Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China

Zhang, Lin; Zhu, Xiongwei; Qiu, Xiangmiao; Li, Yajiao; Chen, Yu‐Cheng; Wang, Hui; He, Shixu; Lai, Wanlin; Peng, Anjiao; Ning, MingMing; Chen, Lei

doi:10.1136/bmjopen-2018-024144

Cited by 6 publications

(13 citation statements)

References 30 publications

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“…Consistently, several clinical reports have described improved symptoms of OSA and migraine, artery stiffness and vasodilation, nocturnal oxygenation, and overall quality of life after closure of RLS 50,51 . Interestingly, it has also been reported that the frequency of seizures in three PWEs with migraine decreased significantly after PFO closure 11 . Based on our analyses, RLS could be a prognostic or predictive biomarker of DRE and the detection of RLS could influence the decision‐making for PWEs with DRE.…”

Section: Discussionsupporting

confidence: 88%

“…Nowadays, it has been found that the high prevalence of RLS was correlated with the commodity of migraine in PWEs, which could be an underlying cause of migraine in PWEs 11 . Epilepsy is often comorbid with migraine, and they share similar symptom profiles, treatment options, and common pathogenic mechanisms, such as hypoxia, CSD, and microthrombi 12,13 .…”

Section: Introductionmentioning

confidence: 99%

“…PWEs concomitant with migraine also have higher incidence of drug resistance and psychiatric disorders 15 . It has also been suggested that treatment for RLS was effective in reducing frequency of seizures and headache attacks in PWE with migraine 11 . Nevertheless, the characteristics of epilepsy have never been investigated in PWEs with and without RLS.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between right‐to‐left shunt, hypoxia, and epilepsy

Dong

et al. 2023

Epilepsia Open

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Objective: A right-to-left shunt (RLS) can mediate the hypoxic state, and hypoxemia is relevant for the development of drug-resistant epilepsy (DRE). The objective of this study was to identify the relationship between RLS and DRE and further investigate the contribution of RLS to the oxygenation state in patients with epilepsy (PWEs). Methods:We performed a prospective observational clinical study of PWEs who underwent contrast medium transthoracic echocardiography (cTTE) between January 2018 and December 2021 at West China Hospital. The collected data included demographics, clinical features of epilepsy, antiseizure medications (ASMs), RLS identified by cTTE, electroencephalography (EEG), and magnetic resonance imaging (MRI). Arterial blood gas was also assessed in PWEs with or without RLS. The association between DRE and RLS was quantified using multiple logistic regression, and the parameters of oxygen levels were furtherly analyzed in PWEs with or without RLS.Results: A total of 604 PWEs who completed cTTE were included in the analysis, of which 265 were diagnosed with RLS. The proportion of RLS was 47.2% in the group of DRE, and the proportion of RLS was 40.3% in the group of non-DRE.Having RLS was associated with DRE in multivariate logistic regression analysis (adjusted OR = 1.53, P = 0.045). In the analysis of blood gas, the partial oxygen pressure in PWEs with RLS was lower than those without RLS (88.74 mmHg versus 91.84 mmHg, P = 0.044).

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship between right‐to‐left shunt, hypoxia, and epilepsy

Dong

et al. 2023

Epilepsia Open

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“…The studies included in this systematic review were published between 2004 and 2019 and the sample size ranging between 86 in Turkey and 1109 in China. Of 17 studies included the final meta-analysis, one from the USA [34], one from India [35], three from Iran [36][37][38], one from Japan [26], one from Taiwan [35], one from Italy [36], three from China [25,39,40], one from Turkey [41], one from Lithuania [42], one from Montenegro [43], one from Bangladesh [44] and two from Egypt [45,46]. Regarding types of headaches assessed among patients with epilepsy, nine studies assessed tension-type headache, fifteen studies assessed migraine with aura, three studies assessed migraine without aura, and seven studies assessed both Ictal headache (IH) and Postictal headache (PIH).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

The epidemiology of headaches among patients with epilepsy: a systematic review and meta-analysis

