Ophthalmoplegic migraine with isolated third cranial nerve palsy in a known case of juvenile myoclonic epilepsy

Abstract

Among the various forms of migraine headaches, ophthalmoplegic migraine is an uncommon and rare form, the incidence of which is approximately 0.7 per million. It presents predominantly with headache and ophthalmoplegia. One of more cranial nerves can be affected, however the third cranial nerve is most often affected. As a result, symptoms wise, mydriasis and ptosis are commonly seen. Patients generally recover completely within a few days or weeks, however residual deficits are known to occur in a minority of patients. One of the common generalised epilepsy syndromes is the juvenile myoclonic epilepsy (JME), its prevalence being roughly up to 10% of all patients with epilepsy. It usually begins in the second decade of life. Generalised tonic-clonic seizures myoclonic jerks absences constitute the main seizure types in JME. Studies indicate a definite association of epilepsy with migraine headaches and a significant number of migraneurs are found to be epileptic. Conversely, patients with epilepsy are two times more likely to have migraine, as compared to their first degree relatives without migraine. We report a known case of a female patient of JME having a history of classical migraine with aura presenting to us with headache and ophthalmoplegia. She was extensively evaluated to rule out other causes of isolated third cranial nerve palsy, with all the investigations being negative for any obvious cause. She was treated with non-steroidal anti-inflammatory drugs for the acute attack and was subsequently put on antimigraine medication, propranolol during her hospital stay, with which her ptosis recovered completely after 2 weeks. The patient was later started on tablet divalproex sodium, which the patient continues to take on a long-term basis, especially because of its efficacy as an antimigraine prophylaxis agent and a potent drug against JME.

Proposed modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy: Five case reports and literature review

“…As shown in Table 1, the demographic and medical characteristics of the cases in our clinic along with the reported cases from other studies that were diagnosed as OM or RPON from 2000 to 2020 were reviewed (4–6,9–15,19–59). From the database, most reported cases were from the USA, India, Japan, and European countries (e.g.…”

“…A total of 70 patients reported this interval (Figure 4). Only two of them initially had ophthalmoplegia followed by the headache in a very short time (39,46). The other 67 patients got ophthalmoplegia concurrently or within 1 week after the headache attack (concurrently: Five cases; within one day: 20 cases; 1–4 days: 20 cases; 4–7 days: 22 cases).…”

Recurrent Headache With Diplopia: A Common Presentation of an Uncommon Entity

“…The oculomotor nerve is reported to be the most frequently affected nerve in RPON, followed by abducens and trochlear nerves [8]. This has been suggested to be due to the porous nature of the oculomotor nerve's blood-nerve barrier [9].…”

Ophthalmople gic cranial neuropathy: clinical case

“…К л и н и ч е с к и е н а б л ю д е н и я нескольких дней или недель, иногда с формированием резидуального неврологического дефицита [5].…”

“…Этиология и патогенез данного синдрома не установлены. Есть предположения, что патология носит демиелинизирующий характер, что подтверждается накоплением контрастного вещества зрительным нервом при проведении магнитно-резонансной томографии (МРТ) и эффективностью кортикостероидов при лечении некоторых пациентов [5].…”