头痛性癫痫诊断的探讨及文献复习

为了探讨头痛与癫痫的关系及头痛性癫痫的诊断，对４０例诊断为“头痛性癫痫”的患者，重新复查脑电图并复习病历，结果显示，４０例中仅３例复查脑电图出现癫痫样波，其余患者均为正常脑电图或仅出现背景活动变慢。其中９例确诊为典型偏头痛，２８例为其他原因引起的头痛，仅３例确诊为癫痫。提示诊断头痛性癫痫时一定要慎重。     

关于儿童头痛性癫痫诊断问题的探讨(摘要)

在１９８７年１１月～１９９６年１２月间，我院癫痫门诊收治的由院外诊断为“头痛性癫痫”，并已进行抗癫痫药物治的１０２例患儿的临床资料分析，详细询问病史，仔细体格检查，复查脑电图１～３次后重新确定诊断，实施治疗并临床随访。结果：１０２例患者中其临床表现均...     

电视-脑电长时间监测对癫痫诊断的临床意义

目的研究电视脑电（ＶｉｄｅｏＥＥＧ）长时间监测在癫痫诊断中的意义。方法对临床上１２４例诊断为癫痫、９２例可疑癫痫及３３例非癫痫患者行ＶｉｄｅｏＥＥＧ监测,并与临床诊断的结果进行对比。结果临床诊断为癫痫组患者中８４７％（１０５／１２４）记录到临床发作,原诊断为强直阵挛性发作（ＧＴＣＳ）中有１０例经ＶｉｄｅｏＥＥＧ监测确认为复杂部分性发作（ＣＰＳ）;９２例可疑癫痫患者中２４％（２２／９２）被确认为癫痫。可疑“头痛型癫痫“、“腹痛型癫痫”的４０例患者中,仅有１例其头痛与发作密切相关。另有６例有ＣＰＳ发作,但头痛或腹痛并非癫痫发作表现。结论ＶｉｄｅｏＥＥＧ对癫痫的诊断、鉴别及分类有重要意义。     

额叶癫痫发作临床表现及脑电改变特征的分析

目的 探讨额叶癫痫发作临床表现及脑电改变特征。方法 利用ＺＮ８０００型同步录像脑电图（ＥＥＧ）对１０例额叶癫痫患者进行脑电和行为监测。结果 监测时间内共监测到８９次临床发作,睡眠６２次,清醒２７次,持续时间１０～９０秒。临床表现：单纯部分性发作３例１２次,复杂部分性发作６例７０次,强直－阵挛性发作１例７次;发作期ＥＥＧ：额区或额区为主的癫痫样放电（棘波、尖波、棘慢、尖慢综合波）８例７１次,高极高幅     

民与心电同步检测对癫痫性与心律失常性晕厥的鉴别诊断价值

目的：探讨２４小时脑电／心电同步监测对癫痫性晕厥和心律失常性晕厥的诊断和鉴别诊断价值。方法：对７２例临床怀疑癫痫性晕厥和心律失常性晕厥患者进行２４小时动态脑电图（ＡＥＥＧ）／心电图（ＥＥＧ）同步监测。结果：（１）癫痫性晕厥４２例中,ＥＥＧ总异常率８３．９１％。痫样放电出现率７１．２４％;心电图显著异常率１９％;（２）心律失常性晕厥２１例中,ＥＥＧ总异常率２４％,痫样放电出现率５％,心电衅显著异常９１％;（３）可疑癫痫性晕厥４例中,ＡＥＥＧ痫样放电１例;（４）可疑心律失常性晕厥３例,ＥＣＧ均为非显著异常;（５）晕厥原因不明（癫痫与民律失常两种疾病并存）２例,均检出痫样放电及显著心律失常。结论：２４小时ＥＣＧ同步监测对癫痫性晕厥和心律失常性晕厥有重要的诊断和鉴别诊断的价值。     

额叶癫痫发作的临床与脑电图特征

目的：分析额叶癫痫发作的临床及ＥＥＧ特征。方法Ｌ经同步录像脑电图（Ｖｉｄｅｏ－ＥＥＧ）监测,对４０例癫痫病人１８１次额叶发作的临床表现及ＥＥＧ进行同步分析。结果：额叶发作频繁而短暂,以睡眠中发作为主。常见的临床表现依次为过度运动、扭转性强直、姿势性强直、发声、假性失神等。发作新时期额区棘、尖波稀少且波形不典型,发作期额 叶限局性或弥漫性的改变与背景活动的差别不明显。结论：临床和ＥＥＧ不典型是导致额叶发作临床诊断困难或误诊的主要原因。认识额叶发作的临床特点,延长ＥＥＧ记录时间及发作期临床－ＥＥ现步分析有助于对额叶发作的诊断。     

