Track: 18. Case Studies
Virginia Tech Carilion Clinic
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, which are classified by the ICHD-III as a complication of migraine with aura attack. Although already reported in the literature for more than fifty years, a number of questions remain unanswered with respect to differentiating between migraine-triggered seizures and ictal epileptic headaches, particularly when originating from the occipital lobe and presenting with visual hallucinations.
A 55 year old man with a 30-year history of migraine without aura presented with a new onset lancinating left parietal pain accompanied by visual disturbances occurring up to 20 times per day. His visual distortions involved "wavy quality" to his visual field with an associated kaleidoscopic pattern, flashes of shadows, and a right superior quadrantanopia lasting 20 minutes. In addition, he described discrete two-minute episodes of scintillating scotomas with an abrupt onset and offset described as seeing flashing red and green circles in his right visual field. Ictal EEG demonstrated a left occipital onset focal aware seizure which correlated with onset and end of his clinical symptoms [visual perception of seeing flashing red and green circles]. 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 a source of confusion for practitioners as there is much overlap in clinical manifestations of these entities. EEG should be obtained when there is clinical suspicion of ictal features present in patients presenting with headache.
Funding: Please list any funding that was received in support of this abstract.: This is a case report. No funding was required.