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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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Fisher RS, Acharya JN, Baumer FM, French JA, Parisi P, Solodar JH, Szaflarski JP, Thio LL, Tolchin B, Wilkins AJ, Kasteleijn-Nolst Trenité D. Visually sensitive seizures: An updated review by the Epilepsy Foundation. Epilepsia 2022; 63:739-768. [PMID: 35132632 DOI: 10.1111/epi.17175] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/19/2022]
Abstract
Light flashes, patterns, or color changes can provoke seizures in up to 1 in 4000 persons. Prevalence may be higher because of selection bias. The Epilepsy Foundation reviewed light-induced seizures in 2005. Since then, images on social media, virtual reality, three-dimensional (3D) movies, and the Internet have proliferated. Hundreds of studies have explored the mechanisms and presentations of photosensitive seizures, justifying an updated review. This literature summary derives from a nonsystematic literature review via PubMed using the terms "photosensitive" and "epilepsy." The photoparoxysmal response (PPR) is an electroencephalography (EEG) phenomenon, and photosensitive seizures (PS) are seizures provoked by visual stimulation. Photosensitivity is more common in the young and in specific forms of generalized epilepsy. PS can coexist with spontaneous seizures. PS are hereditable and linked to recently identified genes. Brain imaging usually is normal, but special studies imaging white matter tracts demonstrate abnormal connectivity. Occipital cortex and connected regions are hyperexcitable in subjects with light-provoked seizures. Mechanisms remain unclear. Video games, social media clips, occasional movies, and natural stimuli can provoke PS. Virtual reality and 3D images so far appear benign unless they contain specific provocative content, for example, flashes. Images with flashes brighter than 20 candelas/m2 at 3-60 (particularly 15-20) Hz occupying at least 10 to 25% of the visual field are a risk, as are red color flashes or oscillating stripes. Equipment to assay for these characteristics is probably underutilized. Prevention of seizures includes avoiding provocative stimuli, covering one eye, wearing dark glasses, sitting at least two meters from screens, reducing contrast, and taking certain antiseizure drugs. Measurement of PPR suppression in a photosensitivity model can screen putative antiseizure drugs. Some countries regulate media to reduce risk. Visually-induced seizures remain significant public health hazards so they warrant ongoing scientific and regulatory efforts and public education.
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Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jayant N Acharya
- Department of Neurology, Penn State Health, Hershey, Pennsylvania, USA
| | - Fiona Mitchell Baumer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline A French
- NYU Comprehensive Epilepsy Center, Epilepsy Foundation, New York, New York, USA
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Jessica H Solodar
- American Medical Writers Association-New England Chapter, Boston, Massachusetts, USA
| | - Jerzy P Szaflarski
- Department of Neurology, Neurobiology and Neurosurgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Liu Lin Thio
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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Raieli V, Capizzi M, Marino A, Di Nardo G, Raucci U, Parisi P. Study on "Atypical" Migraine Auras in the Pediatric Age: The Role of Cortical Spreading Depression and the Physiopathogenetic Hypothesis Arising from Our Clinical Cases. Life (Basel) 2022; 12:450. [PMID: 35330201 PMCID: PMC8954623 DOI: 10.3390/life12030450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 12/26/2022] Open
Abstract
Migraine is a complex neurologic disorder by which several systems of the central nervous system (autonomous system, affective, cognitive, sensory and motor system) may be affected on different levels. About a fourth of migraine patients have migraine auras. The most common aura is the visual aura followed by the sensorial aura but motor deficits, as well as deficits of higher cortical centers (disorders of thinking, orientation, coherence, or concentration), may occur as well. In analogy with a headache diary, an aura diary can deliver important help in the diagnostic process of rare migraine manifestations and prevent the under-diagnosis of unusual migraine manifestations. Complex migraine manifestations are a diagnosis of exclusion, and a broad diagnostic work-up is necessary in order to exclude dangerous neurologic pathologies. In addition, here, we discuss the atypical clinical presentation and possible physio-pathogenetic related aspects of these atypical migraine aura features in the developmental age. In addition, we wanted to stress and analyze the clinical aspects of our children/adolescents with atypical auras, which seem to be more difficult to frame with the mechanisms originally proposed to explain the physio-pathogenetic relationship between CSD and aura. Finally, we discuss in detail the complex aspects of this topic on the basis of available data and propose new terminology: "Multiple, Synchronous and Asynchronous, Cortical and Subcortical Spreading Depression".
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit ISMEP, ARNAS Civico Palermo, Via dei Benedettini 1, P.O. Di Cristina, 90134 Palermo, Italy
| | - Mariarita Capizzi
- Child Neuropsychiatry School, University of Palermo, 90128 Palermo, Italy; (M.C.); (A.M.)
| | - Antonio Marino
- Child Neuropsychiatry School, University of Palermo, 90128 Palermo, Italy; (M.C.); (A.M.)
| | - Giovanni Di Nardo
- Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant’Andrea Hospital, 00189 Rome, Italy; (G.D.N.); (P.P.)
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health & Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant’Andrea Hospital, 00189 Rome, Italy; (G.D.N.); (P.P.)
