Migralepsy: Definition, Cases, Work-Up and Management Barbara L
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Status Epilepticus Clinical Pathway
JOHNS HOPKINS ALL CHILDREN’S HOSPITAL Status Epilepticus Clinical Pathway 1 Johns Hopkins All Children's Hospital Status Epilepticus Clinical Pathway Table of Contents 1. Rationale 2. Background 3. Diagnosis 4. Labs 5. Radiologic Studies 6. General Management 7. Status Epilepticus Pathway 8. Pharmacologic Management 9. Therapeutic Drug Monitoring 10. Inpatient Status Admission Criteria a. Admission Pathway 11. Outcome Measures 12. References Last updated: July 7, 2019 Owners: Danielle Hirsch, MD, Emergency Medicine; Jennifer Avallone, DO, Neurology This pathway is intended as a guide for physicians, physician assistants, nurse practitioners and other healthcare providers. It should be adapted to the care of specific patient based on the patient’s individualized circumstances and the practitioner’s professional judgment. 2 Johns Hopkins All Children's Hospital Status Epilepticus Clinical Pathway Rationale This clinical pathway was developed by a consensus group of JHACH neurologists/epileptologists, emergency physicians, advanced practice providers, hospitalists, intensivists, nurses, and pharmacists to standardize the management of children treated for status epilepticus. The following clinical issues are addressed: ● When to evaluate for status epilepticus ● When to consider admission for further evaluation and treatment of status epilepticus ● When to consult Neurology, Hospitalists, or Critical Care Team for further management of status epilepticus ● When to obtain further neuroimaging for status epilepticus ● What ongoing therapy patients should receive for status epilepticus Background: Status epilepticus (SE) is the most common neurological emergency in children1 and has the potential to cause substantial morbidity and mortality. Incidence among children ranges from 17 to 23 per 100,000 annually.2 Prevalence is highest in pediatric patients from zero to four years of age.3 Ng3 acknowledges the most current definition of SE as a continuous seizure lasting more than five minutes or two or more distinct seizures without regaining awareness in between. -
An Atypical Presentation of Epilepsy; What a Headache! J Neurol Transl Neurosci 5(1): 1078
Central Journal of Neurology & Translational Neuroscience Bringing Excellence in Open Access Case Report Corresponding author Sarah Seyffert, Trinity School of Medicine, 505 Tadmore court Schaumburg, Illinois 60194, USA, Tel: 847-217-4262; An Atypical Presentation of Email: Submitted: 13 April 2017 Epilepsy; What a Headache! Accepted: 07 June 2017 Published: 09 June 2017 Sarah Seyffert* and Wade Kvatum ISSN: 2333-7087 Trinity School of Medicine, USA Copyright © 2017 Seyffert et al. Abstract OPEN ACCESS The relationship between headache and seizure is a poorly understood and controversial topic; however, the literature has recently suggested that the two conditions may be related. Keywords The interplay between these conditions seems to be even more complex in a group of • Epilepsy patients with epilepsy related headaches. It has been proposed that the association could • Headache be classified into preictal, ictal, postictal, or interictal headaches. Here we present a case • Ictal epileptic headache report of a 62 year old male who presented with a chief complaint of new onset severe headache and subsequently underwent multiple diagnostic testing modalities before he was finally diagnosed and treated for epilepsy, which lead to the resolution of his headache. We conclude with a short discussion of how to subcategorize seizure related headaches based on their temporal relationship and why they can pose such a difficult diagnostic challenge. ABBREVIATIONS afebrile with a normal CBC and CMP. On arrival to the hospital he underwent a non-contrast head CT scan; however, no evidence of EEG: Electroencephalogram; CBC: Complete Blood Count; acute intracranial abnormality was seen. Additionally, a lumbar CMP: Complete Metabolic Panel; CT scan: Computerized puncture was performed which was negative for xanthochromia Tomography Scan; CTA: Computed Tomographic Angiography; and showed a protein count of 27, glucose 230, and 2 white MRI: Magnetic Resonance Imaging blood cells. -
The Migraine-Epilepsy Syndrome
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. -
Pure Epileptic Headache and Related Manifestations: a Video-EEG Report and Discussion of Terminology
