Pasquale Parisi1, Alberto Verrotti2, Paola Costa3, Pasquale Striano4, Caterina Zanus3, Marco Carrozzi3, Umberto Raucci5, Maria Pia Villa6, Vincenzo Belcastro7. 1. Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy. Electronic address: pasquale.parisi@uniromal.it. 2. Department of Pediatrics, University of Perugia, Perugia, Italy. 3. Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy. 4. Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy. 5. Emergency Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy. 6. Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy. 7. Neurology Clinic, Department of Neuroscience, Sant'Anna Hospital, Como, Italy.
Abstract
PURPOSE: When we published the diagnostic criteria for "ictal epileptic headache" in 2012, we deliberately and consciously chose to adopt restrictive criteria that probably underestimate the phenomenon, rather than spread panic among patients and physicians who are reluctant to accept this entity. METHODS: Here we discuss four intriguing clinical cases to highlight why we believe, to this day, that it is necessary to follow these restrictive diagnostic criteria. CONCLUSIONS: EEG is not recommended as a routine examination for children diagnosed with headache, but it is mandatory and must be carried out promptly in cases of prolonged headache that does not respond to antimigraine drugs, if epilepsy is suspected or has been diagnosed previously. This is not a marginal or irrelevant question because possible isolated, non-motor, ictal manifestations should be taken into account before declaring that an epileptic patient is "seizure free" so as to ensure that any decision taken to suspend anticonvulsant therapy is safe.
PURPOSE: When we published the diagnostic criteria for "ictal epilepticheadache" in 2012, we deliberately and consciously chose to adopt restrictive criteria that probably underestimate the phenomenon, rather than spread panic among patients and physicians who are reluctant to accept this entity. METHODS: Here we discuss four intriguing clinical cases to highlight why we believe, to this day, that it is necessary to follow these restrictive diagnostic criteria. CONCLUSIONS: EEG is not recommended as a routine examination for children diagnosed with headache, but it is mandatory and must be carried out promptly in cases of prolonged headache that does not respond to antimigraine drugs, if epilepsy is suspected or has been diagnosed previously. This is not a marginal or irrelevant question because possible isolated, non-motor, ictal manifestations should be taken into account before declaring that an epilepticpatient is "seizure free" so as to ensure that any decision taken to suspend anticonvulsant therapy is safe.
Authors: Prisca R Bauer; Else A Tolner; Mark R Keezer; Michel D Ferrari; Josemir W Sander Journal: Nat Rev Neurol Date: 2021-07-26 Impact factor: 42.937
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