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Caprara F, Letícia A, Rissardo JP, Leite MT, Silveira JO, Jauris PG, Arend J, Kegler A, Royes F, Fernando L, Fighera MR. Characteristics of Post-Ictal Headaches in Patients with Epilepsy: a Longitudinal Study. Seizure 2020; 81:244-249. [PMID: 32896689 DOI: 10.1016/j.seizure.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
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Huang C, Hu W, Tan G, Xu Y, Liu L. Clinical and electroencephalographic features of benign childhood epilepsy with centrotemporal spikes comorbidity with attention-deficit hyperactivity disorder in Southwest China. Epilepsy Behav 2020; 111:107240. [PMID: 32603807 DOI: 10.1016/j.yebeh.2020.107240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE This study was conducted to analyze the clinical and electroencephalographic (EEG) features of attention-deficit hyperactivity disorder (ADHD) in children with benign partial epilepsy with centrotemporal spikes (BECTS) in Southwest China, to address the question of what the risk factors are for patients with BECTS who suffer from ADHD. METHODS Overall 118 right-handed children with BECTS were included from two medical centers. Of them, 29 patients were with diagnosed ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) at baseline, and the remaining were considered as typical BECTS. Clinical and EEG characteristics were collected at baseline and follow-up endpoint of one year. All the patients completed an eight-hour video-electroencephalogram (VEEG) without sedation at those two time points using a digital system with international 10-20 array electrode placement. At the follow-up endpoint, we also evaluated the intelligence level of all patients using the Wechsler Intelligence Scale for Children-IV (WISC-IV). Multivariate logistical regression model was performed to assess the risk factors of ADHD in BECTS patients. RESULTS Compared with typical BECTS, patients with BECTS-ADHD had an earlier age of onset, a longer disease course and tended to have lower intelligence quotient (IQ) scores. Their epileptiform discharges were more likely to diffuse to one or both hemispheres, and a higher percentage of patients with BECTS-ADHD patients needed multitherapy to control seizures. Multivariate analysis showed that age of onset, disease course, intelligence score, number of antiepileptic drugs (AEDs), and bilateral or diffusing discharges were independently associated with the occurrence of ADHD in patients with BECTS (p < .05). Additionally, we found that delayed diagnosis (37.3%) and nonadherence to treatment (16.1%) were the main reasons of a long disease course. CONCLUSION Benign partial epilepsy with centrotemporal spikes with ADHD has the characteristics of early age of onset, long course of disease and low intelligence score. In addition, the epileptiform discharges of BECTS-ADHD were prone to be bilateral or diffuse, and polypharmacological treatment is also common in this group.
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Affiliation(s)
- Chao Huang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China; Department of Geriatric Medicine and Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 18, section 3, South Renmin Road, Chengdu, Sichuan 610041, China
| | - Wenguang Hu
- Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Ge Tan
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China
| | - Yang Xu
- Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China; Department of Geriatric Medicine and Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 18, section 3, South Renmin Road, Chengdu, Sichuan 610041, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, Sichuan 610041, China.
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Melo-Carrillo A, Schain AJ, Strassman AM, Burstein R. Activation of Peripheral and Central Trigeminovascular Neurons by Seizure: Implications for Ictal and Postictal Headache. J Neurosci 2020; 40:5314-5326. [PMID: 32527981 PMCID: PMC7329305 DOI: 10.1523/jneurosci.0283-20.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
An epileptic seizure can trigger a headache during (ictal) or after (postictal) the termination of the event. Little is known about the pathophysiology of seizure-induced headaches. In the current study, we determined whether a seizure can activate nociceptive pathways that carry pain signals from the meninges to the spinal cord, and if so, to what extent and through which classes of peripheral and central neurons. To achieve these goals, we used single-unit recording techniques and an established animal model of seizure (picrotoxin) to determine the effects of epileptic seizure on the activity of trigeminovascular Aδ-, C-, wide-dynamic range, and high-threshold neurons in male and female rats. Occurrence of seizure activated 54%, 50%, 68%, and 39% of the Aδ-, C-, wide-dynamic range, and high-threshold neurons, respectively. Regardless of their class, activated neurons exhibited a twofold to fourfold increase in their firing, which started immediately (1 min) or up to 90 min after seizure initiation, and lasted as short as 10 min or as long as 120 min. Administration of lidocaine to the dura prevented activation of all neuronal classes but not the initiation or maintenance of the seizure. These findings suggest that all neuronal classes may be involved in the initiation and maintenance of seizure-induced headache, and that their activation patterns can provide a neural substrate for explaining the timing and duration of ictal and possibly postictal headaches. By using seizure, which is evident in humans, this study bypasses controversies associated with cortical spreading depression, which is less readily observed in humans.SIGNIFICANCE STATEMENT This preclinical study provides a neural substrate for ictal and postictal headache. By studying seizure effects on the activity of peripheral (C and Aδ) and central (wide dynamic range and high-threshold) trigeminovascular neurons in intact and anesthetized dura, the findings help resolve two outstanding questions about the pathophysiology of headaches of intracranial origin. The first is that abnormal brain activity (i.e., seizure) that is evident in human (unlike cortical spreading depression) gives rise to specific and selective activation of the different components of the trigeminovascular system, and the second is that the activation of all components of the trigeminovascular pathway (i.e., peripheral and central neurons) depends on activation of the meningeal nociceptors from their receptors in the dura.
