction, several concomitant neurological diseases, mental disorders, childhood, old and very old age, fever, impaired liver metabolism in patients with liver diseases, impaired drug excretion in patients with kidney diseases, polypharmacy, pharmacokinetic properties of the drugs themselves, allowing them to penetrate the blood-brain barrier in the central nervous system (lipophilicity, transport and communication with blood plasma proteins), drug concentration in blood serum, method and frequency of drug administration, single and daily doses of drugs. No clinical guidelines for the management of patients with drug-induced ES are available. It is recommended to identify patients at risk: elderly patients, patients with impaired liver and kidney function and patients receiving drugs that can cause ES and/or lower the seizure threshold. Benzodiazepines are the first-line treatment in drug-induced status epilepticus, barbiturates and propofol are the second-line treatment. The general principles for the prevention of drug-induced ES include careful selection of the optimal dose of drugs that can cause ES, especially in patients with impaired liver and/or kidney function, monitoring of several parameters in blood serum (for example, liver enzymes, electrolytes, glucose etc.), monitoring of the blood plasma concentration of certain drugs, avoiding the simultaneous administration of several drugs that stimulate the central nervous system, and a rapid discontinuation of such drugs.
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Affiliation(s)
- T M Ostroumova
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow,Russia
| | - O D Ostroumova
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow,Russia; Pirogov Russian National Research Medical University' Russian Clinical and Research Center of Gerontology, Moscow, Russia
| | - E S Akimova
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A I Kochetkov
- Pirogov Russian National Research Medical University' Russian Clinical and Research Center of Gerontology, Moscow, Russia
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Bolay H, Vuralli D, Goadsby PJ. Aura and Head pain: relationship and gaps in the translational models. J Headache Pain 2019; 20:94. [PMID: 31481015 PMCID: PMC6734357 DOI: 10.1186/s10194-019-1042-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Migraine is a complex brain disorder and initiating events for acute attacks still remain unclear. It seems difficult to explain the development of migraine headache with one mechanism and/or a single anatomical location. Cortical spreading depression (CSD) is recognized as the biological substrate of migraine aura and experimental animal studies have provided mechanisms that possibly link CSD to the activation of trigeminal neurons mediating lateralized head pain. However, some CSD features do not match the clinical features of migraine headache and there are gaps in translating CSD to migraine with aura. Clinical features of migraine headache and results from research are critically evaluated; and consistent and inconsistent findings are discussed according to the known basic features of canonical CSD: typical SD limited to the cerebral cortex as it was originally defined. Alternatively, arguments related to the emergence of SD in other brain structures in addition to the cerebral cortex or CSD initiated dysfunction in the thalamocortical network are proposed. Accordingly, including thalamus, particularly reticular nucleus and higher order thalamic nuclei, which functions as a hub connecting the visual, somatosensory, language and motor cortical areas and subjects to modulation by brain stem projections into the CSD theory, would greatly improve our current understanding of migraine.
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Affiliation(s)
- Hayrunnisa Bolay
- Department of Neurology and Algology, Gazi University Faculty of Medicine, Besevler, 06510 Ankara, Turkey
- Neuropsychiatry Center, Gazi University, Besevler, Ankara, Turkey
| | - Doga Vuralli
- Neuropsychiatry Center, Gazi University, Besevler, Ankara, Turkey
- Department of Algology, Bakirkoy Sadi Konuk Training and Research Hospital, Bakirkoy, Istanbul, Turkey
| | - Peter J. Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, King’s College London, London, UK
- NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College Hospital, London, UK
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Abstract
Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical migraine aura is not difficult to diagnose, patients with migraine may report several other visual symptoms, such as prolonged or otherwise atypical auras, "visual blurring", "retinal migraine", "ophthalmoplegic migraine", photophobia, palinopsia, and "visual snow". Here, we provide a short overview of these symptoms and what is known about the relationship with migraine pathophysiology. For some symptoms, the association with migraine is still debated; for other symptoms, recent studies indicate that migraine mechanisms play a role.
