Basilar migraine, seizures, and severe epileptiform EEG abnormalities

Four adolescents had basilar migraine, infrequent cerebral seizures, and severe EEG abnormalities. The clinical course was benign, with normal personality, mentation, and neurologic examination. Almost continuous EEG abnormalities, consisting of rhythmic temporo-occipital sharp and slow wave discharges, or generalized spike and wave complexes, were seen in serial recordings. The rare seizures, either focal or generalized, usually followed a migrainous aura and seemed to be readily controlled with anticonvulsant medication. The complex relationship between classical migraine and epilepsy is illustrated by this syndrome; recognition of its relatively benign course may prevent unnecessary investigation and undue alarm.