Stroke-like migraine attacks after radiation therapy: A misnomer?

Area of Science:

• Neurology
• Neuro-oncology
• Epileptology

Background:

• Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare condition.
• The role of seizures in SMART syndrome pathophysiology is not well understood.

Purpose of the Study:

• To determine the frequency of electrographic and clinical seizures in patients with SMART syndrome.
• To assess the need for comprehensive electroencephalographic (EEG) monitoring and aggressive seizure management in SMART syndrome.

Main Methods:

• Retrospective review of brain imaging reports (2013-2015) to identify suspected SMART syndrome.
• Application of strict clinical inclusion criteria for adult inpatients with cranial radiation history and acute neurological deficits.
• All identified patients underwent prolonged video EEG monitoring.

Main Results:

• Six patients with suspected SMART syndrome were identified and underwent video EEG monitoring.
• Five out of six patients exhibited multiple or prolonged electrographic seizures, consistent with status epilepticus.
• Neurological deficits and mental status changes improved concurrently with seizure activity resolution.

Conclusions:

• SMART syndrome may be a misnomer, as seizures and status epilepticus appear central to its presentation.
• Systematic continuous EEG monitoring is warranted for patients with suspected SMART syndrome.
• Aggressive seizure management is recommended to shorten symptom duration and improve clinical outcomes.