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

Serum aymmetric dimethylarginine levels in migraine patients and its effect in migraine subtypes

Migren; nörolojik, gastrointestinal ve otonom değişikliklerin çeşitli kombinasyonlarda eşlik ettiği, primer epizodik bir baş ağrısıdır. Strüktürel lezyon olmadan nörovasküler transmisyon bozukluğuna bağlı olduğu düşünülmektedir. Yapılan çalışmalarda ekzojen nitrik oksid salgılayan gliseril trinitratla ve vasküler endotelden nitrik oksid serbestleştiren histamin ile migren karakterinde baş ağrısının geliştiğinin görülmesi, nitrik oksidin altta yatan mekanizmadan sorumlu olabileceğini düşündürtmüştür. Asimetrik dimetilarjinin, nitrik oksid sentazın endojen inhibitörüdür ve migren patofizyolojisinde rol oynayabileceği düşünülmektedir. Çalışmamıza Uluslararası Başağrısı Derneği 2004 tanı kriterlerine göre migren tanısı olan atak arası dönemdeki 100 hasta alındı. Hastalar auralı ve aurasız olmak üzere 2 alt gruba ayrıldı. 42'si (%42) auralı migren, 58'i (%58) aurasız migren olarak sınıflandırıldı. Hastalarla yaş ve cinsiyet olarak uyumlu 100 sağlıklı gönüllü kontrol grubu olarak alındı. Hastalardan ve kontrol grubundan alınan venöz kandan ?high performance liquid chromotography? yöntemi ile serum asimetrik dimetilarjinin, simetrik dimetil arjinin ve L-arjinin değerleri ölçüldü. Asimetrik dimetil arjinin, simetrik dimetilarjinin ve L-arjinin düzeyleri çalışma hastalarında kontrol grubuna göre yüksek bulunurken ( üçünde de p=0.001>), auralı ve aurasız alt grupları arasında fark bulunmadı. Profilaktik tedavi alan ve almayan grubun asimetrik dimetilarjinin düzeyleri arasında da fark saptanmadı .Asimetrik dimetilarjinin düzeyi yaşla, L-arjinin düzeyi ağrı şiddeti ile pozitif ilişkili bulundu (sırasıyla p=0.020, p=0.021). Migrene bağlı kayıp değerlendirme ölçeği ve serum asimetrik dimetilarjinin düzeyleri arasında ilişki bulunmadı. Bizim çalışmamızda serum asimetrik dimetilarjinin değerlerinin migrenli hastalarda kontrol grubuna göre anlamlı derecede yüksek olması, asimetrik dimetilarjinin migren patofizyoloisinde önemli bir rol oynadığını ve gelecekte migren tedavilerinin belirlenmesinde etken olabileceğini göstermiştir.AbstractMigraine is a primary episodic headache disorder characterized by various combinations of neurological, gastrointestinal and autonomic changes. It is considered to be a disorder of neurovascular transmission without structural lesions. On the basis of studies in migraine induced by glyceryl trinitrat which is an exogenous nitric oxide donor and histamine which liberates nitric oxide from vascular endothelium, it has been suggested that nitric oxide is a likely candidate responsible molecule. Asymmetrical dimethylarginine is an endogenous inhibitor of nitric oxide synthase and is considered to play an important role in the pathophysiology of migraine. One hunred patients diagnosed as migraine according to the International Headache Society criteria were included in our study. The migraine patients were in the interictal period and classified into two groups as having migraine with aura or migraine without aura. 42(42%) of pateints were diagnosed as migraine with aura and 58(58%) of patients were diagnosed as migraine without aura. The control group consisted of 100 healthy volunteers who were age and gender matched. Serum asymmetric dimethylarginine, symmetric dimethylarginine and L-arginine levels were measured using the high performance liquid chromotography method. Asymmetric dimethylarginine, symmetric dimethylarginine and L-arginine levels were found significantly higher in patients with migraine compared to the control group (all comparisons p=0.001>). But there was no statistically significant difference between the patients with and without aura. Subanalysis of the patients with migraine according to having prophylactic therapy or not revealed no difference for the levels of asymmetric dimethylarginine. Asymmetric dimethylarginine levels were associated with age and L-arginine levels were associated with headache severity positively. There was no correlation between the migraine disabilty assesment scale and serum asymmetric dimethylarginine levels. Our study showed that serum asymmetric dimethylarginine levels are significantly higher in patients with migraine compared to the control group which indicates that ADMA plays an important role in the pathophysiology of migraine and may be an important factor in the direction of future migraine therapies

Pitfalls in the diagnosis of Jeavons syndrome: a study of 32 cases and review of the literature

Aims. Jeavons syndrome (JS) is mainly characterized by eyelid myoclonia with or without absences. It is thought to be underdiagnosed rather than have a rare prevalence. We aimed to investigate the electroclinical features of JS to determine possible factors influencing the diagnosis

The unchanging face of Lennox-Gastaut syndrome in adulthood

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The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey

Objective: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. Methods: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. Results: The mean age of 1358 patients was 35.92 ± 14.11 (range, 18–89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10–48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440–5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128–1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034–1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 – 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084–1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004–1.041]; p = 0.014), were determined as factors affecting quality of life. Significance: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy

Headache in idiopathic/genetic epilepsy: Cluster analysis in a large cohort

Objective The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. Methods Patients aged 6-40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. Results Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, >= 5 headache attacks, duration of headache >= 24 months, headaches lasting >= 1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic-clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with >= 5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). Significance Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies