The complex interrelations between two paroxysmal disorders: headache and epilepsy
TL;DR: The interrelations between headache/migraine and epileptic seizures are an interesting topic, still lacking a systematization, which is the objective of the present revision and a classification is suggested which is shown in Appendix.
Abstract: The interrelations between headache/migraine and epileptic seizures are an interesting topic, still lacking a systematization, which is the objective of the present revision. We organize the general setting on: (a) a distinction between pre-ictal, ictal, post-ictal and inter-ictal headaches, assuming "ictal" as epileptic seizure, and (b) the kind of headache, if it is of migraine type or not. Concerning pre-ictal migraine/headache, the necessity of its differentiation from an epileptic headache presenting as an aura of a seizure is stressed; this is connected with the indefiniteness of the term "migralepsy". The term "migraine aura-triggered seizure" should be used only in front of a proven triggering effect of migraine. Epileptic headache (called also "ictal epileptic headache") is a well-characterized entity, in which different types of head pain may occur and an ictal EEG is necessary for the diagnosis. It may present as an isolated event ("isolated epileptic headache"), requiring a differential diagnosis from other kinds of headache, or it may be uninterruptedly followed by other epileptic manifestations being in this case easily identifiable as an epileptic aura. Hemicrania epileptica is a very rare variant of epileptic headache, characterized by the ipsilaterality of head pain and EEG paroxysms. Ictal non-epileptic headache needs to be differentiated from epileptic headache. Post-ictal headaches are a frequent association of headache with seizures, particularly in patients suffering also from inter-ictal headache-migraine. The reported systematization of the topic led us to suggest a classification which is shown in Appendix.
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TL;DR: The author has an engaging style, and the apostrophe, simile, and pathetic fallacy are woven into the text in an entertaining manner and would make instructive reading for the stilted "subject-predicate" school of medical writers.
Abstract: This work is published in two volumes with numerous illustrations and tables. The author has an engaging style, and the apostrophe, simile, and pathetic fallacy are woven into the text in an entertaining manner. It would make instructive reading for the stilted "subject-predicate" school of medical writers. The opening chapters deal with the early writings on epilepsy and explore the evolving concepts of causation. The various convulsive disorders are then classified and described. There is a chapter on the "Borderlands of Epilepsy" which includes migraine, syncope, carotid sinus syndrome, narcolepsy, hysteria, vertigo, and sleep disorders—the relationship of these to epilepsy it extremely tenuous. Other chapters consider sources of seizures, genetics of epilepsy, acquired epilepsy, electrobiology, and therapeutics. There is an interesting chapter on epileptics of worth and fame. The final chapters are a sympathetic look at the social, emotional, and legal problems of this disorder. The appraisal of the book
302 citations
TL;DR: Clinical overlaps between seizures and migraine attacks, activities of neuronal networks observed during seizures and migraines, and molecular and cellular mechanisms of migraine identified in genetic forms are reviewed, focusing on genetic variants identified in hemiplegic migraine and their functional effects.
52 citations
TL;DR: EH is a particular type of pain seizure that has a complex pathophysiology and, when isolated, requires differential diagnostic consideration and, although it is not frequent, pain as an ictal symptom should be highlighted in the operational classification of seizure types.
Abstract: Purpose To describe the concept, features and mechanisms of epileptic headache (EH). Methods Analysis of all published articles concerning EH and related subjects. Results There are more than 30 published case studies of patients with headache as the only manifestation of a seizure, a condition that has been variously called "EH", "ictal epileptic headache", "hemicrania epileptica", "cephalic pain seizure". It is necessary to differentiate EH from "migralepsy" and "ictal non-epileptic headache". EH may be an isolated event or the initial phase of a seizure followed by other manifestations. An isolated EH is clinically relevant because it is often symptomatic of structural brain disease; this underlines the importance of a differential diagnosis as the head pain of EH has no specific diagnostic characteristics. The described cases indicate that the location of the foci may vary, thus suggesting the involvement of different parts of the pain network. EH is a "focal aware" seizure, but there are a few reports of cases in which it was associated with generalised epileptiform activity. A correct diagnosis of EH requires an ictal EEG recording showing epilepsy-compatible discharges that coincide with the onset and cessation of the headache. A rapid response to the acute administration of an antiepileptic drug may support the diagnosis. Conclusions EH is a particular type of pain seizure that has a complex pathophysiology and, when isolated, requires differential diagnostic consideration. We believe that, although it is not frequent, pain as an ictal symptom should be highlighted in the operational classification of seizure types.
