Migralepsy

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Migralepsy
Specialty Neurology

Migralepsy is a rare condition in which a migraine is followed, within an hour period, by an epileptic seizure. [1] [2] Because of the similarities in signs, symptoms, and treatments of both conditions, such as the neurological basis, the psychological issues, and the autonomic distress that is created from them, they individually increase the likelihood of causing the other. However, also because of the sameness, they are often misdiagnosed for each other, as migralepsy rarely occurs. [3] [4]

Contents

Signs and symptoms

General symptoms of migralepsy are: [5]

Cause

The connection between migraines and epileptic seizures is currently being researched and not much is known. Patients have been shown to have had migraines long before developing epileptic symptoms, creating the possibility of severe cases of migraines creating epilepsy. [6] [7] However, not every migraine may be accompanied by a seizure and sometimes the seizures happen without any migraine involvement. Due to this, finding the origin of migralepsy is difficult and enveloped somewhere in the overlap between both conditions. Some patients have shown that their relatives suffered from migraines as well and even some from migralepsy, forming the possibility that migralepsy is genetic in origin and forms only rarely as both, generally resulting in only one condition or the other. [8] [9] [10]

Diagnosis

Because epileptic seizures may occur with a side effect that resembles migraine aura, it is complicated to diagnose whether a patient is having a normal epileptic episode or if it is a true migraine that is then being followed by a seizure, which would be a true sign of migralepsy. Many neurological symptoms can only be expressed by the patient, who can confuse different feelings, especially when the symptoms of a migraine are extremely similar to that of a seizure. Thus, many physicians are reluctant to consider migralepsy to be a true condition, considering its rarity, and those that do believe in it are prone to over-diagnose it, leading to more problems in terms of finding the truth of the condition. [11] [12] [13]

However, it has been found that EEG scans have been able to differentiate between migraine auras and auras related to epilepsy. It has generally been seen that EEG scans are not as helpful in determining facets of migraines as they are with epilepsy. Though they are able to work in determining the starting and ending points of migraines and the overlap of epileptic episodes during or after them, even if the scans are still lacking in considerable necessary data and confusing results. EEG scans have been able to observe seizures that occur in between the aura and headache phase of migraines and such occurrences have been termed intercalated seizures. [14]

Treatment

Since migralepsy is, for all intents and purposes, a combination of migraines and epilepsy, the medication for the conditions supplied individually can be combined jointly in order to lessen the effects of both. It is also helpful that many antiepileptic drugs also work as antimigraines, lessening the number of medications that must be taken. Thus, while neither can be cured, they can be treated so that they occur less frequently and allow a patient to live a relatively normal life. [7]

Related Research Articles

Epilepsy Human neurological disorder causing seizures

Epilepsy is a group of neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking. These episodes can result in physical injuries, including occasionally broken bones. In epilepsy, seizures have a tendency to recur and, as a rule, have no immediate underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to their condition.

Seizure Period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain

A seizure, formally known as an epileptic seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. Most of the time these episodes last less than 2 minutes and it takes some time to return to normal. Loss of bladder control may occur.

Micropsia

Micropsia is a condition affecting human visual perception in which objects are perceived to be smaller than they actually are. Micropsia can be caused by optical factors, by distortion of images in the eye, by changes in the brain, and from psychological factors. Dissociative phenomena are linked with micropsia, which may be the result of brain-lateralization disturbance.

Absence seizures are one of several kinds of generalized seizures. These seizures are sometimes referred to as petit mal seizures. Absence seizures are characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy.

A headache is often present in patients suffering from epilepsy. If the headache occurs in the vicinity of a seizure, it is defined as peri-ictal headache, which can occur either before (pre-ictal) or after (post-ictal) the seizure, to which the term ictal refers. An ictal headache itself may or may not be an epileptic manifestation. In the first case it is defined as ictal epileptic headache or simply epileptic headache. It is a real painful seizure, that can remain isolated or be followed by other manifestations of the seizure. On the other hand, the ictal non-epileptic headache is a headache that occurs during a seizure but it is not due to an epileptic mechanism. When the headache does not occur in the vicinity of a seizure it is defined as inter-ictal headache. In this case it is a disorder autonomous from epilepsy, that is a comorbidity.

