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

EPİLEPSİ FARE MODELLERİNDE KETOJENİK DİYET ARALIKLI AÇLIK VE YÜKSEK YAĞLI DİYETİN DAVRANIŞ VE BDNF ÜZERİNE ETKİSİNİN DEĞERLENDİRİLMESİ

Dirençli epilepsi tedavisinde ketojenik diyet etkinliği bilinen bir tedavi yöntemidir. Keton cisimlerin serumda artışı, kan beyin bariyerini geçerek santral sinir sistemine kolay iletişimi ile tedavi edici özelliği oluşmaktadır. Ancak keton cisimlerin santral sinir sistemine ulaşımı ile birlikte oluşan antiepileptik durumun moleküler mekanizmaları tam olarak bilinmemektedir. Ketojenik diyetin epilepsi üzerine etkisinden yola çıkarak normal diyete karşın yüksek yağlı diyet, aralıklı açlık ve santral sinir sistemindeki etkisi BDNF düzeyleri ölçülerek değerlendirilecektir.8 haftalık erkek farelere PTZ enjeksiyonu ile epilepsi modeli oluşturulacaktır. Fareler dört ayrı beslenme grubuna ayrılarak ketojenik diyet, aralıklı açlık, yüksek yağlı diyet ve standart diyet uygulanacaktır. Diyet uygulaması 3 ay boyuca devam edecek ve sürecin sonunda serumdan BDNF düzeyi analiz edilecek ve davranış testleri uygulanacaktır.BDNF farklı diyet uygulamalarında farklı etkileri olan; nöbet oluşumunda ve tedavisinde etkili bir moleküldür. Bu çalışma farklı diyet uygulamalarının BDNF ve davranış üzerine etkisini anlamayı amaçlar.</p