2020

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Background: Headache is the symptom of pain in the face, head or neck that causes disability in most people with medical and neurological disorders. It frequently co-occurs with most chronic diseases such as epilepsy and significantly impacts the quality of life. However, epidemiologic data from different studies showed different rates of prevalence. Therefore, we conducted this review to summarize the available epidemiologic evidence on the topic and formulate recommendations for future research and clinical practice. Methods: We followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. We systematically searched the literature using popular databases such as PubMed, EMBASE, Psych-INFO, and SCOPUS. We further scanned the reference lists of the eligible studies to supplement our electronic search. The Comprehensive Meta-Analysis software version 3.0 (CMA 3.0) was used to conduct a meta-analysis. Subgroup and sensitivity analysis were performed and Cochran's Q-and the I 2-test were used to assess the source of heterogeneity. The funnel plot and Egger's regression tests were used to assess potential publication bias. Results: A total of 17 studies conducted both in developed and developing countries including 5564 study participants were combined in this meta-analysis. The pooled estimated prevalence of headache among patients with epilepsy was 48.4%. The pooled estimated prevalence of Inter-Ictal headache (IIH) (42.2%) and Postictal headache (PIH) (43.1%) were higher when compared to tension-type headache (TTH) (26.2%), migraine with aura (26.0%) and migraine without aura (10.4%). The pooled prevalence of headache was 50.6% and 49.5% for developed and developing countries respectively. The pooled prevalence of headache among patients with epilepsy was considerably higher among females (63.0%) when compared to males (33.3%). Moreover, the pooled estimated prevalence of headache among patients with epilepsy was ranging from 46.0% to 52.2% in a leave-one-out sensitivity analysis. Conclusion: The pooled estimated prevalence of headache among patients with epilepsy was considerably high (48.4%). Screening and appropriate management of headaches among patients with epilepsy are warranted.

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“…Epilepsy–migraine comorbidities are classified into epileptic migraine, pre-seizure migraine, post-seizure migraine, and inter-epileptic migraine. Among them, migraine after a seizure is the most common [ 7 , 8 ]. Compared with ordinary patients with epilepsy, the epilepsy symptoms of patients with epilepsy–migraine comorbidity are more difficult to alleviate, and the quality of life will be further reduced [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Downregulation of GABAARα1 Aggravates Comorbidity of Epilepsy and Migraine via the TLR4 Signaling Pathway

Ding

Gong

et al. 2022

Brain Sciences

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Epilepsy and migraine are among the most prevalent neurological disorders. By being comorbid, the presence of one disorder increases the likelihood of the other. Although several similar clinical features of epilepsy and migraine have been observed as early as the 19th century, only in recent years have researchers engaged in finding a common pathogenic mechanism between them. In this study, the epilepsy–migraine comorbidity rat model was generated, and the pathophysiological basis of epilepsy–migraine comorbidity was examined. Male rats were divided into four groups: control, migraine, epilepsy, epilepsy–migraine comorbidity. After establishing the models, the amount of scratching and the pain threshold of the rats were observed. Western blot and immunofluorescence staining were used to detect the protein expression levels of TLR4 and GABAARα1 in the temporal cortex, hippocampus, trigeminal ganglion, and medullary dorsal horn. Subsequently, co-immunoprecipitation of GABAARα1 and TLR4 was performed. Then, the rats were divided into three groups: comorbidity, comorbidity + TAK-242, and comorbidity + muscimol. After drug intervention, the seizure latency, seizure level, amount of scratching, and pain threshold were observed. Western blot was used to detect the protein expression levels of TLR4 and GABAARα1 in the temporal cortex, hippocampus, trigeminal ganglion, and medullary dorsal horn. Our results demonstrate that the seizure attacks in comorbidity and epilepsy groups performed severely, and the comorbidity and migraine groups displayed a remarkable increase in the amount of head-scratching and a noticeable decrease in the facial mechanical withdrawal threshold. Further analysis revealed considerably increased Toll-like receptor 4 (TLR4), associated with reduced γ-aminobutyric acid type A receptor α1 (GABAARα1) and microglia enhanced in the epilepsy–migraine comorbidity rat. Additionally, co-immunoprecipitation proved GABAARα1 binding TLR4. Following muscimol to activate GABAARα1, seizure attacks and migraine-like behavior were rescued. GABAARα1 level increment was accompanied by the decline of TLR4, while TAK-242, the inhibitor of TLR4, only decreased TLR4 without affecting GABAARα1 expression. It also ameliorated the migraine-like behavior with no impact on seizure activity. We propose that GABAARα1 binding and negatively regulating TLR4 contribute to epilepsy–migraine comorbidity; TLR4 is a critical intermediate link in epilepsy–migraine comorbidity; immune-induced neuroinflammation in microglia may be involved in migraine and epilepsy–migraine comorbidity.

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Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China

Cited by 6 publications

References 30 publications

Relationship between right‐to‐left shunt, hypoxia, and epilepsy

Relationship between right‐to‐left shunt, hypoxia, and epilepsy

The epidemiology of headaches among patients with epilepsy: a systematic review and meta-analysis

Downregulation of GABAARα1 Aggravates Comorbidity of Epilepsy and Migraine via the TLR4 Signaling Pathway

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