动态脑电图对32例晕厥患者的监测分析

目的：观察动态脑电图（ＡＥＥＧ）对晕厥患者监测的阳性率,并与常规脑电图（ＥＥＧ）、ＣＴ进行对照观察。方法：应用ＡＥＥＧ、ＥＥＧ和ＣＴ对晕厥患者进行检查。结果：３２例晕厥患者ＡＥＥＧ监测结果,１６例异常,阳性率为５０％,ＥＥＧ异常３例,阳性率为１１．５％;头ＣＴ检查２例异常,阳性率为６．３％。结论：ＡＥＥＧ对晕厥监测阳性率明显高于ＥＥＧ及ＣＴ。对晕厥患者中不典型及睡觉中亚临床癫痫发作提供了诊断与鉴别诊断依据。     

心脏性心律失常型癫痫10例临床分析

目的探讨心脏性心律失常型癫痫的临床特征和诊断要点。方法总结１０例心脏性心律失常型癫痫的临床资料。结果本组患者的临床表现为心律失常性发作，历时２～３分钟，蝶骨电极ＥＥＧ描记异常。结论心脏性心律失常型癫痫易误诊，单用抗癫痫药物有效     

偏头痛和癫痫

偏头痛和癫痫在临床表现、发病机制和治疗上均存在联系,两者在临床上不易鉴别.本文评价了国际头痛协会发布的国际分类中的定义及诊断标准,并对三种分类,即偏头痛引起的癫痫发作、偏头痛型癫痫和癫痫后头痛分别进行简述,同时比较了偏头痛和头痛型癫痫二者之间的脑电图差异及关系,并建议尽快重新修订分类标准,明确这几种疾病的定义.     

自然夜间睡眠脑电图对癫痫的诊断价值

目的：观察自然夜间睡眠脑电图（ＥＥＧ）对癫痫的诊断价值，方法；对２００例临床拟诊为癫痫的患者行白昼常规ＥＥＧ和夜间自然睡眠ＥＥＧ，结果：常规ＥＥＧ３６％（７２例）出现痫样放电，而自然夜间睡眠ＥＥＧ７８％（１５６例）出现痫样放电，痫样波检出率与年龄，临床发作类型，睡眠周期有关。结论：自然夜间睡眠ＥＥＧ可显著地提高痫样放电的检出率，对癫痫的诊断与鉴别诊断有重要的参考价值。     

头痛型癫痫的临床和脑电图分析

本文报告85例头痛型癫痫。绝大多数为儿童和青少年。主要的临床症状为反复发作性剧烈头痛,或伴有其他植物神经症状和意识障碍,大部分头颅CT检查未见异常。脑电图检查对诊断和鉴别诊断有重要意义。通过常规检查和诱发试验大多数显示阵发性两侧半球或两额部同步对称性中至极高波幅2～7Hz慢波,阵发性或散发性尖波、尖—慢波、棘波、棘—慢波,少数局限于颞、顶、枕部的棘—慢波发放。本病预后较好。本组72.3％病例经系统服用一种抗癫痫药半年至一年后,头痛基本控制,多次脑电图检查未见典型的痫性放电。两者结合,方可考虑逐渐减药或停药为宜。     

Ictal headache: Headache as first ictal symptom in focal epilepsy

Headache may be associated with seizures as a preictal, ictal, or postictal phenomenon, but it is often neglected because of the dramatic neurological manifestations of the seizure. Headache can also be the sole or predominant clinical manifestation of epileptic seizures, although this is a relatively rare condition. We describe two cases of focal symptomatic drug-resistant epilepsy with headache as the first ictal symptom. In both cases, the headache, which lasted a few seconds, was contralateral to the ictal discharge and did not have the clinical features of migraine. Ictal headache is a rare epilepsy symptom that can help to localize ictal EEG discharges. Recently, the term ictal epileptic headache has been proposed in cases in which headache is the sole ictal epileptic manifestation Diagnosis requires the simultaneous onset of headache with EEG-demonstrated ictal discharges.     

