Elisabeth Hartl1, Jose Angel Gonzalez-Victores2, Jan Rémi1, Christoph J Schankin3, Soheyl Noachtar1. 1. Department of Neurology, Epilepsy Center, University of Munich, Munich, Germany. 2. Department of Neurology, University of Regensburg, Regensburg, Germany. 3. Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Abstract
OBJECTIVE: To evaluate the characteristics of visual auras (VA) in epilepsy and migraine. BACKGROUND: Both disorders are usually diagnosed on clinical grounds, but differentiation might be challenging in isolated auras or because of the similar presentation in migraine and epilepsy. METHODS: A retrospective study of two cohorts was performed to compare the VA characteristics of 27 epilepsy patients and 27 age-matched migraine patients. RESULTS: The duration of VA was significantly shorter in epilepsy (median: 56s; 1st quartile Q1: 26s; 3rd quartile Q3: 130s) than in migraine (20 min; Q1: 10 min; Q3: 30 min) (P < .0001). A cutoff duration of ≥5 minutes identified all migraine patients (100% sensitivity, 92% specificity). VAs of epileptic etiology were characterized by restriction to a visual hemifield (74.1% vs 29.6% in migraine, P = .0024) with stereotypic affection of one hemifield (55.5% vs 7.4% in migraine, P = 0.0003). Centrifugal or centripetal spread of visual phenomena only occurred in migraine (37.0%), but not in epilepsy (P = 0.0007). If present, accompanying symptoms such as nausea/vomiting (19/27) or photo-/phonophobia (17/27) identify migrainous auras (vs 0/27 in the epilepsy patients; P < .0001). Headache presented in all migraine patients, but was also observed in six of the epilepsy patients during cephalic auras or the postictal phase (P < .0001). None of the visual migrainous auras evolved into an epileptic seizure, a concept called migralepsy. CONCLUSIONS: Several clinical characteristics differentiate VA of epileptic and migrainous origin - if presenting in classical manner. Additional EEG evaluations should be performed in patients with VA of unclear etiology and epileptic VA features added to current classifications to increase their discriminatory power.
OBJECTIVE: To evaluate the characteristics of visual auras (VA) in epilepsy and migraine. BACKGROUND: Both disorders are usually diagnosed on clinical grounds, but differentiation might be challenging in isolated auras or because of the similar presentation in migraine and epilepsy. METHODS: A retrospective study of two cohorts was performed to compare the VA characteristics of 27 epilepsypatients and 27 age-matched migrainepatients. RESULTS: The duration of VA was significantly shorter in epilepsy (median: 56s; 1st quartile Q1: 26s; 3rd quartile Q3: 130s) than in migraine (20 min; Q1: 10 min; Q3: 30 min) (P < .0001). A cutoff duration of ≥5 minutes identified all migrainepatients (100% sensitivity, 92% specificity). VAs of epileptic etiology were characterized by restriction to a visual hemifield (74.1% vs 29.6% in migraine, P = .0024) with stereotypic affection of one hemifield (55.5% vs 7.4% in migraine, P = 0.0003). Centrifugal or centripetal spread of visual phenomena only occurred in migraine (37.0%), but not in epilepsy (P = 0.0007). If present, accompanying symptoms such as nausea/vomiting (19/27) or photo-/phonophobia (17/27) identify migrainous auras (vs 0/27 in the epilepsypatients; P < .0001). Headache presented in all migrainepatients, but was also observed in six of the epilepsypatients during cephalic auras or the postictal phase (P < .0001). None of the visual migrainous auras evolved into an epilepticseizure, a concept called migralepsy. CONCLUSIONS: Several clinical characteristics differentiate VA of epileptic and migrainous origin - if presenting in classical manner. Additional EEG evaluations should be performed in patients with VA of unclear etiology and epileptic VA features added to current classifications to increase their discriminatory power.
Authors: Anam Hareem; Mahsa Pahlavanzadeh; Nicholas E Calvo; Sanaz Monjazeb; Chinekwu Anyanwu Journal: Front Neurol Date: 2022-08-11 Impact factor: 4.086
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