18 citations
Cites background from "The complex interrelations between ..."
...In the interviewor questionnaire-based epidemiological studies (see references in [51]), the term generically refers to a headache occurring during an epileptic seizure (necessarily with preserved consciousness) without any EEG verification....
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...“Ictal non-epileptic headache” [51] has been proposed on the basis of a number of epidemiological studies reporting the occurrence of “ictal headaches” (i....
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TL;DR: The role of electroencephalography (EEG) in detect... brain functional analysis has provided scientific evidence supporting the neuronal basis of migraine.
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.
15 citations
TL;DR: This is the first time to address the common ground of epilepsy and migraine by a systematic biology method and provides a novel way to explain the potential mechanisms of these two diseases and a new set of therapeutic targets.
Abstract: Background Epilepsy and migraine are both considered as paroxysmal neurologic disorders. Previous studies have reported some cases with comorbidity of these two diseases. As the underlying molecular mechanism remains unclear, we performed a network-and-pathway-based method with candidate gene sets of epilepsy and migraine to explore it. Methods : Comparing the candidate genes between epilepsy and migraine, we identified 21 common genes. Functional enrichment analysis indicated that epilepsy and migraine are dysfunctional in the similar biological processes, such as glutamatergic transmissions, channel activities, and transporter activities. We also explored many shared pathways between these two diseases such as neuroactive ligand-receptor interaction. Results By combining systematical analysis and previous studies review, we finally identified six essential genes associated with the comorbidity of epilepsy and migraine. Conclusions This is the first time to address the common ground of epilepsy and migraine by a systematic biology method. The present study provides a novel way to explain the potential mechanisms of these two diseases and a new set of therapeutic targets.
8 citations
Cites background from "The complex interrelations between ..."
...Application of advanced brain imaging and electroencephalogram (EEG) devices can help to distinguish epilepsy from non-epileptic seizures (6)....
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...Third, they both show abnormal discharge in an EEG (17)....
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References
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TL;DR: The International Classification of Headache Disorders, 3 edition (beta version), may be reproduced freely for scientific, educational or clinical uses by institutions, societies or individuals as mentioned in this paper. But the authors require the permission of the International Headache Society.
Abstract: The International Classification of Headache Disorders, 3 edition (beta version), may be reproduced freely for scientific, educational or clinical uses by institutions, societies or individuals. Otherwise, copyright belongs exclusively to the International Headache Society. Reproduction of any part or parts in any manner for commercial uses requires the Society’s permission, which will be granted on payment of a fee. Please contact the publisher at the address below. International Headache Society 2013. Applications for copyright permissions should be submitted to Sage Publications Ltd, 1 Oliver’s Yard, 55 City Road, London EC1Y 1SP, United Kingdom (tel: þ44 (0) 20 7324 8500; fax: þ44 (0) 207 324 8600) (www.sagepub.co.uk). Translations
6,519 citations
TL;DR: The ICHD identifies and categorizes more than a hundred different kinds of headache in a logical, hierarchal system and has provided explicit diagnostic criteria for all of the headache disorders listed.
Abstract: A set of related medical disorders that lack a proper classification system and diagnostic criteria is like a society without laws. The result is incoherence at best, chaos at worst. For this reason, the International Classification of Headache Disorders (ICHD) is arguably the single most important breakthrough in headache medicine over the last 50 years. The ICHD identifies and categorizes more than a hundred different kinds of headache in a logical, hierarchal system. Even more important, it has provided explicit diagnostic criteria for all of the headache disorders listed. The ICHD quickly became universally accepted, and criticism of the classification has been minor relative to that directed at other disease classification systems. Over the 20 years following publication of the first edition of the ICHD, headache research has rapidly accelerated despite sparse allocation of resources to that effort. In summary, the ICHD has attained widespread acceptance at the international level and has substantially facilitated both clinical research and clinical care in the field of headache medicine.