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Affiliation(s)
- Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02215
| | - Aaron J Schain
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02215
| | - Andrew M Strassman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02215
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02215
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Parisi P, Paolino MC, Raucci U, Della Vecchia N, Belcastro V, Villa MP, Striano P. Ictal Epileptic Headache: When Terminology Is Not a Moot Question. Front Neurol 2019; 10:785. [PMID: 31396147 PMCID: PMC6664028 DOI: 10.3389/fneur.2019.00785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
The relationship between headache and epilepsy is complex and despite the nature of this association is not yet clear. In the last few years, it has been progressively introduced the concept of the “ictal epileptic headache” that was included in the recently revised International Classification of Headaches Disorders 3rd edition (ICHD-3-revised). The diagnostic criteria for ictal epileptic headache (IEH) suggested in 2012 were quite restrictive thus leading to the underestimation of this phenomenon. However, these criteria have not yet been included into the ICHD-3 revision published in 2018, thus creating confusion among both, physicians and experts in this field. Here, we highlight the importance to strictly apply the original IEH criteria explaining the reasons through the analysis of the clinical, historical, epidemiological and pathophysiological characteristics of the IEH itself. In addition, we discuss the issues related to the neurophysiopathological link between headache and epilepsy as well as to the classification of these epileptic events as “autonomic seizure.”
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Affiliation(s)
- Pasquale Parisi
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Vincenzo Belcastro
- Neurology Unit, Department of Neuroscience, Sant'Anna Hospital, Como, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy.,Paediatric Neurology and Muscular Diseases Unit, G. Gaslini' Institute, Genova, Italy
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Salma Z, Hanen HK, Salma S, Olfa H, Nouha F, Mariem D, Chokri M. Headaches and their relationships to epileptic seizures. Epilepsy Behav 2019; 90:233-237. [PMID: 30583857 DOI: 10.1016/j.yebeh.2018.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/03/2018] [Accepted: 11/15/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE The frequent association between headache and epilepsy has been increasingly studied in recent years. Through this study, we attempted to study possible temporal associations between epileptic seizures and headaches. We also tried to describe clinical aspects of headache in our patients with epilepsy. PATIENTS AND METHODS We included patients with epilepsy and patients without epilepsy who presented for a first neurologic episode suggestive of epileptic seizure or unusual headache. These patients were invited to answer a standardized questionnaire screening for headache characteristics. Patients with epilepsy were asked for further data about their epilepsy. Electroencephalogram (EEG) was performed in all patients. Brain Magnetic resonance imaging MRI was reserved for patients in whom we suspected a structural lesion. RESULTS Overall, we included 47 patients with a mean age of about 39 ± 15 years (19 to 68 years old) and a female predominance (Sex Ratio: SR = 1.47). Most frequently, our patients documented periictal headache (Peri-IH) (85.1%) including respectively ictal headache (IH: 31.9%); postictal headache (Post-IH: 21.3%), and preictal headache (Pre-IH: 4.3%). Less frequently, our patients noted interictal headache (Inter-IH: 31.9%). Interestingly, these subgroups exhibited different headache patterns with predominantly unclassified-type headache (U-TH) in patients with IH (72.7%), tension-type headache (T-TH) in patients with Post-IH (73.3%), and migraine-type headache (M-TH) in patients with Inter-IH (60%). CONCLUSIONS Our results suggest that patients with epilepsy could exhibit different headache types. The clinical pattern of headache seemed to be linked to the time of seizure onset.
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Affiliation(s)
- Zouari Salma
- Department of Neurology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Neuroscience Laboratory "LR-12-SP-19", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia.
| | - Haj Kacem Hanen
- Department of Neurology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Neuroscience Laboratory "LR-12-SP-19", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Sakka Salma
- Department of Neurology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Neuroscience Laboratory "LR-12-SP-19", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Hdiji Olfa
- Department of Neurology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Neuroscience Laboratory "LR-12-SP-19", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Farhat Nouha
- Department of Neurology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Neuroscience Laboratory "LR-12-SP-19", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Damak Mariem
- Department of Neurology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Neuroscience Laboratory "LR-12-SP-19", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Clinical Investigation Center "CIC", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Mhiri Chokri
- Department of Neurology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Neuroscience Laboratory "LR-12-SP-19", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia; Clinical Investigation Center "CIC", Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
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Parisi P, Belcastro V, Verrotti A, Striano P, Kasteleijn-Nolst Trenitè DGA. "Ictal epileptic headache" and the revised International Headache Classification (ICHD-3) published in Cephalalgia 2018, vol. 38(1) 1-211: Not just a matter of definition! Epilepsy Behav 2018; 87:243-245. [PMID: 30115602 DOI: 10.1016/j.yebeh.2018.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Pasquale Parisi
- Child Neurology, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy.
| | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, University of Genoa, "G. Gaslini" Institute, Genova, Italy
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Coci EG, Riedel J. Exploring two novel cases of suspected ictal epileptic headache, a rare form of paediatric epilepsy. Acta Paediatr 2017; 106:786-790. [PMID: 27992068 DOI: 10.1111/apa.13713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/22/2016] [Accepted: 12/12/2016] [Indexed: 01/03/2023]
Abstract
AIM Ictal epileptic headache (IEH) is a rare and underestimated epileptic form, characterised by epileptiform discharges and headache attacks without any other ictal sensory-motor manifestations. IEH is difficult to diagnose, because the epileptiform discharges have to be registered during the headache attack and the headache has to disappear after the intravenous administration of an anti-epileptic drug, according to the last diagnostic criteria. This study explored the clinical, neuro-physiological and therapeutic features of IEH in the paediatric population. METHODS We analysed two novel cases of adolescent female patients with chronic headache and a long history of unsuccessful analgesic oral therapy and without any other ictal sensory-motor events. We also reviewed the entire literature on paediatric IEH. RESULTS The clinical history and diagnostic process led us to highly suspect IEH in both patients, and the successful therapy with oral anti-epileptic drugs, namely topiramate and ethosuximide, which resolved the chronic headache, enforced our diagnostic hypothesis. Our literature review highlighted the rarity of IEH clinical reports, particularly in the paediatric population, mainly due to the stringent diagnostic criteria. CONCLUSION Our study sheds further light on IEH in the paediatric population and on the importance of diagnostic electroencephalograms in the clinical management of paediatric patients suffering from chronic headache.
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Affiliation(s)
- Emanuele G. Coci
- Center of Social Pediatrics and Pediatric Neurology; General Hospital of Celle; Celle Germany
- Department of Neuropediatrics; University Children's Hospital; Ruhr University of Bochum; Bochum Germany
| | - Joachim Riedel
- Center of Social Pediatrics and Pediatric Neurology; General Hospital of Celle; Celle Germany
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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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Seo JH, Joo EY, Seo DW, Hong SB. Correlation between headaches and affective symptoms in patients with epilepsy. Epilepsy Behav 2016; 60:204-208. [PMID: 27236023 DOI: 10.1016/j.yebeh.2016.03.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 01/03/2023]
Abstract
Headaches are a neglected entity in patients with epilepsy (PWE), although PWE have a high chance of suffering from seizure-related as well as seizure-unrelated headaches. We aimed to identify the prevalence and characteristics of headaches and investigate the correlation between headaches and affective symptoms in PWE. Consecutive PWE who visited our tertiary outpatient clinic were interviewed about headaches and epilepsy. Affective symptoms were evaluated using the Korean version of the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and suicidality portion of the Mini-International Neuropsychiatric Interview. We classified headaches as interictal or seizure-related headaches (SRHs; pre- and postictal). Tension-type headache and migraine were defined based on International Classification of Headache Disorders criteria. From the initial cohort of 177 patients (92 men, mean age: 37.1years), 73 (41.2%) reported suffering from interictal (N=34, 19.2%), preictal (N=3, 1.7%), and postictal (N=48, 27.1%) headaches. Univariate analysis revealed significantly higher BDI and BAI scores in the headache group. Tension-type headaches were the most frequent, and half of the interictal headaches and most of the SRHs were untreated. Spearman's partial correlation analyses showed that headaches overall were significantly related with depression and anxiety. Interictal headaches were correlated with depression only, and postictal headaches were correlated with depression as well as suicidality, separately. These results show that investigating and controlling headaches may relieve affective symptoms and ultimately improve the quality of life of PWE.
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Affiliation(s)
- Ji-Hye Seo
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute (SBRI), Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute (SBRI), Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute (SBRI), Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute (SBRI), Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Fanella M, Morano A, Fattouch J, Albini M, Casciato S, Manfredi M, Giallonardo AT, Di Bonaventura C. Ictal epileptic headache revealing non convulsive status epilepticus in a case of eyelid myoclonia with absences. J Headache Pain 2015; 16:105. [PMID: 26644029 PMCID: PMC4671982 DOI: 10.1186/s10194-015-0587-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/28/2015] [Indexed: 02/07/2023] Open
Abstract
Epileptic seizures and headache attacks are two common neurologic phenomena characterized by paroxysmal alteration of brain functions followed by complete restauration of the baseline condition. Headache and epilepsy are related in numerous ways, and they often co-occur. Although the link between these two diseases is not completely clear, several clinical, physiopathological and therapeutic features overlap. Headache is reported in association with epileptic seizures as a pre-ictal, ictal or post-ictal phenomenon. We present the case of a 40 year-old woman affected by eyelid myoclonia with absences (EMA) with a history of prolonged headache attacks. A video-EEG recording performed during one of these episodes showed subcontinuous epileptic activity consisting of generalized spike-and-wave discharges (GSWDs), clinically associated with tensive headache. Our work represents one of the few well EEG-documented cases of ictal epileptic headache in idiopathic generalized epilepsy (IGE).
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Affiliation(s)
- Martina Fanella
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Alessandra Morano
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Sara Casciato
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Department of Neuroscience, Neurology Unit, "Sapienza" University, Rome, Italy
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Parisi P, Verrotti A, Costa P, Striano P, Zanus C, Carrozzi M, Raucci U, Villa MP, Belcastro V. Diagnostic criteria currently proposed for "ictal epileptic headache": Perspectives on strengths, weaknesses and pitfalls. Seizure 2015; 31:56-63. [PMID: 26362378 DOI: 10.1016/j.seizure.2015.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE When we published the diagnostic criteria for "ictal epileptic headache" in 2012, we deliberately and consciously chose to adopt restrictive criteria that probably underestimate the phenomenon, rather than spread panic among patients and physicians who are reluctant to accept this entity. METHODS Here we discuss four intriguing clinical cases to highlight why we believe, to this day, that it is necessary to follow these restrictive diagnostic criteria. CONCLUSIONS EEG is not recommended as a routine examination for children diagnosed with headache, but it is mandatory and must be carried out promptly in cases of prolonged headache that does not respond to antimigraine drugs, if epilepsy is suspected or has been diagnosed previously. This is not a marginal or irrelevant question because possible isolated, non-motor, ictal manifestations should be taken into account before declaring that an epileptic patient is "seizure free" so as to ensure that any decision taken to suspend anticonvulsant therapy is safe.
