Hareem Anam, Pahlavanzadeh Mahsa, Calvo Nicholas E, Monjazeb Sanaz, Anyanwu Chinekwu
Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
Department of Neurology, Carilion Clinic, Roanoke, VA, United States.
Front Neurol. 2022 Aug 11;13:953224. doi: 10.3389/fneur.2022.953224. eCollection 2022.
Migraine and epilepsy are common chronic neurological disorders presenting with paroxysmal attacks of transient cerebral dysfunction, followed by subsequent return to baseline between episodes. The term "migralepsy" has been proposed to define migraine-triggered epileptic seizures classified by the ICHD-III as a complication of migraine with an aura.
A 55-year-old man with a 30-year history of migraine without aura presented with a new onset left parietal pain accompanied by visual disturbances occurring up to 20 times per day. His visual distortions included kaleidoscopic vision, flashes of shadows, and a right superior quadrantanopia lasting 20 min. He described discrete 2-min episodes of scintillating scotomas in his right visual field. Ictal EEG demonstrated a left occipital onset focal aware seizure with his clinical symptoms. The patient was started on valproic Acid and has remained asymptomatic.
The diagnostic criteria as set out by the ICHD-III for migralepsy and other syndromes with migrainous and ictal features remain confusing for practitioners as there is much overlap in clinical manifestations of these entities. EEG should be obtained when ictal features are noted among patients presenting with headache.
偏头痛和癫痫是常见的慢性神经系统疾病，表现为短暂性脑功能障碍的阵发性发作，发作间期随后恢复至基线状态。“偏头痛性癫痫”一词已被提出，用于定义国际头痛疾病分类第三版（ICHD-III）归类为伴有先兆偏头痛并发症的偏头痛诱发的癫痫发作。
一名有30年无先兆偏头痛病史的55岁男性，出现新发的左顶叶疼痛，并伴有视觉障碍，每天发作多达20次。他的视觉扭曲包括万花筒样视觉、阴影闪烁，以及持续20分钟的右上象限盲。他描述在右侧视野有离散的2分钟闪烁暗点发作。发作期脑电图显示左侧枕叶起始的局灶性觉知发作，并伴有其临床症状。该患者开始服用丙戊酸，此后一直无症状。
ICHD-III规定的偏头痛性癫痫和其他具有偏头痛及发作期特征的综合征的诊断标准，对从业者来说仍然很困惑，因为这些实体的临床表现有很多重叠之处。在出现头痛的患者中发现发作期特征时，应进行脑电图检查。