6,470 citations
TL;DR: Converging evidence from multiple and independent clinical, EEG and magnetoencephalographic studies has documented Panayiotopoulos syndrome (PS) as a model of childhood autonomic epilepsy, which is also common and benign.
Abstract: A big advance in epileptology has been the recognition of syndromes with distinct aetiology, clinical and EEG features, treatment and prognosis. A prime and common example of this is rolandic epilepsy that is well known by the general paediatricians for over 50 years, thus allowing a precise diagnosis that predicts an excellent prognosis. However, rolandic is not the only benign childhood epileptic syndrome. Converging evidence from multiple and independent clinical, EEG and magnetoencephalographic studies has documented Panayiotopoulos syndrome (PS) as a model of childhood autonomic epilepsy, which is also common and benign. Despite high prevalence, lengthy and dramatic features, PS as well as autonomic status epilepticus had eluded recognition because emetic and other ictal autonomic manifestations were dismissed as non-epileptic events of other diseases. Furthermore, PS because of frequent EEG occipital spikes has been erroneously considered as occipital epilepsy and thus confused with the idiopathic childhood occipital epilepsy of Gastaut (ICOE-G), which is another age-related but rarer and of unpredictable prognosis syndrome. Encephalitis is a common misdiagnosis for PS and migraine with visual aura for ICOE-G. Pathophysiologically, the symptomatogenic zone appears to correspond to the epileptogenic zone in rolandic epilepsy (sensory-motor symptomatology of the rolandic cortex) and the ICOE-G (occipital lobe symptomatology), while the autonomic clinical manifestations of PS are likely to be generated by variable and widely spread epileptogenic foci acting upon a temporarily hyperexcitable central autonomic network. Rolandic epilepsy, PS, ICOE-G and other possible clinical phenotypes of benign childhood focal seizures are likely to be linked together by a genetically determined, functional derangement of the systemic brain maturation that is age related (benign childhood seizure susceptibility syndrome). This is usually mild but exceptionally it may diverge to serious epileptic disorders such as epileptic encephalopathy with continuous spike and wave during sleep. Links with other benign and age-related seizures in early life such as febrile seizures, benign focal neonatal and infantile seizures is possible. Overlap with idiopathic generalized epilepsies is limited and of uncertain genetic significance. Taking all these into account, benign childhood focal seizures and related epileptic syndromes would need proper multi-disciplinary re-assessment in an evidence-based manner.
330 citations
TL;DR: The author has an engaging style, and the apostrophe, simile, and pathetic fallacy are woven into the text in an entertaining manner and would make instructive reading for the stilted "subject-predicate" school of medical writers.
Abstract: This work is published in two volumes with numerous illustrations and tables. The author has an engaging style, and the apostrophe, simile, and pathetic fallacy are woven into the text in an entertaining manner. It would make instructive reading for the stilted "subject-predicate" school of medical writers. The opening chapters deal with the early writings on epilepsy and explore the evolving concepts of causation. The various convulsive disorders are then classified and described. There is a chapter on the "Borderlands of Epilepsy" which includes migraine, syncope, carotid sinus syndrome, narcolepsy, hysteria, vertigo, and sleep disorders—the relationship of these to epilepsy it extremely tenuous. Other chapters consider sources of seizures, genetics of epilepsy, acquired epilepsy, electrobiology, and therapeutics. There is an interesting chapter on epileptics of worth and fame. The final chapters are a sympathetic look at the social, emotional, and legal problems of this disorder. The appraisal of the book
302 citations
"The complex interrelations between ..." refers background in this paper
...Lennox and Lennox [34] called ‘‘migralepsy’’ an ‘‘ophthalmic migraine…followed by symptoms characteristic of epilepsy’’....
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...Lennox and Lennox [34] called ‘‘migralepsy’’ an ‘‘ophthalmic migraine....
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...The definition by Lennox and Lennox [34] may apply to both (a) an occipital epileptic seizure with migrainous aura and (b) the sequence of a true migraine followed by a seizure....
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