Lennox–Gastaut syndrome

Lennox–Gastaut syndrome (LGS) is a complex, rare, and severe childhood-onset epilepsy. It is characterized by multiple and concurrent seizure types, cognitive dysfunction, and slow spike waves on electroencephalogram (EEG). Typically, it presents in children aged 3–5 years and can persist into adulthood. It has been associated with several gene mutations, perinatal insults, congenital infections, brain tumors/malformations, and genetic disorders such as tuberous sclerosis and West syndrome. The prognosis for LGS is poor with a 5% mortality in childhood and persistent seizures into adulthood (80%–90%).

Aura (symptom)

An aura is a perceptual disturbance experienced by some with epilepsy or migraine.

Psychogenic non-epileptic seizures (PNES) are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. They are of psychological origin, and are one type of non-epileptic seizure mimics. PNES are also known less specifically as non-epileptic attack disorder (NEAD) and functional neurological symptom disorder.

Acephalgic migraine is a neurological syndrome. It is a relatively uncommon variant of migraine in which the patient may experience aura, nausea, photophobia, hemiparesis, and other migraine symptoms, but does not experience headache. It is generally classified as an event fulfilling the conditions of migraine with aura with no headache. It is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine.

Temporal lobe epilepsy Chronic focal seizure disorder

Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. TLE is the most common form of epilepsy with focal seizures. A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures that arise in the frontal lobes of the brain, often while the patient is sleeping. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form by the fact that both forms are characterized by the occurrence of partial (focal) seizures. Partial seizures occurring in the frontal lobes can occur in one of two different forms: either simple partial seizures or complex partial seizures. The symptoms and clinical manifestations of frontal lobe epilepsy can differ depending on which specific area of the frontal lobe is affected.

Sudden Unexpected Death in Epilepsy (SUDEP) is a fatal complication of epilepsy. It is defined as the sudden and unexpected, non-traumatic and non-drowning death of a person with epilepsy, without a toxicological or anatomical cause of death detected during the post-mortem examination.

Rolandic epilepsy Most common epilepsy syndrome in childhood, usually subsiding with age

Benign Rolandic epilepsy or benign childhood epilepsy with centrotemporal spikes (BCECTS) is the most common epilepsy syndrome in childhood. Most children will outgrow the syndrome, hence the label benign. The seizures, sometimes referred to as sylvian seizures, start around the central sulcus of the brain.

Panayiotopoulos syndrome is a common idiopathic childhood-related seizure disorder that occurs exclusively in otherwise normal children and manifests mainly with autonomic epileptic seizures and autonomic status epilepticus. An expert consensus has defined Panayiotopoulos syndrome as "a benign age-related focal seizure disorder occurring in early and mid-childhood. It is characterized by seizures, often prolonged, with predominantly autonomic symptoms, and by an EEG [electroencephalogram] that shows shifting and/or multiple foci, often with occipital predominance."

Chrysostomos (Tomis) P. Panayiotopoulos FRCP was a Greek neurologist in the field of the epilepsies. Panayiotopoulos syndrome is named after him.

Idiopathic childhood occipital epilepsy of Gastaut (ICOE-G) is a pure but rare form of idiopathic occipital epilepsy that affects otherwise normal children and adolescents. It is classified amongst benign idiopathic childhood focal epilepsies such as rolandic epilepsy and Panayiotopoulos syndrome.

Jeavons syndrome is a type of epilepsy. It is one of the most distinctive reflex syndromes of idiopathic generalized epilepsy characterized by the triad of eyelid myoclonia with and without absences, eye-closure-induced seizures, EEG paroxysms, or both, and photosensitivity. Eyelid myoclonia with or without absences is a form of epileptic seizure manifesting with myoclonic jerks of the eyelids with or without a brief absence. These are mainly precipitated by closing of the eyes and lights. Eyelid myoclonia is the defining seizure type of Jeavons syndrome.

Benign familial infantile epilepsy (BFIE) is an epilepsy syndrome. Affected children, who have no other health or developmental problems, develop seizures during infancy. These seizures have focal origin within the brain but may then spread to become generalised seizures. The seizures may occur several times a day, often grouped in clusters over one to three days followed by a gap of one to three months. Treatment with anticonvulsant drugs is not necessary but they are often prescribed and are effective at controlling the seizures. This form of epilepsy resolves after one or two years, and appears to be completely benign. The EEG of these children, between seizures, is normal. The brain appears normal on MRI scan.

