Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Comparison of Compliance Rates and Classification of Epileptic Seizures with ILAE 1981, Lüders, ILAE 2001 Epilepsy Classification Systems, Before and After Their Monitorization

Objectives:Epileptic seizures diagnosed wth clinical and electroencephalographic (EEG) signs were classified according to ILAE 1981, Lüders, and ILAE 2001 systems in the present study, the aim of which was to compare classification systems by means of preictal and postictal consistency, and to determine deficiencies of the classification systems.Methods:In the present study, 50 patients who had epileptic seizures during monitorization were evaluated by a single observer at the Gazi University Medical Faculty Long-Term Video-EEG Monitorization Unit between March 2003 and September 2004. Seizures were classified by their anamnesis according to ILAE 1981, Lüders, and ILAE 2001 classification systems. After monitorizing patients with video-EEG, each seizure was classified with these systems by a single observer. During classification, EEG results and magnetic resonance imaging (MRI) information were not evaluated, and syndromic classification was not performed.Results:According to ILAE 1981, the classifications of 37 out of 50 patients (74%) were consistent with pre- and post-monitorization classification. According to ILAE 2001, 36 classifications (72%) were consistent, and according to Lüders classification, 39 classifications (78%) were consistent.Conclusion:Comparison performed by a single observer revealed no significant difference among the 3 classification systems before and after monitorization

Hemiplegic Migraine: A Case Report

A 37-years-old female was admitted to another clinic with a 10-day history of headache, right hemiparesis and aphasia, and was diagnosed as conversion disorder. She was admitted to our emergency room for repeated tonic-clonic convulsions. She had a history of migraine and two attacks characterized by hemiparesis and aphasia during the last year. Left-sided cerebral edema and vasospasm of the left middle cerebral artery were observed in imaging studies. A detailed clinical and family history led us to diagnose this case as hemiplegic migraine. Calcium channel blocker and antiepileptic treatment was started and her symptoms disappeared completely. Magnetic resonance imaging repeated one month later showed regression of the edema. The interesting clinical and imaging findings of this patient diagnosed as hemiplegic migraine are reported because of its rare occurrenc

Paraneoplastic Ischemic Stroke: Case Report and Review

OBJECTIVE: Paraneoplastic etiology is not frequent among cerebrovascular disorders. This rare disorder is interesting with different mechanisms, clinical manifestations and treatment options. Diagnosis may be overlooked for its rarity. We present a paraneoplastic ischemic stroke patient with its clinical and imaging characteristics for recalling this rare disease. CASE: A sixty years old woman with a history of ovarian and colon cancer and liver metastasis admitted with acute left sided hemiplegia. Brain magnetic resonance imaging showed multiple ischemic lesions at the same age. Laboratory findings were compatible with chronic disseminated intravascular coagulopathy. She was anticoagulated but the clinical findings were not changed. She died one month after her discharge from the hospital. CONCLUSIONS: Paraneoplastic ischemic stroke is rare and it should be recognized by the clinician to differentiate from other ischemic strokes by its different mechanisms, imaging characteristics and treatment modalities. Prognosis depends on the characteristics of the primary tumo