Journal Identification = EPD Article Identification = 0552 Date: March 26, 2013 Time: 2:54 pm Clinical commentary with video sequences Epileptic Disord 2013; 15 (1): 84-92 Pure epileptic headache and related manifestations: a video-EEG report and discussion of terminology Carlo Cianchetti 1, Dario Pruna 1, Lucia Porcu 1, Maria Teresa Peltz 2, Maria Giuseppina Ledda 1 1 Child and Adolescent Neuropsychiatry, University, Epilepsy Unit, Azienda Ospedaliero-Universitaria 2 Diagnostic Imaging Department, AOB, Cagliari, Italy Received June 28, 2012; Accepted January 9, 2013 ABSTRACT – We present the first video-EEG recording of episodes of “epileptic headache”. The case reported is that of a 9-year-old girl with brief episodes (of a few minutes) of severe frontal headache, which cor- responded to the presence of concurrent spikes and slow waves, starting in the right temporal area. A dysplastic lesion of the right temporal lobe was observed by MRI and the patient received surgery, with subsequent dis- appearance of headaches. This case highlights ictal EEG as the main dia- gnostic tool for epileptic headache. We discuss the terminology regarding this type of manifestation and believe that cases without subsequent epileptic manifestations, as in the present case, should be more appropri- ately referred to as “pure ictal epileptic headache” or simply “pure epileptic headache”. [Published with video sequences] Key words: epilepsy, headache, migraine, seizure, pain, video-EEG The terms “epileptic headache” patients and occur independently. (Nymgard, 1956; Grossman et al., As a rule, migraine is not an epileptic 1971) and “ictal headache” (Laplante phenomenon, however, headache et al., 1983) were used in the first can follow an epileptic seizure reports of the rare condition of (postictal headache). -
Migraine Triggered Seizures and Epilepsy Triggered Headache and Migraine Attacks: a Need for Re-Assessment
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by PubMed Central J Headache Pain (2011) 12:287–288 DOI 10.1007/s10194-011-0344-2 COMMENTARY Migraine triggered seizures and epilepsy triggered headache and migraine attacks: a need for re-assessment Paul T. G. Davies • C. P. Panayiotopoulos Received: 5 April 2011 / Accepted: 8 April 2011 / Published online: 24 April 2011 Ó The Author(s) 2011. This article is published with open access at Springerlink.com In this issue of the Journal, Belcastro and associates review Migralepsy terminology and classification issues for migralepsy, hem- icrania epileptica, post-ictal and ictal headache [1]. They According to the ICHD-II 1.5.5, ‘‘migraine-triggered sei- raise key points such as ictal headache and visual seizures zure (sometimes referred to as migralepsy)’’ denotes an are often misdiagnosed as migraine, ‘‘migralepsy’’ is unli- epileptic seizure that occurs ‘‘during or within one hour kely to exist and an ‘‘epilepsy-migraine sequence’’ is much after a migraine aura’’ [3]. However, the evidence of this more common and well documented than the dominant ‘‘migraine-seizure’’ sequence is weak and the proposed view of a ‘‘migraine-epilepsy sequence’’. Their relevant criterion of 1 h gap between the end of the ‘‘aura’’ and the proposals need appropriate attention by the committee of start of an epileptic seizure is entirely arbitrary the international classification of headache disorders Migralepsy is an old term derived from migra(ine) and (ICHD) as well as the physicians in their clinical practice (epi)lepsy, coined by Dr Douglas Davidson, but mainly because of the consequences that misdiagnosis may have on attributed to Lennox and Lennox, which we quote, ‘‘a patients. -
Migraine Mimics
ISSN 0017-8748 Headache doi: 10.1111/head.12518 © 2015 American Headache Society Published by Wiley Periodicals, Inc. Expert Opinion Migraine Mimics Randolph W. Evans, MD The symptoms of migraine are non-specific and can be present in many other primary and secondary headache disorders, which are reviewed. Even experienced headache specialists may be challenged at times when diagnosing what appears to be first or worst, new type, migraine status, and chronic migraine. Key words: migraine, migraine mimic, symptomatic migraine, hemicrania continua (Headache 2015;55:313-322) The symptoms of migraine are non-specific and She had seen 2 headache specialists previously. can be present in many other primary and secondary She had been tried on sumatriptan p.o. and subcuta- headache disorders.1,2 Even experienced headache neously, diclofenac powder, ketorolac oral and intra- specialists may be challenged at times when diagnos- muscular, dihydroergotamine nasal spray, and had an ing what appears to be first or worst, new type, occipital nerve block without benefit. Gabapentin migraine status, and chronic migraine. Another diag- and pregabalin did not help. She was placed on indo- nosis may be responsible when physicians use the term methacin 75 mg sustained release once a day for 8 “atypical migraine.” days without benefit. Prednisone 60 mg daily for 10 days did not help.An intravenous dihydroergotamine CASE HISTORIES regimen for 5 days did not help. Case 1.—This 48-year-old woman was seen for a A magnetic resonance imaging (MRI) and mag- third opinion with a 20-year history of only menstrual netic resonance angiogram (MRA) of the brain and headaches always preceded by a visual aura followed cervical spine and magnetic resonance venogram by a generalized throbbing with an intensity of 5–6/10 (MRV) of the brain were negative. -
