Migraine Aura Lasting 1–24 h in Children: A Sequence of EEG Slow-Wave Abnormalities Vs. Vascular Events

Abstract

The aim of this study was to describe the abnormalities associated with migraine aura lasting 1-24 h in children as shown by EEG, trancranial Doppler (TCD) and single photon emission computed tomography (SPECT). In this retrospective study, 11 patients each underwent EEG, TCD and brain SPECT on the day of admission and the day thereafter. On the day of admission, the migrainous hemisphere of all patients showed that the mean velocities were decreased in the middle cerebral artery by TCD, slow-wave abnormalities were recorded after several hours of aura by EEG and the SPECT showed hypoperfusion. On the day after, in the same hemisphere, slow waves were recorded only in the occipital area by EEG, and SPECT showed slight hyperperfusion. In these patients, there was a clear sequence of EEG, TCD and SPECT abnormalities.

Migraine and Epilepsy: Review of the Literature

“…There is relative lack of recent literature treating the syndrome specifically, but there do appear to be patients, particular children, in whom focal or otherwise localizing neurological signs and headache are relatively minor, and a change in mental state is the principal sign or symptom of migraine . EEG abnormalities are bilateral …”

“…Functional neuroimaging with PET and SPECT is clearly useful in the localization of seizure foci and guiding the surgical treatment of epilepsy; but whether such studies aid in the differential diagnosis of migraine and epilepsy, or in guiding medical therapy for either condition, is much less certain. As noted earlier, during acute migraine, PET scan shows cerebral hypoperfusion, whereas in migraine with complicated neurological features, SPECT may show bilateral or unilateral hypoperfusion that correlates with EEG findings . It is possible that in the right clinical setting, functional imaging studies and EEG may give confirmatory evidence of a particular migraine syndrome.…”

“…102,103 EEG abnormalities are bilateral. 104 Alternating Hemiplegia of Childhood.-This complicated neurodevelopmental disorder is characterized by recurrent episodes of hemiplegia lasting from minutes to days and alternating between the sides. 105 Abnormal ocular movements, seizures, and dystonia have also been described.Attacks begin in the first 1-2 years of life, and any cases appear to be sporadic, whereas others are clearly genetic and overlap with hemiplegic migraine.…”

“…101 However, most migraine is not associated with EEG changes, and EEG is not recommended for the assessment of adult or pediatric migraine in the absence of other neurological symptoms and signs. 135 Functional neuroimaging with PET and SPECT is clearly useful in the localization of seizure foci and guiding the surgical treatment of epilepsy; 104,136 but whether such studies aid in the differential diagnosis of migraine and epilepsy, or in guiding medical therapy for either condition, is much less certain. As noted earlier, during acute migraine, PET scan shows cerebral hypoperfusion, whereas in migraine with complicated neurological features, SPECT may show bilateral or unilateral hypoperfusion that correlates with EEG findings.…”

“…As noted earlier, during acute migraine, PET scan shows cerebral hypoperfusion, whereas in migraine with complicated neurological features, SPECT may show bilateral or unilateral hypoperfusion that correlates with EEG findings. 68,104 It is possible that in the right clinical setting, functional imaging studies and EEG may give confirmatory evidence of a particular migraine syndrome.…”