Ictal headache: headache as first ictal symptom in focal epilepsy

Headache may be associated with seizures as a preictal, ictal, or postictal phenomenon, but it is often neglected because of the dramatic neurological manifestations of the seizure. Headache can also be the sole or predominant clinical manifestation of epileptic seizures, although this is a relatively rare condition. We describe two cases of focal symptomatic drug-resistant epilepsy with headache as the first ictal symptom. In both cases, the headache, which lasted a few seconds, was contralateral to the ictal discharge and did not have the clinical features of migraine. Ictal headache is a rare epilepsy symptom that can help to localize ictal EEG discharges. Recently, the term ictal epileptic headache has been proposed in cases in which headache is the sole ictal epileptic manifestation Diagnosis requires the simultaneous onset of headache with EEG-demonstrated ictal discharges.     

Effect of tyramine in migraine: a double-blind study

The incidence of headache and changes in the EEG after tyramine were studied in 25 migrainous patients in a double-blind placebo-controlled investigation. There were three groups of patients: the first had migraine alone, the second had migraine and epilepsy, and the third had migraine which was precipitated by food substances containing tyramine. Psychological tests showed that all the patients were more neurotic, more introverted, and more obsessional than normal subjects. Headache occurred in 12 of 50 patient sessions and 10 of these occurred in the group with dietary precipitated migraine. In this group, however, headache followed tyramine alone in only two patients. The remaining eight headaches occurred in two patients after placebo alone, and in three after both test capsules. The EEG was activated after tyramine, but not after placebo, in 11 of the 15 patients with migraine and epilepsy, and dietary precipitated migraine. This effect was observed, however, in only two of the 10 patients with classical migraine alone. There was no relation between the occurrence of headache and EEG activation. Although there was no significant relationship between tyramine ingestion and the occurrence of headache, the EEG changes observed during the study support the hypothesis that tyramine has an action on the central nervous system in some migrainous subjects.     

Electroclinical features in children and adolescents with epilepsy and/or migraine, and occipital epileptiform EEG abnormalities.

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.     

Epileptic seizures and headache/migraine: A review of types of association and terminology

PurposeThere are different possible temporal associations between epileptic seizures and headache attacks which have given rise to unclear or controversial terminologies. The classification of the International League Against Epilepsy does not refer to this type of disorder, while the International Classification of Headache Disorders (ICHD-2) defines three kinds of association: 1. migraine-triggered seizure (“migralepsy”), 2. hemicrania epileptica, and 3. post-ictal headache.MethodsWe performed an extensive review of the literature, not including “post-ictal” and “inter-ictal” headaches.ResultsOn the basis of well-documented reports, the following clinical entities may be identified: (A) “epileptic headache (EH)” or “ictal epileptic headache (IEH)”: in this condition headache (with or without migrainous features) is an epileptic manifestation per se, with onset, and cessation if isolated, coinciding with the scalp or deep EEG pattern of an epileptic seizure. EH maybe followed by other epileptic manifestations (motor/sensory/autonomic); this condition should be differentiated from “pure” or “isolated” EH, in which headache/migraine is the sole epileptic manifestation (requiring differential diagnosis from other headache forms). “Hemicrania epileptica” (if confirmed) is a very rare variant of EH, characterized by ipsilateral location of headache and ictal EEG paroxysms. (B) “Pre-ictal migraine” and “pre-ictal headache”: when a headache attack is followed during, or shortly after, by a typical epileptic seizure. The migraine attack may be with or without aura, and its seizure-triggering role (“migraine-triggered seizure”) is still a subject of debate. A differentiation from occipital epilepsy is mandatory. The term “migralepsy” has not been used uniformly, and may therefore led to misinterpretation.ConclusionsOn the basis of this review we suggest definitions and a terminology which may become the basis of a forthcoming classification of headaches associated with epileptic seizures.     

Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendations

The use of instrumental examinations in headache patients varies widely. In order to evaluate their usefulness, the most common instrumental procedures were evaluated, on the basis of evidence from the literature, by an EFNS Task Force (TF) on neurophysiological tests and imaging procedures in non-acute headache patients. The conclusions of the TF regarding each technique are expressed in the following guidelines for clinical use. 1 Interictal electroencephalography (EEG) is not routinely indicated in the diagnostic evaluation of headache patients. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic and basilar migraine. 2 Recording of evoked potentials is not recommended for the diagnosis of headache disorders. 3 There is no evidence to justify the recommendation of autonomic tests for the routine clinical examination of headache patients. 4 Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pressure algometry and electromyography (EMG) cannot be recommended as clinical diagnostic tests. 5 In adult and paediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological signs or symptoms, the routine use of neuroimaging is not warranted. In patients with atypical headache patterns, a history of seizures and/or focal neurological signs or symptoms, magnetic resonance imaging (MRI) may be indicated. 6 If attacks can be fully accounted for by the standard headache classification [International Headache Society (IHS)], a positron emission tomography (PET) or single-photon emission computerized tomography (SPECT) and scan will generally be of no further diagnostic value. 7 Nuclear medicine examinations of the cerebral circulation and metabolism can be carried out in subgroups of headache patients for diagnosis and evaluation of complications, when patients experience unusually severe attacks, or when the quality or severity of attacks has changed. 8 Transcranial Doppler examination is not helpful in headache diagnosis. Although many of the examinations described are of little or no value in the clinical setting, most of the tools have a vast potential for further exploring the pathophysiology of headaches and the effects of pharmacological treatment.     