Myoclonic Status Epilepticus in Juvenile Myoclonic Epilepsy
Original article Epileptic Disord 2009; 11 (4): 309-14 Myoclonic status epilepticus in juvenile myoclonic epilepsy Julia Larch, Iris Unterberger, Gerhard Bauer, Johannes Reichsoellner, Giorgi Kuchukhidze, Eugen Trinka Department of Neurology, Medical University of Innsbruck, Austria Received April 9, 2009; Accepted November 18, 2009 ABSTRACT – Background. Myoclonic status epilepticus (MSE) is rarely found in juvenile myoclonic epilepsy (JME) and its clinical features are not well described. We aimed to analyze MSE incidence, precipitating factors and clini- cal course by studying patients with JME from a large outpatient epilepsy clinic. Methods. We retrospectively screened all patients with JME treated at the Department of Neurology, Medical University of Innsbruck, Austria between 1970 and 2007 for a history of MSE. We analyzed age, sex, age at seizure onset, seizure types, EEG, MRI/CT findings and response to antiepileptic drugs. Results. Seven patients (five women, two men; median age at time of MSE 31 years; range 17-73) with MSE out of a total of 247 patients with JME were identi- fied. The median follow-up time was seven years (range 0-35), the incidence was 3.2/1,000 patient years. Median duration of epilepsy before MSE was 26 years (range 10-58). We identified three subtypes: 1) MSE with myoclonic seizures only in two patients, 2) MSE with generalized tonic clonic seizures in three, and 3) generalized tonic clonic seizures with myoclonic absence status in two patients. All patients responded promptly to benzodiazepines. One patient had repeated episodes of MSE. Precipitating events were identified in all but one patient. Drug withdrawal was identified in four patients, one of whom had additional sleep deprivation and alcohol intake. -
Clinical Evaluation of Headache in Pa- Tients with Epilepsy in a Tertiary Care
Stanley Medical Journal ORIGINAL ARTICLE - NEUROLOGY CLINICAL EVALUATION OF HEADACHE IN PA- TIENTS WITH EPILEPSY IN A TERTIARY CARE HOSPITAL K.Mugundhan (1), T.C.R.Ramakrishnan (2). Abstract Aim: The aim of the study is to analyse and classify headaches occurring in patients with epilepsy and study the pattern of headaches associated with different types of epilepsies . Setting and design : It is a Cross Sectional Descriptive study of Patients with epilepsy who have headache either inter- ictally or periictally or both were taken up for the study. Materials and Methods | 2016 4 | October-December 3 | Issue Vol Study Design: Cross Sectional Descriptive study. Study Population: Patients with epilepsy who have headache either interictally or peri ictally or both who attended Neurology O.P. Government General Hospital, Chennai during the study period (July 2003 to August 2005) were taken up for the study. Inclusion Criteria: Patients with epilepsy who have inter ictal headache of >3 months duration antecedent to or after the onset of seizures and Patients with epilepsy who have peri ictal headache Exclusion Criteria: Patients with epilepsy who developed sudden onset severe headache, headache with systemic signs such as fever, neck stiffness, cutaneous rash, headache with papilloedema, headache triggered by cough, exertion or valsalva maneuver were excluded from the study. Patients with epilepsy who have either interictal or perictal headaches who did not have any features of exclusion criteria were selected for the study. Statistical analysis used : SPSS software Results : The total number of patients studied were 124 of which males comprised 33% (n=42) and females 66% (n= 82). -
Emergency Department Management of Neuroleptic Malignant Syndrome
The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–4, 2016 Ó 2016 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2015.10.042 Selected Topics: Psychiatric Emergencies PSYCHIATRIC EMERGENCIES FOR CLINICIANS: EMERGENCY DEPARTMENT MANAGEMENT OF NEUROLEPTIC MALIGNANT SYNDROME Michael P. Wilson, MD, PHD,*† Gary M. Vilke, MD,*† Stephen R. Hayden, MD,* and Kimberly Nordstrom, MD, JD‡§ *University of California at San Diego Medical Center, San Diego, California, †Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Laboratory, University of California San Diego, San Diego, California, ‡Denver Health Medical Center, Department of Behavioral Health, Psychiatric Emergency Service, Denver, Colorado, and §University of Colorado Denver, School of Medicine, Aurora, Colorado Reprint Address: Michael P. Wilson, MD, PHD, Department of Emergency Medicine, University of California at San Diego Medical Center, 200 West Arbor Drive, Mail Code #8676, San Diego, CA, 92103 , Keywords—altered mental status; neuroleptic malig- What Do You Think is Going on with This Patient? nant syndrome; dystonia; catatonia; rigidity The clinical presentation suggests neuroleptic malignant syndrome (NMS). Although first described more than 50 years ago, the diagnosis of NMS is primarily CLINICAL SCENARIO clinical (1). A 25-year-old man presents with a recent diagnosis of schizophrenia. He was discharged 1 week earlier from What Key Findings Lead to the Diagnosis? an inpatient psychiatric unit. His mother states that he has been acting ‘‘differently’’ for the past 2 days. He Clues to an NMS diagnosis include a recent diagnosis of a has not been ‘‘making any sense,’’ has felt warm to the psychotic disorder and inpatient psychiatric hospitaliza- touch, and today has been stiff and moving rigidly like tion. -
