doi:10.1684/epd.2013.0582 . . ”. e.g (e.g pure 2013b; ., 2012). . epilep- e.g et al et al., ictal epileptic . (2013) as well as ., 2012; Belcastro . et al et al ., 2013). In particular, per se et al Epileptic Disord, Vol. 15, No. 2, June 2013 ” was used 30 years ago by isolated epileptic headache ”or“ ” because epileptic manifestation ( . (1983) and recently also proposed by . (2011) to define headache occurring as ictal headache , 2013c). ictal ” instead of “ictal headache” for two reasons: et al et al et al. , 2013). Finally, the term “HE”, according to the ”, since this appears to represent true epileptic HE suspect IEH are imperative inand order consensus to in achieve this clarity while, area of we research. discourage In the the mean- use of additional terms, Of note, inas epilepsy an patients, interictal,making preictal, headache differentiation between migraine ictal can and epilepsy or occur difficult postictal in symptom, someword patients. Thus, “ictal” we reinforcesheadache/migraine believe the that as the concept genuinetic of seizure headache) paroxysmal ( andconcept avoids of migraine-triggered thetriggered seizures misleading headache or temporal (Belcastro epilepsy- et al. current ICHD-II 7.6.1 criteria, shouldthe be applied headache, when whether brief ora long-lasting, more is part complex of seizure,or including overlapping other (sensory-motor,autonomic) sequential psychiatric ictal or manifestationsParisi non- (Parisi Clinical depiction and EEG recordings in cases with In view of the above uncertaintiesclassification, on we terminology and encourage the use ofheadache “ a) when headache is the sole ictal event,to it is mandatory consider themal epileptic condition origin; may also b) be non-epilepticvascular) an in and origin ictal in paroxys- such“ictal” cases, may the not use be straightforward onlyare for of physicians not the who term familiar with epilepsy (Striano the term “ The term “ Laplante Dainese the sole manifestation of an epileptic seizure. and discussed theIEH terminology and and classification HEthe of (Cianchetti authors suggestedheadache” that that are not allother accompanied seizure cases or types followed ofepileptic by should headache “epileptic be referredMoreover, to the as authors “ “ proposed to avoidheadache and the the only term reported casesabout were 25 published years ago by Cianchetti epileptic headache) is ictal ” ., ., et al et al ., 2012a; ., 2013a; Epileptic Disord 2013; 15 (2): 216-7 Letter to the Editor . according et al et al et al. Epileptic e.g ” clinical pic- ., 2011). as the sole ictal ” (IEH) has recently epileptic headache et al specific ., 2011; Parisi ., 2012b). In particular, IEH et al et al ., 2013b). ” without any “ ., 2013b). Status epilepticus migrainosus et al ., 2013b). As a rule, ictal headache is asso- ictal epileptic headache ., 2013b). Published data suggest that ictal 2013; 15: 84-92. et al et al et al migraine-like features (Belcastro probably under-reported condition (Parisi Parisi has been described intal lobe a epilepsy few and its casesby epileptic ictal of nature EEG documented mainly recordings. Thus, occipi- epilepticusis also migrainosus considered as ictal epileptic headache, imitating (Parisi ciated with other seizure symptomatologyfrom emanating the affected epileptogenicto zone ( the currentepileptica ICHD-II [HE]). 7.6.1 criteriaFor this for reason, hemicrania lated ictal ictal epileptic manifestation, headache, appears as an to iso- be a rare and Parisi headache manifests with multiple and diverse sympto- matology, such as avague ache sensation in of thepains bifrontal or head, pressure, a sharp sensation stabbing ofhead electricity retro-orbital of passing varying through intensity, the discomfort, and localisation 216 ture of migraine, migraineheadache) with which aura, lasts or tension-type fordence of seconds ictal epileptiform to EEG discharges days, (Parisi with evi- The term “ been proposed byrecorded our epileptic group seizurelike to with features migraine/headache- describe (Parisi anis EEG- recognisedmanifestation as a headache (“ documented (Verrotti To the Editor A comment to the proposal of Cianchetti Disord Headache as a symptom of epileptic seizure is well and classification: opening Pandora’s box Migraine and epilepsy terminology that may be intermingledwithout with photoparoxysmal sharp response waves, (Belcastro 2011; Parisi with or In the last issueciates of reported the a Journal, patient Cianchetti with and asso- “ 2012b). Notably, differentmay be types observed ofpolyspike-and-wave, as focal EEG generalised or spike-and-wave anomalies activity or or generalised, focal, subcontinuous spikes rhythmic or theta activity Migraine and epilepsy terminology and classification: opening Pandora’s box
such as “isolated” or “pure” epileptic headache, which Belcastro V, Striano P, Parisi P. Is it migralepsy? No evidence could potentially increase confusion in this field. yet. Neurol Sci 2013. In press. Cianchetti C, Pruna D, Porcu L, Peltz MT, Ledda MG. Pure Disclosures. epileptic headache and related manifestations: a video- None of the authors have any conflict of interest to disclose. EEG report and discussion of terminology. Epileptic Disord 2013; 15: 84-92. 1 2 Vincenzo Belcastro , Pasquale Striano , Dainese F, Mai R, Francione S, Mainardi F, Zanchin G, Paladin 3 Pasquale Parisi F. Ictal headache: headache as first ictal symptom in focal epilepsy. Epilepsy Behav 2011; 22: 790-2. 1 Neurology Clinic, Department of Neuroscience, Laplante P, Saint-Hilaire JM, Bouvier J. Headache as an epilep- Sant’ Anna Hospital, Como tic manifestation. Neurology 1983; 33: 1493-5. 2 Pediatric Neurology and Muscular Diseases Unit, Parisi P, Striano P, Negro A, Martelletti P, Belcastro V. Ictal Department of Neurosciences, Rehabilitation, epileptic headache: an old story with courses and appeals.J Ophtalmology, Genetics, Maternal and Child Health, Headache Pain 2012a; 13: 607-13. University of Genoa, “G Gaslini” Institute, Genova 3 Parisi P, Striano P, Kasteleijn-Nolst Trenité D, et al. Ictal epilep- Child Neurology & Headache Paediatric, Chair of tic headache: recent concepts for new classifications criteria. Pediatrics, NESMOS Department, Faculty of Medicine Cephalalgia 2012b; 32: 723-4. and Psychology, Sapienza University, Rome, Italy Parisi P, Striano P, Belcastro V. The crossover between
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