Migraine triggered by epileptic discharges in a Rasmussen's encephalitis patient after surgery

Area of Science:

• Neurology
• Epileptology
• Pediatric Neurology

Background:

• Rasmussen's encephalitis is a rare autoimmune disease causing progressive neurological deficits.
• Disconnective surgery is a treatment option for severe, medically intractable epilepsy associated with Rasmussen's encephalitis.
• Post-surgical complications, such as migraines, require thorough investigation.

Observation:

• A 9-year-old child, 2 years post-disconnective surgery for Rasmussen's encephalitis, developed severe, unilateral migraines.
• Video/EEG monitoring during migraine attacks revealed ictal discharges in the affected, disconnected hemisphere.
• These ictal discharges and migraines resolved with intravenous diazepam administration.

Findings:

• A strong correlation was observed between migraine episodes and electroencephalogram (EEG) ictal discharges on the operated side.
• Subclinical ictal discharges were infrequent during migraine-free periods, suggesting a link between migraine and epileptiform activity.
• The findings suggest a potential neuronal pathway, possibly involving cortical depression, linking post-surgical changes to migraine pathogenesis.

Implications:

• This case highlights a potential link between post-surgical epileptiform activity and migraine in patients with Rasmussen's encephalitis.
• Further research into neuronal mechanisms underlying post-surgical migraines is warranted.
• Understanding this association may lead to improved management strategies for neurological sequelae after epilepsy surgery.