The Eleventh International Annual Meeting
Of Syrian Pediatricians Society.
Damascus 19- 21 Oct. 1999

Occipital Spikes In Migraine Suppressed By Eyes
Opening Like Benign occipital Epilepsy.

Purpose: The Purpose Of This Abstract Is To Support An Old Interesting Point That The EEG May Not Differentiate Between Epilepsy And Migraine; And To Report For The First Time That The Interictal Occipital Spikes In common Migraine During Closure Of Eyes Will Be Suppressed By Opening Them Like: "Benign Occipital Epilepsy Of Childhood ."

Method: A Twelve Year Old Boy Was Transferred To Me For Refractory "Seizures". The History Started At The Age of Eight years, With Recurrent Diurnal Attacks Of Severe Headache Lasting 24-48 hours, 1-3 Attacks /Month . The Headache That Is Not Preceded By Aura, Is Bifrontal, Sometimes Unitemporal, Throbbing ,Associated With Pallor Sometimes With Abdominal Discomfort, Alleviated By Sleep And Followed By Severe Vomiting, There Is No : Hemiparesis, Visual Manifestations , Brain Stem Signs, Conscious Disturbance, Automatism or Any Convulsive Phenomenon. Since Four Years, This Patient Has Been Treated, Certainly Because His EEG Was Severly Epileptic, By Different Combination of Antiepileptic Drugs (AED) . Including Lamotrigine 300 mg/day Without Response. The Child Has Normal Physical And Neurologic Examination And With Normal Schooling . His Mother That Has A Normal Brain Ct Scan, Has Paroxysmal Attacks Of Alternating Throbbing Temporal Headache With Vomiting Since Several Years. His Brain Ct Scan And MRI Are Normal. The EEG Showed, During Closure Of Eyes, Bursts Of Occipital Spikes And Spike -Waves (4hz) That Disappear On Opening Of Eyes. Extensive Laboratory Data Were Negative . So I Put The Patient Just Under Cyproheptadine (4mg) 3 Times /Day With Complete Recovery For Six Months. Then Treatment Was Stopped With Recrudescence of The Attacks Within Two Months. So Cyproheptadine Was Resumed Giving This Time Also A Full Response. This "Challenge Test" Has Been Repeated By The Mother Her Self, Three Times With The Same Results .

Discussion: Migraine And Epilepsy Have Overlaping Symptoms, Risk Factors , Brain Mechanisms And Treatments. The Clinical History Is The Most Important Tool In Differentiating Between Migraine Without Aura And Epilepsy. When Tonic Or Clonic Movements Are Absent, Differentiating Migraine With Aura From Epilepsy Can Be Difficult. The Characteristics Of The Aura May Help: The Aura Usually Lasts Longer Than 5 Minutes In Migraine And Less Than 1 Minute In Epilepsy. EEGs Recorded During A Migraine With Aura, Unlike Those Recorded During Epileptic Seizures, Are Usually Normal . Basilar Migraine May Be Difficult To Differentiate From Simple Or Complex Partial Seizures. Acute Migraine Confusional State May Occur During Complex Partial Seizures And In The Postictal State.

Conclusion: In Typical Patients, The Clinical History Usually Allows To Differentiate Migraine From Epilepsy. In More Complex Cases EEG And 24h Video -EEG Recording Can Help Separation Between Migraine And Epilepsy. However The Present Case Shows That The EEG In Common Migraine Can Behave As Benign Occipital Epilepsy.