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Türk BG, Yeni SN, Atalar AÇ, Ekizoğlu E, Gök DK, Baykan B, Özge A, Ayta S, Erdoğan FF, Taşdelen B, Velioğlu SK. Exploring shared triggers and potential etiopathogenesis between migraine and idiopathic/genetic epilepsy: Insights from a multicenter tertiary-based study. Clin Neurol Neurosurg 2024; 237:108146. [PMID: 38367542 DOI: 10.1016/j.clineuro.2024.108146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Migraine and epilepsy are two episodic disorders that share common pathophysiological mechanisms. The aim of our research was to assess the possible shared etiopathogenesis by analyzing the relations of headache, and seizure triggers, based on information obtained from a national cohort surveying the headache characteristics of 809 patients who had been diagnosed with idiopathic/genetic epilepsy. MATERIAL AND METHODS Our study utilized data from a multi-center, nationwide investigation of headaches in 809 patients with idiopathic/genetic epilepsy. Out of these, 508 patients reported complaints related to any type of headache (333 Migraines, 175 Headaches of other types). In the initial phase of the study encompassing the entire sample of 809 epilepsy patients, differences in seizure triggers were assessed between the migraine group (n = 333) and the non-migraine group (n = 476). Additionally, the subsequent part of the study pertains to a subgroup of the entire patient group, namely those affected by all types of headaches (n = 508), and differences in headache triggers were assessed among migraine patients (n = 333) and those with other types of headaches (n = 175). Similar differences were observed between epilepsy patients with and without a family history of epilepsy. RESULTS The most frequently reported seizure triggers in all I/GE group (n = 809) were stress (23%), sleep deprivation (22%) and fatigue (18%), respectively. The most frequently reported headache triggers in migraine patients were stress (31%), sleep deprivation (28%), and noise (26%). The occurrence of menstruation-triggered seizures in individuals with migraine and I/GE was found to be considerably higher than those without migraine. The most common triggers for seizure and headache among the individuals with a positive family history of epilepsy were determined to be light stimuli and sleep deprivation. CONCLUSION In conclusion, our study provides valuable insights into the overlapping triggers including sleep patterns, stress levels, and menstrual cycles, etc. and potential shared etiology of migraine and I/GE. Recognizing these connections may facilitate the development of more precise therapeutic strategies and underscore the significance of adopting a holistic, multidisciplinary approach to the management of these intricate neurological conditions. Further research is essential to explore in greater depth the shared mechanisms underpinning these associations and their implications for clinical practice.
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Affiliation(s)
- Bengi Gül Türk
- Istanbul University-Cerrahpasa, Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey.
| | - Seher Naz Yeni
- Istanbul University-Cerrahpasa, Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey
| | - Arife Çimen Atalar
- University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Esme Ekizoğlu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey
| | - Duygu Kurt Gök
- Erciyes University, Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Kayseri, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey
| | - Aynur Özge
- Mersin University School of Medicine, Department of Neurology, Algology and Clinical Neurophysiology, Mersin, Turkey
| | - Semih Ayta
- University of Health Sciences, Haseki Training and Research Hospital, Department of Pediatrics, Child Neurology Unit, Istanbul, Turkey
| | - Füsun Ferda Erdoğan
- Erciyes University, Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Kayseri, Turkey
| | - Bahar Taşdelen
- Mersin University School of Medicine, Department of Biostatistics and Medical Informatics, Mersin University, Mersin, Turkey
| | - Sibel K Velioğlu
- Karadeniz Technical University Medical Faculty, Department of Neurology, Clinical Neurophysiology Unit, Trabzon, Turkey
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Asadi-Pooya AA, Brigo F, Lattanzi S, Blumcke I. Adult epilepsy. Lancet 2023; 402:412-424. [PMID: 37459868 DOI: 10.1016/s0140-6736(23)01048-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 07/31/2023]
Abstract
Epilepsy is a common medical condition that affects people of all ages, races, social classes, and geographical regions. Diagnosis of epilepsy remains clinical, and ancillary investigations (electroencephalography, imaging, etc) are of aid to determine the type, cause, and prognosis. Antiseizure medications represent the mainstay of epilepsy treatment: they aim to suppress seizures without adverse events, but they do not affect the underlying predisposition to generate seizures. Currently available antiseizure medications are effective in around two-thirds of patients with epilepsy. Neurosurgical resection is an effective strategy to reach seizure control in selected individuals with drug-resistant focal epilepsy. Non-pharmacological treatments such as palliative surgery (eg, corpus callosotomy), neuromodulation techniques (eg, vagus nerve stimulation), and dietary interventions represent therapeutic options for patients with drug-resistant epilepsy who are not suitable for resective brain surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany; Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Iba C, Ohtani S, Lee MJ, Huh S, Watanabe N, Nakahara J, Peng KP, Takizawa T. Migraine triggers in Asian countries: a narrative review. Front Neurol 2023; 14:1169795. [PMID: 37206912 PMCID: PMC10189151 DOI: 10.3389/fneur.2023.1169795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 05/21/2023] Open