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Affiliation(s)
- Pasquale Parisi
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | | | - Paola Costa
- Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy
| | - Caterina Zanus
- Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marco Carrozzi
- Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Umberto Raucci
- Emergency Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Maria Pia Villa
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Vincenzo Belcastro
- Neurology Clinic, Department of Neuroscience, Sant'Anna Hospital, Como, Italy
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Caminero A, Manso-Calderón R. Links between headaches and epilepsy: current knowledge and terminology. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2011.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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17
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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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18
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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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Parisi P, Striano P, Verrotti A, Villa MP, Belcastro V. What have we learned about ictal epileptic headache? A review of well-documented cases. Seizure 2013; 22:253-8. [PMID: 23428422 DOI: 10.1016/j.seizure.2013.01.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The case report published in this issue by Wang et al. offers us an opportunity to review previously published "ictal epileptic headache" cases and draw attention to the criteria that have recently been published for this condition, taking into consideration not only the clinical-EEG and physiopathogenetic investigations required to diagnose this condition, but also the therapeutic aspects of the issue. METHODS To this aim we reviewed all well-documented cases that have been reported in the literature. RESULTS The relationship between headache and seizures is somewhat complicated. Although the nature of this association is not yet fully clear, several plausible explanations have been proposed. Further experimental and clinical investigations are, however, warranted to gain a better understanding of this relationship. Epilepsy and idiopathic headache/migraine share several pathophysiological mechanisms; a better understanding of these mechanisms will allow us to more accurately to assess the "real burden" and prevalence of the "ictal epileptic headache" phenomenon and its therapeutic implications. CONCLUSIONS The development of animal models and molecular studies and, above all, multicenter clinical studies conducted according to the proposed IEH criteria represent the starting point for a definitive international consensus on this intriguing topic. In addition, to improve the recognition of ictal epileptic headache, we should encourage the use of EEG recording in the emergency setting.
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Affiliation(s)
- Pasquale Parisi
- Child Neurology, Headache Paediatric Center, Paediatric Sleep Disorders, Chair of Paediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant'Andrea Hospital, Rome, Italy.
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Kasteleijn-Nolst Trenité D, Parisi P. Migraine in the borderland of epilepsy: “Migralepsy” an overlapping syndrome of children and adults? Epilepsia 2012; 53 Suppl 7:20-5. [DOI: 10.1111/j.1528-1167.2012.03711.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parisi P, Striano P, Negro A, Martelletti P, Belcastro V. Ictal epileptic headache: an old story with courses and appeals. J Headache Pain 2012; 13:607-13. [PMID: 23015297 PMCID: PMC3484263 DOI: 10.1007/s10194-012-0485-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/13/2012] [Indexed: 11/27/2022] Open
Abstract
The term “ictal epileptic headache” has been recently proposed to classify the clinical picture in which headache is the isolated ictal symptom of a seizure. There is emerging evidence from both basic and clinical neurosciences that cortical spreading depression and an epileptic focus may facilitate each other, although with a different degree of efficiency. This review address the long history which lead to the 'migralepsy' concept to the new emerging pathophysiological aspects, and clinical and electroencephalography evidences of ictal epileptic headache. Here, we review and discuss the common physiopathology mechanisms and the historical aspects underlying the link between headache and epilepsy. Either experimental or clinical measures are required to better understand this latter relationship: the development of animal models, molecular studies defining more precise genotype/phenotype correlations as well as multicenter clinical studies with revision of clinical criteria for headache-/epilepsy-related disorders represent the start of future research. Therefore, the definition of ictal epileptic headache should be used to classify the rare events in which headache is the only manifestation of a seizure. Finally, using our recently published criteria, we will be able to clarify if ictal epileptic headache represents an underestimated phenomenon or not.
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Affiliation(s)
- Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Child Neurology, Headache Paediatric Center, Paediatric Sleep Disorders, Chair of Paediatrics, Sapienza University, c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, Rome, Italy.
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22
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Ozkan M, Teber ST, Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches. Pediatr Neurol 2012; 46:154-7. [PMID: 22353289 DOI: 10.1016/j.pediatrneurol.2011.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 11/30/2011] [Indexed: 11/19/2022]
Abstract
This study evaluates specific electroencephalogram abnormalities in pediatric migraine and tension-type headaches, and demonstrates the clinical value of these abnormalities. We studied 50 migraine patients and 50 tension-type headache patients. Their mean age ± SD was 10.62 ± 3.21 (range, 5-16) years in the migraine group, and 13.00 ± 2.37 (7-16) years in the tension-type headache group. Diagnoses were rendered according to the International Classification of Headache Disorders, 2nd Edition, First Revision, of the International Headache Society. All patients underwent two waking-state electroencephalograms, one during a headache, and the other when headache-free. Thirty-six percent (18/50) of migraine patients and 12% (6/50) of tension-type headache patients revealed specific electroencephalogram abnormalities in headache attack electroencephalograms (P < 0.05). In headache-free period electroencephalograms, 16% (8/50) of the migraine group and 2% (1/50) of the tension-type headache group revealed abnormalities (P < 0.05). Our results indicate that electroencephalogram abnormalities are particularly prevalent in migraines, especially during headache attacks. This study is the first, to the best of our knowledge, on electroencephalographic evaluation of pediatric migraine and tension-type headache patients during both headache attacks and headache-free periods.
