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The Migraine-Epilepsy Syndrome

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medigraphic Artemisaen línea Arch Neurocien (Mex) Vol 11, No. 4: 282-287, 2006 The Migraine- Epilepsy Syndrome Arch Neurocien (Mex) Vol. 11, No. 4: 282-287, 2006 Artículo de revisión ©INNN, 2006 de caso The migraine-epilepsy syndrome Enrique Otero Siliceo†, Fernando Zermeño EL SINDROME MIGRAÑA-EPILEPSIA represent a neural exitation. Since that the glutamate has in important rol in both patologys depending of the part of the brain more affected the symptoms might RESUMEN vary from visual to abdominal phemomena. La migraña y la epilepsia tienen varios puntos en común Key words: migraine epilepsy, EEG abnormalities, sintomática clínica y genéticamente lo que ha sido glutamate, diagnosis. postulado por más de cien años. El fenómeno referido como migraña-epilepsia sugiere que exista una he first steps of a practical, approach by patofisiología común. El síndrome de migraña o physicians in recognizing and treating neuro- epilepsia tiene fenómenos comunes de dolor adominal T logic diseases are to recognithat there are jaqueca anormalidades del EE y respuesta a droga various overlaps between migraine and epilepsy. antiepilépticas. En ocasiones el paciente puede tener Epileptic seizures and classic migraine episodes may un ataque migrañoso o una convulsión o en otras occur in the same patient. Migraine and epilepsy share ambas. La comorbilidad puede explicarse por estados several genetic, clinical, evolutive and neurophysio- de hiperrexcitabilidad neural. Alteraciones electroen- logic features. A relationship between epilepsy and cefalográficas son comunes en estos estados. En migraine has been postulated for over a hundred years apariencia el glutamato tiene un papel importante tanto and the syndrome of Migraine-Epilepsy illustrates this en la migraña como en la epilepsia. Según el lóbulo complex relationship between both. afectado los síntomas premátorios pueden variar de Clinically, the diagnosis of epilepsy is supported alteraciones visuales a gástricas, por lo que no deben by additional positive motor phenomena or by a usarse divisiones artificiales. transition into a complex partial seizure, e.g. when epileptic activity secondarily spreads into a temporal Palabras clave: migraña, epilepsia, alteraciones comu- lobe. Secondarily generalized seizures, however, may nes, electroencefalograma. also occur in patients with migraine. The complex relationship between migraine and epilepsy is ABSTRACT highlighted by the occurrence of a seizure during a migraine attack without aura. This phenomenon, Migrane and epilepsy have common points from the clinic symptomatic and genetic view and this has being Recibido: 13 enero 2006. Aceptado: 30 enero 2006. noticed for more than hundred years. The migrain epilpetic syndrom sugest a common pathophysiology Subdirección de Neurología. Instituto Nacional de Neurología y with simptoms as abdominal pain, headache Neurocirugía. Correspondencia: Fernando Zermeño Polhs. abnormalities at the spiral fluid and goodmedigraphic.com response to Subdirección de Neurología. Instituto Nacional de Neurología y antieplieptic drugs some times the patient might have Neurocirugía. Insurgentes Sur # 3877. Col. La Fama, 14269, México, both symptoms headache and convultions and both D.F. 282 Arch Neurocien (Mex) Enrique Otero Siliceo Vol 11, No. 4: 282-287, 2006 referred to as “Migralepsy”, suggests an inherent The relation of migraine and epilepsy overlap in the underlying pathophysiology of these The two conditions were thought to be closely events17. related by Liveing and Vining, while others held that the A general pathogenetic model of migraine and occurrence of migraine and epilepsy in the same seizures may be characterized by a given predis- patient is probably coincidental, for example Bramwell, position, various co-factors which enhance the Alvarez and Brain. In discussing the relation of migraine tendency, and finally, trigger mechanisms, which indu- and epilepsy, Gowers in 1907, began with alteration ce an attack. In assessing the importance of various where “one replaces the other in the same subject” but factors thought to be related to idiopathic migraine- also observed that epileptic attack and paroxysmal epilepsy syndrome, it is necessary to differentiate headaches may coexist. between causal relation, unspecific association, and Dealing with the premonitory symptoms of coincidence. migraine and their distinction from epilepsy, he The syndrome of migraine-epilepsy is infrequent emphasized the difference in duration and also pointed phenomena with paroxystic episodes of headache or out that when isolated prodromas occur, they are often abdominal pain, awareness, EEG abnormalities and very much briefer than when followed by headache positive results with