Ictal epileptic headache as "subtle" symptom in generalized idiopathic epilepsy

Epilepsy and migraine are common neurologic chronic disorders with episodic manifestations characterized by recurrent attacks and a return to baseline conditions between attacks. Epilepsy and migraine are frequently observed in comorbidity, with the occurrence of one disorder increasing the probability of the other: Migraine occurs in about one-fourth of patients with epilepsy, whereas epilepsy is present in 8-15% of patients with migraine. The link between headache and seizures is controversial and multifactorial. In epilepsy, headache can be seen as a preictal, ictal, or postictal phenomenon. In this report, we describe a case of a 37-year-old patient, affected by both drug-resistant generalized idiopathic epilepsy and headache, who displayed the sudden onset of a headache attack referred during a 24-h electroencephalography (EEG). The EEG tracing during this event revealed the activation of subcontinuous epileptic activity consisting of generalized spike-wave discharges (GSWDs) and generalized polyspike and wave discharges (GPSWDs) that persisted for 60 min, that is, until the disappearance of the headache. The case we describe appears to be original in that it represents one of the few EEG-documented ictal epileptic headaches in generalized idiopathic epilepsy.     

Hemicrania in children: diagnostic and therapeutic problems (author's transl)

Four children with migraine raised some problems of differential diagnosis (cerebral circulatory disorders; structural brain diseases; or primary psychiatric disorders). Organic lesions were excluded through special investigations (EEG, CAT, Scintigraphy, Angiography etc.). Relationships between migraine and epilepsy in children were considered and the recent literature was reviewed. No agreement was reached on how to evaluate paroxysmal electroencephalograms recorded during migrainous episodes. In a child with personal and family history of migraine suffering from a sudden attack of acute headache accompanied by focal neurological deficits, migraine is the most likely diagnosis. Only if the neurological deficit fails to resolve rapidly (after a few hours), a detailed investigation is necessary (CAT etc.). A paroxysmal electroencephalogram during the attack of migraine does not imply necessarily a diagnosis of epilepsy. Children with history of migraine must be treated with specific anti-migranious drugs even if paroxysmal EEGs are recorded during the migraine attack. It must be remembered that both disorders (i.e. migraine and epilepsy) can exist in the same patient.     

Polymorphism of epilepsy associated with the A3243G mutation of mitochondrial DNA (MELAS): reasons for delayed diagnosis

INTRODUCTION: Mitochondrial disease is a potential diagnosis in patients with epilepsy beginning in childhood or adolescence with a typical polymorphic presentation and preponderant occipital lobe seizures. Diagnosis may however be delayed in some patients with long-standing disease, particularly when cardinal mitochondrial symptoms are missing; clinical manifestations may be dissociated over time leading to genetic diagnostic tests being prescribed long after disease onset. OBSERVATION: We report the case of a 17 year old woman in whom the diagnosis of lipothymic episodes, migraine, idiopathic photo-sensitive generalized epilepsy, and partial occipital epilepsy complicated by occipital epileptic status were successively proposed because of the initial clinical presentation and the slow disease course. Eleven years after disease onset the diagnosis of progressive myoclonic epilepsy was made due to the occurrence of myoclonic jerks with giant SEPs associated with a cerebellar syndrome, deterioration of psychomotor performances and diffuse slowing of EEG activity with pseudo-periodic bursts of delta waves. Genetic analysis showed an A3243G mutation of mitochondrial DNA, usually correlated with the MELAS phenotype, while the clinical presentation of progressive myoclonic epilepsy was more suggestive of MERRF. CONCLUSION: Although each of the symptoms successively observed in this patient has been reported in MELAS, the slow course of the disease, which is unusual in this mutation, the absence of stroke-like episodes, and the polymorphism of the epilepsy all contributed to delayed final diagnosis.