Brinciotti M, Di Sabato M L, Matricardi M, Guidetti V
Dipartimento di Scienze Neurologiche e Psichiatriche dell'Età Evolutiva, University La Sapienza, Rome, Italy.
Clin Electroencephalogr. 2000 Apr;31(2):76-82. doi: 10.1177/155005940003100205.
This study attempted to better define clinical and EEG features for differential diagnosis between epilepsy and migraine in children with occipital epileptiform EEG abnormalities. We studied 126 children (57 males, 69 females; age 4-18 years) suffering from epilepsy (63), migraine (43) or both (20). Patients were selected because of the presence of epileptiform abnormalities in the occipital regions on their EEG at rest. Differences among groups were statistically analyzed (Pearson chi square; ANOVA) for sex, age at onset of seizures and migrainous attacks, family history, ictal signs and symptoms, EEG at rest (unilateral vs bilateral distribution of epileptiform abnormalities), and EEG during Hyperventilation (HV) and Intermittent Photic Stimulation (IPS). Significant differences were found in family history, ictal signs and symptoms, EEG at rest and during activation tests. A family history of epilepsy, visual symptoms such as colored hallucinations and micro/macropsias, frequently associated with clinical signs in the visual system (eye deviation, nystagmus), unilateral EEG abnormalities, and abnormal response to IPS were closely related to diagnosis of epilepsy. On the other hand, a family history of migraine, visual symptoms such as amaurosis and scotomata, without evident clinical signs, bilateral EEG abnormalities, and no changes during IPS were significantly related to migraine. In conclusion, these clinical and EEG differences should be considered in the differential diagnosis between epilepsy and migraine in children with occipital epileptiform EEG abnormalities.
本研究旨在更好地界定枕叶癫痫样脑电图异常儿童癫痫与偏头痛鉴别诊断的临床及脑电图特征。我们研究了126名儿童（57名男性，69名女性；年龄4 - 18岁），他们患有癫痫（63例）、偏头痛（43例）或两者皆有（20例）。入选患者是因为其静息脑电图枕叶区域存在癫痫样异常。对各分组在性别、癫痫发作及偏头痛发作的起病年龄、家族史、发作期体征和症状、静息脑电图（癫痫样异常的单侧与双侧分布）以及过度换气（HV）和间歇性光刺激（IPS）期间的脑电图进行了统计学分析（Pearson卡方检验；方差分析）。结果发现家族史、发作期体征和症状、静息脑电图以及激活试验期间的脑电图存在显著差异。癫痫家族史、视觉症状如彩色幻觉和视物显大/显小症，常伴有视觉系统的临床体征（眼球偏斜、眼球震颤）、单侧脑电图异常以及对IPS的异常反应与癫痫诊断密切相关。另一方面，偏头痛家族史、视觉症状如黑矇和暗点，无明显临床体征、双侧脑电图异常以及IPS期间无变化与偏头痛显著相关。总之，在枕叶癫痫样脑电图异常儿童癫痫与偏头痛的鉴别诊断中应考虑这些临床及脑电图差异。