the introduction of antiepileptic and might easily be thought to be “minor epileptic drugs. The most constant characteristic is the seizures” but the identity of character with those that paroxysmal occurrence of the symptoms, frequently preceded the headaches made their nature certain. triggered by emotional stress, fatigue or flashing light, heralded by prodromal signs and symptoms such as Risk for migraine and epilepsy pallor, flushing, sweating, languor, irritability and In adults, Marks and Ehrenberg studied the dizziness and on occasions sensory disturbances or relationship between migraine and epilepsy in 395 transient hemiparesis, followed by sleep. A individual seizure patients, 20% also had migraine syndrome and may have a seizure on one occasion and a classic 3% of these patients experienced seizures during or attack of migraine on another. Histories of children with immediately following a migraine aura. Patients with epilepsy occasionally disclose that the seizures have catamenial epilepsy and patients with migraine with been preceded for several years by attacks of aura were at an increased risk for an association migraine. However, epilepsy is more likely to become between these two disorders. migraine than migraine to become epilepsy. A familial Lees and Watkins found only 2.1 per cent of ilieir history of the syndrome is present in 70 to 85 per cent cases of migraine showed features of epilepsy, and of children with migraine and in 3 to 8 per cent of those Lance and Anthony found the same incidence of with epilepsy. The history of migraine is more common epilepsy, 2 per cent, both in their series of migraine in the families of epileptic patients than in the normal and tension headaches. Ely in 1930, from the ancestral population. histories, concluded that “migraine is possibly the The syndrome has been elaborated with bases morbid ancestor of both migraine and epilepsy”. in his clinical features and in the EEG contributions and Classical investigations have shown that epilepsy long-term video/EEG that has allowed improved occurs more commonly in patients with migraine that differentiation between epileptic syndromes and non- would be expected by chance (Slatter 1968, epileptic disorders that may mimic epilepsy clinically Hockaday and Whitty 1969) although the frequency of or migraine disorders; recognition of its relatively the association varies from study to study. By the other benign course may prevent unnecessary investigation hand, the incidence of migraine studied in several and undue alarm. groups of patients show that migraines were present in A critical review of the data indicative of a 62% of the patients with centro-temporal epilepsy, 34% relationship between migraine and epilepsy show that of the patients with absence of epilepsy, 8% of the the pathogenesis point towards their combined patients with partial epilepsy and 6% of the patients occurrence are frequent.These data are considered with cranial trauma. These results suggest that the under five major headings: genetic, epidemiological, association of centro-temporal epilepsy and migraine clinical, electroneurophysiological and neurochemical. is non-fortuitous as well as, to a lesser degree, Besides purely coincidental combinations,medigraphic.com a absence of epilepsy and migraine and that centro-tem- variety of reasons is held responsible for this side-by- poral epilepsy together might be a feature for the side occurrence. diagnosis of migraine. 283 Arch Neurocien (Mex) Vol 11, No. 4: 282-287, 2006 The Migraine- Epilepsy Syndrome Migraine in childhood and adolescence seems was an exaggerated and prolonged response to to be definitively associated with vegetative dysfunction, hyperventilation. Slatter concluded that the response to abdominal symptoms and hormonal factors and photic stimulation reflected a constitutional predispo- possibly with allergic reactions, whereas a relation to sition to migraine and suggested that permanent epilepsy can be excluded. cerebral damage resulting from migraine may produ- Pathogenic models of the syndrome of migraine- ce abnormal electroencephalographic findings and epilepsy rarely cause local epileptic changes. This suggestion is very difficult to substantiate simply based on a Electroencephalographic abnormalities temporal sequence of events in successive elec- The comorbidity of migraine and epilepsy may troencephalograms. The generally dysrhythmic be explained by a state of neuronal hyperexcitability electroencephalograms of some migraine patients that increases the risk of both disorders. Individuals with could not be distinguished from certain of the epilepsy are 2.4 times more likely to develop migraine epilepsies and that the aura in migraine is associated than their relatives without epilepsy. Risk of migraine is with cortical
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