Case report: An EEG captured case of migralepsy/migraine aura-triggered seizures

Area of Science:

• Neurology
• Epileptology
• Neuroscience

Background:

• Migraine and epilepsy are common chronic neurological disorders characterized by transient cerebral dysfunction.
• Migralepsy, a proposed term, defines epileptic seizures triggered by migraine with aura, classified under the ICHD-III.
• Distinguishing between migralepsy and other syndromes with overlapping features can be challenging for clinicians.

Observation:

• A 55-year-old man with a 30-year history of migraine without aura presented with new-onset left parietal pain and frequent visual disturbances.
• The patient experienced visual distortions including kaleidoscopic vision, flashes of shadows, and right superior quadrantanopia, lasting up to 20 minutes.
• Ictal electroencephalography (EEG) revealed a left occipital onset focal aware seizure correlating with his reported symptoms.

Findings:

• The case highlights a patient with migraine history experiencing symptoms consistent with a focal aware seizure.
• Ictal EEG confirmed the epileptic nature of the patient's symptoms, originating from the left occipital region.
• The patient was successfully treated with valproic acid, remaining asymptomatic.

Implications:

• The diagnostic criteria for migralepsy and related syndromes require clarification due to overlapping clinical presentations.
• Electroencephalography (EEG) is recommended for patients experiencing headache with ictal features to aid diagnosis.
• Accurate diagnosis and timely intervention are essential for managing patients with complex migraine and epilepsy comorbidities.