ILAE Classification and Definition of Epilepsy Syndromes with Onset in Childhood: Position Paper by the ILAE Task Force on Nosology and Definitions
ILAE Classification and Definition of Epilepsy Syndromes with Onset in Childhood: Position Paper by the ILAE Task Force on Nosology and Definitions N Specchio1, EC Wirrell2*, IE Scheffer3, R Nabbout4, K Riney5, P Samia6, SM Zuberi7, JM Wilmshurst8, E Yozawitz9, R Pressler10, E Hirsch11, S Wiebe12, JH Cross13, P Tinuper14, S Auvin15 1. Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesu’ Children’s Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy 2. Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester MN, USA. 3. University of Melbourne, Austin Health and Royal Children’s Hospital, Florey Institute, Murdoch Children’s Research Institute, Melbourne, Australia. 4. Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker–Enfants Malades Hospital, APHP, Member of European Reference Network EpiCARE, Institut Imagine, INSERM, UMR 1163, Université de Paris, Paris, France. 5. Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia. Faculty of Medicine, University of Queensland, Queensland, Australia. 6. Department of Paediatrics and Child Health, Aga Khan University, East Africa. 7. Paediatric Neurosciences Research Group, Royal Hospital for Children & Institute of Health & Wellbeing, University of Glasgow, Member of European Refence Network EpiCARE, Glasgow, UK. 8. Department of Paediatric Neurology, Red Cross War Memorial Children’s Hospital, Neuroscience Institute, University of Cape Town, South Africa. 9. Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology, Montefiore Medical Center, Bronx, NY USA. 10. Programme of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, UK 11. -
Lafora Disease Masquerading As Hepatic Dysfunction
Thomas Jefferson University Jefferson Digital Commons Abington Jefferson Health Papers Abington Jefferson Health 8-24-2018 Lafora Disease Masquerading as Hepatic Dysfunction Faisal Inayat Allama Iqbal Medical College Waqas Ullah Abington Jefferson Health Hanan T. Lodhi University of Nebraska at Omaha Zarak H. Khan St. Mary Mercy Hospital Livonia Ghulam Ilyas SUNY Downstate Medical Center Follow this and additional works at: https://jdc.jefferson.edu/abingtonfp See next page for additional authors Part of the Gastroenterology Commons, and the Medical Genetics Commons Let us know how access to this document benefits ouy Recommended Citation Inayat, Faisal; Ullah, Waqas; Lodhi, Hanan T.; Khan, Zarak H.; Ilyas, Ghulam; Ali, Nouman Safdar; and Abdullah, Hafez Mohammad A., "Lafora Disease Masquerading as Hepatic Dysfunction" (2018). Abington Jefferson Health Papers. Paper 7. https://jdc.jefferson.edu/abingtonfp/7 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Abington Jefferson Health Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Authors Faisal Inayat, Waqas Ullah, Hanan T. Lodhi, Zarak H. Khan, Ghulam Ilyas, Nouman Safdar Ali, and Hafez Mohammad A. -
RLS), a Clinical Diagnosis
Liza Ashbrook, MD February 10, 2017 Recent Advances in Neurology Patient 1 This 70-year-old man has restless leg syndrome (RLS), a clinical diagnosis. RLS affects 5-10% of the adult population of European ancestry, though likely only 2-3% come to clinical attention. The cause of RLS is not clear but it is associated with low central iron stores. This is supported by evidence from autopsy studies, CSF analysis, gradient echo MRI and transcranial ultrasound. A family history of RLS is reported in 63-92% of individuals suggesting a strong genetic component as well. RLS is typically separated into intermittent symptoms, defined by fewer than twice/week over a year and chronic symptoms. When symptoms are only bothersome intermittently, such as a long plane flight, medications such as carbidopa/levodopa 25/100 can be very effective, however use more than twice weekly can lead to augmentation. Benzodiazepines and hypnotics are also recommended only for as needed use. Periodic limb movements (PLMs) occur in up to 80% of patients with RLS and are diagnosed by polysomnography. These are stereotyped kicking movements and patients are usually unaware of their presence though bed partners may complain. A small subset of those with PLMs are thought to have periodic leg movement disorder (PLMD), defined by PLMs causing either night time or daytime impairment. Other causes of insomnia and hypersomnia must be ruled out and those with RLS cannot have a diagnosis of PLMD. PLMs are of unclear clinical significance and may be a part of normal aging or an epiphenomenon. RLS and PLMs are commonly confused.