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Affiliation(s)
- Robin M. van Dongen
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Joost Haan
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurology, Alrijne Ziekenhuis, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
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Abstract
Introduction: In the past few years, brain functional analysis has provided scientific evidence supporting the neuronal basis of migraine. The role of electroencephalography (EEG) in detecting subtle dysfunctions in sensory temporal processing has been fully re-evaluated, thanks to advances in methods of quantitative analysis. However, the diagnostic value of EEG in migraine is very low, and migraine diagnosis is completely based on clinical criteria, while the utility of EEG in migraine pathophysiology has only been confirmed in more recent applications. Areas covered: The present review focuses on the few situations in which EEG may provide diagnostic utility, and on the numerous and intriguing applications of novel analysis, based on time-related changes in neuronal network oscillations and functional connectivity. Expert opinion: Although routine EEG is not particularly useful for the clinical assessment of migraine, novel methods of analysis, mostly based on functional connectivity, could improve knowledge of the migraine brain. The application is worthy of promotion and improvement in support of neuroimaging data to shed light on migraine mechanisms and support the rationale for therapeutic approaches.
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Affiliation(s)
- Marina de Tommaso
- a Applied Neurophysiology and Pain Unit, Basic Medical Neuroscience and Sensory System Department , Bari Aldo Moro University , Bari , Italy
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Terrin A, Mainardi F, Maggioni F. The pathological spectrum behind migraine aura status: a case series. Neurol Sci 2018; 40:861-864. [DOI: 10.1007/s10072-018-3671-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/29/2018] [Indexed: 12/21/2022]
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Ward TN. AHS Members’ Choice Award for the Best Headache
Article. Headache 2018; 58:359-360. [DOI: 10.1111/head.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
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Hartl E. [Syncope, transient ischemic attacks, transient global amnesia and migraine]. DER NERVENARZT 2017; 88:1126-1132. [PMID: 28849251 DOI: 10.1007/s00115-017-0398-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epileptic seizures can manifest with a variety of clinical symptoms. Depending on the dominant symptom, several differential diagnoses have to be considered. Their differentiation can be challenging, especially after the first episode. The review article summarizes the most common differential diagnoses as well as their characteristics compared to epileptic seizures, aiming at providing guidelines for their clinical differentiation. Whenever a clear diagnosis is not possible based on the patient history and clinical signs, diagnostic evaluation with, e. g. an electroencephalogram (EEG) and finally EEG video monitoring can be helpful.
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Affiliation(s)
- E Hartl
- Epilepsie-Zentrum, Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, München-Großhadern, Deutschland.
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Noachtar S, Güldiken B. [Diagnosis of non-epileptic paroxysmal disorders and epileptic seizures]. DER NERVENARZT 2017; 88:1109-1118. [PMID: 28842725 DOI: 10.1007/s00115-017-0397-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Non-epileptic paroxysmal disorders may clinically manifest in a similar way to epileptic seizures and have to be considered in the differential diagnosis of epilepsy. Syncope, non-epileptic psychogenic seizures, paroxysmal movement disorders, migraine, transient ischemic attacks and parasomnia constitute the major differential diagnoses. A meticulous history and a third party description are useful for the differential diagnosis. Neurological, psychiatric and cardiological examinations are required for the correct differential diagnosis. The interictal electroencephalogram (EEG), which is normal in non-epileptic patients, is frequently normal in epileptic patients at the onset of seizures, but reaches a high sensitivity after repeated recordings. In equivocal cases EEG video monitoring and in the case of suspected cardiac asystole, event recorders are useful diagnostic tools.
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Affiliation(s)
- S Noachtar
- Epilepsie-Zentrum, Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland.
| | - B Güldiken
- Neurologische Klinik, Medizinische Fakultät, Trakya Universität, Edirne, Türkei
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