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Affiliation(s)
- Mehpare Ozkan
- Department of Pediatric Neurology, Doctor Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey.
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23
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Fanella M, Fattouch J, Casciato S, Lapenta L, Morano A, Egeo G, Manfredi M, Prencipe M, Giallonardo AT, Di Bonaventura C. Ictal epileptic headache as “subtle” symptom in generalized idiopathic epilepsy. Epilepsia 2012; 53:e67-70. [DOI: 10.1111/j.1528-1167.2011.03387.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Caminero A, Manso-Calderón R. Links between headaches and epilepsy: current knowledge and terminology. Neurologia 2012; 29:453-63. [PMID: 22217520 DOI: 10.1016/j.nrl.2011.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 10/12/2011] [Accepted: 10/15/2011] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Headaches (including migraines) and epilepsy have a high level of comorbidity and may be confused during diagnosis. Although physicians have known for centuries that these two conditions are somehow linked, their relationship remains poorly understood. Herein we describe the known associations between them, their underlying physiopathologic and genetic mechanisms, and the treatments recommended for them. METHOD We have reviewed the most relevant publication of headache/migraine and epilepsy by using the PubMed data base. DESCRIPTION An individual can suffer both from headaches (either migraine and/or other type of headache) and epilepsy, either by chance or because of a common underlying pathology. In these cases, the headache usually occurs at a different moment than the seizure ("interictal headache"). However, headaches sometimes occur simultaneously with, or very close in time to, the seizure: one that occurs at the same time as an epileptic seizure is known as an "ictal epileptic headache" or as "hemicrania epileptica"; one that precedes a seizure is known as a "pre-ictal headache"; and one that follows a seizure is known as a "post-ictal headache". There is a particular type of pre-ictal headache, known as "migralepsy", which occurs during or just after a migraine aura. CONCLUSIONS The terminology and concepts employed to describe possible associations between headaches (mainly migraines) and epilepsy have evolved over time with increasing clinical and physiopathogenic knowledge. Some researchers have suggested eliminating the term migralepsy and using the terms ictal epileptic headache and hemicrania epileptica exclusively and uniformly in all classification systems.
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Affiliation(s)
- A Caminero
- Sección de Neurología, Complejo Asistencial de Ávila, Ávila, España.
| | - R Manso-Calderón
- Sección de Neurología, Complejo Asistencial de Ávila, Ávila, España
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25
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Kasteleijn-Nolst Trenité D, Rubboli G, Hirsch E, Martins da Silva A, Seri S, Wilkins A, Parra J, Covanis A, Elia M, Capovilla G, Stephani U, Harding G. Methodology of photic stimulation revisited: Updated European algorithm for visual stimulation in the EEG laboratory. Epilepsia 2011; 53:16-24. [DOI: 10.1111/j.1528-1167.2011.03319.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Nunes JC, Zakon DB, Claudino LS, Guarnieri R, Nunes FC, Queiroz LP, Lin K, Walz R. Headache among mesial temporal lobe epilepsy patients: a case-control study. J Neurol Sci 2011; 306:20-3. [PMID: 21549393 DOI: 10.1016/j.jns.2011.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/14/2011] [Accepted: 04/04/2011] [Indexed: 11/25/2022]
Abstract
Epilepsy and headache are two chronic disorders that are characterized by recurrent attacks, but the relationship between them is not completely understood. Using a structured questionnaire, we investigated the prevalence of headache during the previous year in a homogeneous group of 100 patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). The control group consisted of 100 age-matched individuals who were randomized from a nationwide Brazilian headache database. There was a significantly higher prevalence of headache (92%) among the MTLE-HS patients when compared with the controls (73%; p=0.001). Chronic daily headache (CDH) was significantly associated with MTLE-HS (OR 6.1, CI 95% 1.7-22, p=0.005). We did not find any association between the diagnosis of migraine or tension-type headache and MTLE-HS. This study showed that MTLE-HS increases the likelihood of a headache diagnosis. In addition, CDH was more prevalent among the MTLE-HS patients, which supports a common pathophysiological mechanism for epilepsy and headache.
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Affiliation(s)
- Jean Costa Nunes
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil.
