Hartl Elisabeth, Gonzalez-Victores Jose Angel, Rémi Jan, Schankin Christoph J, Noachtar Soheyl
Department of Neurology, Epilepsy Center, University of Munich, Munich, Germany.
Department of Neurology, University of Regensburg, Regensburg, Germany.
Headache. 2017 Jun;57(6):908-916. doi: 10.1111/head.13113. Epub 2017 May 10.
To evaluate the characteristics of visual auras (VA) in epilepsy and migraine.
Both disorders are usually diagnosed on clinical grounds, but differentiation might be challenging in isolated auras or because of the similar presentation in migraine and epilepsy.
A retrospective study of two cohorts was performed to compare the VA characteristics of 27 epilepsy patients and 27 age-matched migraine patients.
The duration of VA was significantly shorter in epilepsy (median: 56s; 1st quartile Q1: 26s; 3rd quartile Q3: 130s) than in migraine (20 min; Q1: 10 min; Q3: 30 min) (P < .0001). A cutoff duration of ≥5 minutes identified all migraine patients (100% sensitivity, 92% specificity). VAs of epileptic etiology were characterized by restriction to a visual hemifield (74.1% vs 29.6% in migraine, P = .0024) with stereotypic affection of one hemifield (55.5% vs 7.4% in migraine, P = 0.0003). Centrifugal or centripetal spread of visual phenomena only occurred in migraine (37.0%), but not in epilepsy (P = 0.0007). If present, accompanying symptoms such as nausea/vomiting (19/27) or photo-/phonophobia (17/27) identify migrainous auras (vs 0/27 in the epilepsy patients; P < .0001). Headache presented in all migraine patients, but was also observed in six of the epilepsy patients during cephalic auras or the postictal phase (P < .0001). None of the visual migrainous auras evolved into an epileptic seizure, a concept called migralepsy.
Several clinical characteristics differentiate VA of epileptic and migrainous origin - if presenting in classical manner. Additional EEG evaluations should be performed in patients with VA of unclear etiology and epileptic VA features added to current classifications to increase their discriminatory power.
评估癫痫和偏头痛中视觉先兆（VA）的特征。
这两种疾病通常根据临床症状进行诊断，但在孤立性先兆或由于偏头痛和癫痫表现相似时，鉴别可能具有挑战性。
对两个队列进行回顾性研究，以比较27例癫痫患者和27例年龄匹配的偏头痛患者的VA特征。
癫痫中VA的持续时间（中位数：56秒；第一四分位数Q1：26秒；第三四分位数Q3：130秒）显著短于偏头痛（20分钟；Q1：10分钟；Q3：30分钟）（P < 0.0001）。≥5分钟的截止持续时间可识别所有偏头痛患者（敏感性100%，特异性92%）。癫痫性病因的VA特征为局限于一个视觉半视野（偏头痛中为74.1%对29.6%，P = 0.0024），且一个半视野有刻板性受累（偏头痛中为55.5%对7.4%，P = 0.0003）。视觉现象的离心或向心扩散仅发生在偏头痛中（37.0%），而未见于癫痫（P = 0.0007）。如果存在，伴随症状如恶心/呕吐（19/27）或畏光/畏声（17/27）可识别偏头痛性先兆（癫痫患者中为0/27；P < 0.0001）。所有偏头痛患者均出现头痛，但在6例癫痫患者的头部先兆或发作后阶段也观察到头痛（P < 0.0001）。没有视觉性偏头痛先兆演变为癫痫发作，这一概念称为偏头痛性癫痫。
如果以经典方式呈现，一些临床特征可区分癫痫性和偏头痛性VA。对于病因不明的VA患者应进行额外的脑电图评估，并将癫痫性VA特征添加到当前分类中以提高其鉴别能力。