Abstract
Background Migraine is one of the most common neurological disorders worldwide. Clinical characteristics of migraine may be somewhat different across ethnic groups. Although factors such as stress, lack of sleep, and fasting are known as migraine triggers, the discussion about geographical differences of migraine triggers in Asia is lacking. Methods In this study, we performed a narrative review on migraine triggers in Asia. We searched PubMed for relevant papers published between January 2000 and February 2022. Results Forty-two papers from 13 Asian countries were included. Stress and sleep are the most frequently reported migraine triggers in Asia. There were some differences in migraine triggers in Asian countries: fatigue and weather common in Eastern Asia and fasting common in Western Asia. Conclusion Majority of the common triggers reported by patients with migraine in Asia were stress and sleep, similar to those reported globally, thus showing they are universally important. Some triggers linked to internal homeostasis are influenced by culture (e.g., alcohol, food/eating habit), and triggers related to environmental homeostasis, such as weather, are highly heterogenous between regions.
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Affiliation(s)
- Chisato Iba
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Seiya Ohtani
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunjun Huh
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Narumi Watanabe
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tsubasa Takizawa
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
- *Correspondence: Tsubasa Takizawa
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Amianto F, Davico C, Bertino F, Bartolini L, Vittorini R, Vacchetti M, Vitiello B. Clinical and Instrumental Follow-Up of Childhood Absence Epilepsy (CAE): Exploration of Prognostic Factors. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101452. [PMID: 36291387 PMCID: PMC9600757 DOI: 10.3390/children9101452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
Background: Idiopathic generalized epilepsies (IGEs) represent 15−20% of all cases of epilepsy in children. This study explores predictors of long-term outcome in a sample of children with childhood absence epilepsy (CAE). Methods: The medical records of patients with CAE treated at a university paediatric hospital between 1995 and 2022 were systematically reviewed. Demographics and relevant clinical data, including electroencephalogram, brain imaging, and treatment outcome were extracted. Outcomes of interest included success in seizure control and seizure freedom after anti-seizure medication (ASM) discontinuation. An analysis of covariance using the diagnostic group as a confounder was performed on putative predictors. Results: We included 106 children (age 16.5 ± 6.63 years) with CAE with a mean follow-up of 5 years. Seizure control was achieved in 98.1% (in 56.6% with one ASM). Headache and generalized tonic-clonic seizures (GTCS) were more frequent in children requiring more than one ASM (p < 0.001 and p < 0.002, respectively). Of 65 who discontinued ASM, 54 (83%) remained seizure-free, while 11 (17%) relapsed (mean relapse time 9 months, range 0−18 months). Relapse was associated with GTCS (p < 0.001) and number of ASM (p < 0.002). Conclusions: A history of headache or of GTCS, along with the cumulative number of ASMs utilized, predicted seizure recurrence upon ASM discontinuation. Withdrawing ASM in patients with these characteristics requires special attention.
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Affiliation(s)
- Federico Amianto
- Neurosciences Department, Psychiatry Section, Service for Eating Disorders, University of Torino, Via Cherasco 11, 10126 Turin, Italy
- Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126 Turin, Italy
| | - Chiara Davico
- Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126 Turin, Italy
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, P.zza Polonia 94, 10126 Torino, Italy
- Correspondence: ; Tel.: +39-011-3135248; Fax: +39-011-3135439
| | - Federica Bertino
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, P.zza Polonia 94, 10126 Torino, Italy
| | - Luca Bartolini
- Hasbro Children’s Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Roberta Vittorini
- Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126 Turin, Italy
| | - Martina Vacchetti
- Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126 Turin, Italy
| | - Benedetto Vitiello
- Department of Pediatrics, Regina Margherita Pediatric Hospital, 10126 Turin, Italy
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, P.zza Polonia 94, 10126 Torino, Italy
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