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27
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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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28
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Migralepsy and related conditions: Advances in pathophysiology and classification. Seizure 2011; 20:271-5. [DOI: 10.1016/j.seizure.2011.02.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/08/2011] [Accepted: 02/21/2011] [Indexed: 01/30/2023] Open
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29
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Specchio N, Kasteleijn-Nolst Trenité DGA, Piccioli M, Specchio LM, Trivisano M, Fusco L, Buttinelli C, Vigevano F. Diagnosing photosensitive epilepsy: fancy new versus old fashioned techniques in patients with different epileptic syndromes. Brain Dev 2011; 33:294-300. [PMID: 20615639 DOI: 10.1016/j.braindev.2010.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 05/04/2010] [Accepted: 06/01/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To demonstrate the clinical importance of using a high quality photic stimulator for recording EEGs to diagnose photosensitivity. METHODS We performed EEG examinations on 2 adult and 2 paediatric patients with a history of visually induced seizures; routinely we used a Grass PS 40 photic stimulator (rectangular Xenon lamp giving flashes of 10 μs duration, 0.7J, 1-30 Hz, width 7 cm, length 12 cm). We repeated the IPS with a Grass PS 33 plus stimulator (round Xenon lamp giving flashes of 10 μs duration, 1J, 1-60 Hz, diameter 14 cm). RESULTS Patients were affected by both benign and catastrophic epilepsies. They complained about episodes of dizziness (case 1), dizziness accompanied by a sensation in the arms and fear (case 2), absences (case 3), and myoclonic jerks (case 4). These symptoms occurred when working with neon lights, computers or ironing striped clothes (case 1), while driving (case 2), whenever there was sunlight (case 3 and 4). Only IPS performed with the Grass PS 33 plus stimulator evoked PPRs accompanied by their typical complaints. In all cases, the revised diagnosis led to changes in their treatment and the disappearance or diminishment of their complaints and PPR range. CONCLUSION A PPR can occur in various types of epilepsy, can have a different meaning, and requires a different therapeutic intervention. Only an appropriate photic stimulator with diffuse white light and a flash intensity level of 1J/flash, can reliably demonstrate whether a patient is photosensitive, or equally important exclude it.
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Affiliation(s)
- Nicola Specchio
- Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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30
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Belcastro V, Striano P, Kasteleijn-Nolst Trenité DGA, Villa MP, Parisi P. Migralepsy, hemicrania epileptica, post-ictal headache and "ictal epileptic headache": a proposal for terminology and classification revision. J Headache Pain 2011; 12:289-94. [PMID: 21360158 PMCID: PMC3094666 DOI: 10.1007/s10194-011-0318-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 02/08/2011] [Indexed: 04/29/2024] Open
Abstract
Despite the fact that migraine and epilepsy are among the commoner brain diseases and that comorbidity of these conditions is well known, only few reports of migralepsy and hemicrania epileptica (HE) have been published according to the current ICHD-II criteria. Particularly, ICHD-II describes "migraine-triggered seizure" (i.e., migralepsy) among complications of migraine at "1.5.5" (as a rare event in which a seizure happens during migrainous aura), while hemicrania epileptica (coded at "7.6.1") and post-ictal headache (coded at "7.6.2") are described among headaches attributed to epileptic seizure. However, to date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may be the sole ictal epileptic manifestation. Based on the current knowledge, migralepsy is highly unlikely to exist as such. We, therefore, propose to delete this term until clear evidence its existence is provided. Moreover, we herein propose a revision of terminology and classification criteria to properly represent the migraine/headache relationships. We suggest the term "ictal epileptic headache" in cases in which headache/migraine is the sole ictal epileptic manifestation.
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Affiliation(s)
- Vincenzo Belcastro
- Department of Neuroscience, Neurology Clinic, Sant'Anna Hospital, Como, Italy
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31
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González Mingot C, Santos Lasaosa S, García Arguedas C, Ballester Marco L, Mauri Llerda J. Migralepsia, una entidad controvertida. Neurologia 2011; 26:120-2. [DOI: 10.1016/j.nrl.2010.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 03/09/2010] [Indexed: 11/15/2022] Open
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32
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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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33
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González Mingot C, Santos Lasaosa S, García Arguedas C, Ballester Marco L, Mauri Llerda J. Migralepsy; a controversial entity. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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34
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Brazzo D, Di Lorenzo G, Bill P, Fasce M, Papalia G, Veggiotti P, Seri S. Abnormal visual habituation in pediatric photosensitive epilepsy. Clin Neurophysiol 2011; 122:16-20. [PMID: 20591728 DOI: 10.1016/j.clinph.2010.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/27/2010] [Accepted: 06/04/2010] [Indexed: 01/19/2023]
Affiliation(s)
- D Brazzo
- School of Life and Health Sciences, Wellcome Laboratory for MEG Studies, Aston University, Birmingham, UK
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35
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Kasteleijn-Nolst Trenité DGA, Verrotti A, Di Fonzo A, Cantonetti L, Bruschi R, Chiarelli F, Villa MP, Parisi P. Headache, epilepsy and photosensitivity: how are they connected? J Headache Pain 2010; 11:469-76. [PMID: 20963464 PMCID: PMC3476223 DOI: 10.1007/s10194-010-0229-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 05/25/2010] [Indexed: 11/17/2022] Open
Abstract
Although headache and epilepsy have often been associated, the precise electroclinical and pathophysiological interaction between these disorders and in particular its relations with photosensitivity is as yet to be fully understood in adults or children. The association between headache and epilepsy commonly occurs in all types of epilepsy and not only in occipital epilepsy. Generally, peri-ictal headache is often neglected, regardless of its severity, because patients are more concerned about their seizures. Altered cerebral cortex excitability may be the link between these two conditions and photosensitivity shows this. The physician should bear this association in mind when dealing with epileptic and migraine patients so as to be able to offer such patients an accurate diagnosis and appropriate treatment; this should be borne in mind when declaring epileptic patients 'seizure free'. To date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may, on occasion, be the sole ictal epileptic manifestation. Lastly, studies designed to investigate the triggering role of photosensitivity in both headache and epilepsy are warranted.
