Migraine with Visual Aura and Photosensitive Epileptic Seizures

Summary: A relationship between epilepsy and migraine has long been postulated, but the nature of this interaction is still debated. We observed this association in a 23-year old man with a history of migraine with visual aura who had seizures at age 15 years while watching television. Waking EEG was normal, but sleep recordings demonstrated posterior spike-waves during sleep. During intermittent photic stimulation (IPS), a photoparoxysmal response occurred, maximum in occipital areas. Brain magnetic resonance imaging scan was normal. Seizures did not recur after 4-year treatment with valproate. He is currently seizure-free, but continues to have rare migraine with visual aura. The role of spreading depression or of a putative dopaminergic failure in occipital cortex is discussed.