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

Quality of Life in Children and Adolescents With Primary Headache Disorders

The frequency and significance of headache in children and adolescent has been drawing more attention nowadays. Similarly, growing body of data is being collected on the quality of life of headache in children and adolescent to which increased attention is paid. Compared with other chronic disorders, headache in children has more negative effect on school performance, as well as emotional status. As for school children, it is reported that these children could not go to school on a regular basis, they do less performance and their careers are negatively affected on the long-term. Accompanying symptoms such as depression, somatization, anxiety also impairs the quality of life. Early identification and treatment of headache will not only improve a health condition, but also will provide advancement in academic and social area as well as psychological development for children with headache

The Clinical and Electroencephalography Findings of Children with Pervasive Developmental Disorder

Objective: The aim of this study was to document the findings in a case series of 43 patients diagnosed as having pervasive developmental disorder (PDD) and to show the relationship between these findings. Materials and Methods: This study on children with autism was performed in child neurology and child psychiatry outpatient clinics. After neurologic and psychiatric detailed history and examinations, developmental tests were performed and electroencephalographies (EEGs) were recorded. Results: In the systemic and neurologic examinations and investigations, findings of a specific disease that could cause autism was not detected. Among 34 of 43 patients, history of febrile seizures existed; eight patients (18.6%) had epileptic seizures, 14 (32.6%) had a period of autistic regression, and in the remaining 29 patients, the clinical picture had been present since birth. Among the 14 patients with regression, three had epileptic seizure histories. Twenty-two patients (51.2%) showed epileptiform activity (EA) in their EEGs. In 14 patients with autistic regression, nine (64.6%) had EA. Of the 29 patients with no history of regression, 13 (44.8%) had EA. In the group of 22 patients with EA, six (27.3%) had a history of seizures. Conclusion: The diagnosis of PDD is made according to detailed history and examination. A certain disease that can be diagnosed co-exists in only a small percent of patients. For this reason, laboratory tests can not show much benefit. On the other hand, EEG recordings have great importance in the measurement of background activity of the brain and the existence of EA. During autistic regression, EEG recordings can have great benefits for patients with or without clinical seizures. It may be possible to distinguish between stereotypical movements, tics and epileptic seizures with EEG recordings, which will be repeated in time in these patients

The Clinical and Electroencephalography Findings of Children with Pervasive Developmental Disorder

Objective: The aim of this study was to document the findings in a case series of 43 patients diagnosed as having pervasive developmental disorder (PDD) and to show the relationship between these findings. Materials and Methods: This study on children with autism was performed in child neurology and child psychiatry outpatient clinics. After neurologic and psychiatric detailed history and examinations, developmental tests were performed and electroencephalographies (EEGs) were recorded. Results: In the systemic and neurologic examinations and investigations, findings of a specific disease that could cause autism was not detected. Among 34 of 43 patients, history of febrile seizures existed; eight patients (18.6%) had epileptic seizures, 14 (32.6%) had a period of autistic regression, and in the remaining 29 patients, the clinical picture had been present since birth. Among the 14 patients with regression, three had epileptic seizure histories. Twenty-two patients (51.2%) showed epileptiform activity (EA) in their EEGs. In 14 patients with autistic regression, nine (64.6%) had EA. Of the 29 patients with no history of regression, 13 (44.8%) had EA. In the group of 22 patients with EA, six (27.3%) had a history of seizures. Conclusion: The diagnosis of PDD is made according to detailed history and examination. A certain disease that can be diagnosed co-exists in only a small percent of patients. For this reason, laboratory tests can not show much benefit. On the other hand, EEG recordings have great importance in the measurement of background activity of the brain and the existence of EA. During autistic regression, EEG recordings can have great benefits for patients with or without clinical seizures. It may be possible to distinguish between stereotypical movements, tics and epileptic seizures with EEG recordings, which will be repeated in time in these patients

EEG Findings in Patients with Rett Syndrome

Objectives: Rett syndrome (RS) is a neurodevelopmental disorder that primarily affects girls and is characterized by microcephaly, regression of language, loss of effective hand use, epilepsy, and electroencephalogram (EEG) abnormalities. This study investigated EEG findings of 12 female patients diagnosed with RS