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Affiliation(s)
| | - Alberto Verrotti
- Chair of Paediatrics, Paediatric Department, University of Chieti, Chieti, Italy
| | - Alessia Di Fonzo
- Chair of Paediatrics, Paediatric Department, University of Chieti, Chieti, Italy
| | - Laura Cantonetti
- Unit of Paediatric Rehabilitation, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Santa Marinella, Rome Italy
| | - Raffaella Bruschi
- Chair of Paediatrics, Child Neurology, Headache Paediatric Center, Paediatric Sleep Disorders, II Faculty of Medicine, “Sapienza University”, c/o Sant’Andrea Hospital, Via di Grottarossa 1035-1039, Rome, Italy
| | - Francesco Chiarelli
- Chair of Paediatrics, Paediatric Department, University of Chieti, Chieti, Italy
| | - Maria Pia Villa
- Chair of Paediatrics, Child Neurology, Headache Paediatric Center, Paediatric Sleep Disorders, II Faculty of Medicine, “Sapienza University”, c/o Sant’Andrea Hospital, Via di Grottarossa 1035-1039, Rome, Italy
| | - Pasquale Parisi
- Chair of Paediatrics, Child Neurology, Headache Paediatric Center, Paediatric Sleep Disorders, II Faculty of Medicine, “Sapienza University”, c/o Sant’Andrea Hospital, Via di Grottarossa 1035-1039, Rome, Italy
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Migraine and Epilepsy: A Focus on Overlapping Clinical, Pathophysiological, Molecular, and Therapeutic Aspects. Curr Pain Headache Rep 2010; 14:276-83. [DOI: 10.1007/s11916-010-0121-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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38
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Comorbidity between headache and epilepsy in a pediatric headache center. J Headache Pain 2010; 11:235-40. [PMID: 20112041 PMCID: PMC3451908 DOI: 10.1007/s10194-010-0191-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 01/12/2010] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to analyse the comorbidity between headache and epilepsy in a large series of children with headache (1,795). Fifty-six cases (3.1%) suffered from idiopathic headache and idiopathic or cryptogenic epilepsy or unprovoked seizures. There was a strong association between migraine and epilepsy: in migraineurs (46/56) the risk of epilepsy was 3.2 times higher when compared with tension-type headache, without significant difference between migraine with and without aura (P = 0.89); children with epilepsy had a 4.5-fold increased risk of developing migraine than tension-type headache. In cases with comorbidity, focal epilepsies prevailed (43/56, 76.8%). Migraineurs affected by focal epilepsies (36/56) had a three times higher risk of having a cryptogenic epilepsy (27/36, 75%) than an idiopathic epilepsy (9/36, 25%) (P = 0.003). In migraine with aura, epilepsy preceded migraine in 71% of cases. Photosensitivity (7/56, 12.5%) and positive family history for epilepsy (22/56, 39%) were frequent in cases with comorbidity.
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39
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Moeller F, Siebner HR, Ahlgrimm N, Wolff S, Muhle H, Granert O, Boor R, Jansen O, Gotman J, Stephani U, Siniatchkin M. fMRI activation during spike and wave discharges evoked by photic stimulation. Neuroimage 2009; 48:682-95. [DOI: 10.1016/j.neuroimage.2009.07.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 07/09/2009] [Accepted: 07/10/2009] [Indexed: 11/29/2022] Open
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40
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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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41
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Parisi P. Who's still afraid of the link between headache and epilepsy? Some reactions to and reflections on the article by Marte Helene Bjørk and co-workers. J Headache Pain 2009; 10:327-9. [PMID: 19705058 PMCID: PMC3452089 DOI: 10.1007/s10194-009-0149-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 07/31/2009] [Indexed: 11/16/2022] Open
Affiliation(s)
- Pasquale Parisi
- Child Neurology, Paediatric Headache Centre, Chair of Paediatrics, Second Faculty of Medicine, Sapienza University, Rome, Italy.
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42
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Valenti MP, Cretin B, Rudolf G, Dylgjeri S, De Saint-Martin A, Hirsch E. [Is there a bridge between migraine and familial mesial temporal lobe epilepsy?]. Rev Neurol (Paris) 2009; 165:774-81. [PMID: 19762056 DOI: 10.1016/j.neurol.2009.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 07/28/2009] [Indexed: 11/29/2022]
Abstract
Numerous reviews have emphasized the links between certain types of epilepsy and migraine. Historically, Gowers was one of the first, in 1907, to have drawn attention to a possible relationship between migraine headache and epilepsy in a period when no additional examination was available. In the last two decades, progress in molecular biology, electrophysiology, and neuro-imaging has enabled a better approach to the fundamental elements underlying the interrelationship between these two nosological domains. During this same time, a new term "channelopathy" has appeared in the literature. This term groups together affections involving a dysfunction of ion channels. In this article, the links between the different types of migraine and familial mesial temporal lobe epilepsy are illustrated by two case reports. This association does not appear to occur at random but would undoubtedly depend on a common genetic substratum, leading to a direct comorbidity. These occasional recurring symptoms would lie within the framework of a more general concept of "Primary Brain Channelopathies".
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Affiliation(s)
- M P Valenti
- Pôle tête-cou-CETD, LINC-UMR, CNRS, Strasbourg, France
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