People with epilepsy may be classified into different syndromes based on specific clinical features. These features include the age at which seizures begin, the seizure types, and EEG findings, among others. Identifying an epilepsy syndrome is useful as it helps determine the underlying causes as well as deciding what anti-seizure medication should be tried. Epilepsy syndromes are more commonly diagnosed in infants and children. Some examples of epilepsy syndromes include benign rolandic epilepsy, childhood absence epilepsy and juvenile myoclonic epilepsy. Severe syndromes with diffuse brain dysfunction caused, at least partly, by some aspect of epilepsy, are also referred to as epileptic encephalopathies. These are associated with frequent seizures that are resistant to treatment and severe cognitive dysfunction, for instance Lennox-Gastaut syndrome and West syndrome.

Occipital epilepsy

Occipital epilepsy is a neurological disorder that arises from excessive neural activity in the occipital lobe of the brain that may or may not be symptomatic. Occipital lobe epilepsy is fairly rare, and may sometimes be misdiagnosed as migraine when symptomatic. Epileptic seizures are the result of synchronized neural activity that is excessive, and may stem from a failure of inhibitory neurons to regulate properly.

References

  1. ↑ "Migraine Variants" - eMedicine
  2. ↑ "Epilepsy: A Comprehensive Textbook, Volume 1" - Google Books
  3. ↑ Bigal, M.E; Lipton, R.B; Cohen, J; Silberstein, S.D (2003). "Epilepsy and migraine". Epilepsy & Behavior. 4: 13–24. doi:10.1016/j.yebeh.2003.07.003. PMID   14527480. S2CID   45270770.
  4. ↑ Toldo, Irene; Perissinotto, Egle; Menegazzo, Francesca; Boniver, Clementina; Sartori, Stefano; Salviati, Leonardo; Clementi, Maurizio; Montagna, Pasquale; Battistella, Pier Antonio (2010). "Comorbidity between headache and epilepsy in a pediatric headache center". The Journal of Headache and Pain . 11 (3): 235–40. doi:10.1007/s10194-010-0191-6. PMC   3451908 . PMID   20112041.
  5. ↑ Jha, Sanjeev; Kumar, Rajesh (2007). "Migraine-like Visual Hallucinations as the Presenting Manifestations of Focal Seizures in Neurocysticercosis". Journal of Neuro-Ophthalmology. 27 (4): 300–3. doi:10.1097/WNO.0b013e31815bfa7a. PMID   18090566.
  6. ↑ "Pathomechanisms of persistent aura" - Migraine Aura Foundation Archived 2010-12-19 at the Wayback Machine
  7. 1 2 "Migraine, Epilepsy, and Migralepsy: Myths and Realities" - UC Davis Department of Neurology
  8. ↑ Lipton, Richard B.; Marcelo Eduardo Bigal (2006). Migraine and other headache disorders. Informa Healthcare. ISBN   0-8493-3695-3 . Retrieved February 4, 2012.
  9. ↑ "Epilepsy Migraine - More than just a headache" - .docstoc
  10. ↑ Milligan, Tracey A.; Bromfield, Edward (2005). "A Case of 'Migralepsy'". Epilepsia. 46: 2–6. doi: 10.1111/j.1528-1167.2005.00349.x . PMID   16359463. S2CID   9846083.
  11. ↑ Panayiotopoulos, C. P. (2007). A Clinical Guide to Epileptic Syndromes and Their Treatment. Springer. pp. 107–112. ISBN   978-1-84628-643-8 . Retrieved February 4, 2012.
  12. ↑ Panayiotopoulos, C. P. (1999). Benign childhood partial seizures and related epileptic syndromes. John Libbey Eurotext. pp. 288–291. ISBN   0-86196-577-9 . Retrieved February 4, 2012.
  13. ↑ "Migralepsy" and the Significance of Differentiating Occipital Seizures from Migraine - InterScience
  14. ↑ "The EEG: Differential diagnosis of migraine and epilepsy" - Epilepsy.com
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