Episodic syndromes that may be associated with migraine / 中风与神经疾病杂志

Episodic syndromes that may be associated with migraine@#Episodic syndromes that may be associated with migraine are commonly seen in children and are likely to evolve into migraine in the subsequent course of the disease， including several subtypes such as benign paroxysmal torticollis， benign paroxysmal vertigo， and recurrent gastrointestinal disturbance. Understanding the above syndromes has an important clinical significance in the diagnosis of migraine in children.

Migraña Abdominal: variaciones en el diagnóstico y tratamiento entre gastroenterólogos y neurólogos pediatras / Abdominal migraines: variations in diagnosis and care between pediatric gastroenterologists and neurologists

Resumen: Introducción: La migraña abdominal (MA) es infrecuente y poco estudiada. Nuestro objetivo fue investigar el diagnóstico y tratamiento de niños y adolescentes con MA y compararlos entre gastroen terólogos y neurólogos pediatras. Pacientes y Método: Todos los cuadros de MA (1-18 años) de un hospital de EE. UU, con diagnóstico de MA o sus variantes (ICD-9 346.2 o IC-10 G43.D, G43.D0, G43.D1) entre 2011-2017 fueron revisados. La información sobre diagnóstico, intervalo desde inicio de síntomas, criterios diagnósticos, pruebas diagnósticas, tratamiento y resultado se analizaron. Re sultados: Sesenta y nueve historias médicas fueron identificadas. La edad media al diagnóstico fue 9,7 años. El 48% de los pacientes fueron del sexo femenino. Cincuenta (72,4%) pacientes fueron tratados solo por gastroenterólogos pediatras, y 10/69 (14,5%) por neurológos pediatras exclusivamente. 6/69 (8,7%) fueron inicialmente evaluados por gastroenterología y posteriormente referidos a neurología, y 2/69 (2,9%) fueron inicialmente evaluados por neurología y luego referidos a gastroenterología. 3/10 (30%) de las MA diagnosticadas por neurólogos no mencionaban que el paciente tuviera dolor abdominal, sin embargo, todos los diagnósticos realizados por gastroenterólogos presentaron dicho síntoma (p=0,0035). 5/50 (10%) de las historias médicas de gastroenterología y ninguna de las histo rias de neurología mencionaban los criterios de Roma. Conclusiones: La mayoría de los niños fueron diagnosticados por pediatras gastroenterólogos. Los gastroenterólogos rara vez utilizaron los criterios de Roma. Pacientes evaluados por neurología son frecuentemente diagnosticados con MA, incluso sin presentar dolor abdominal (criterio necesario para el diagnóstico). Se recomienda educación para el correcto y oportuno diagnóstico de la migraña abdominal.

Abstract: Introduction: Abdominal migraine (AM) is uncommon and understudied. Our objective was to investigate the diagnosis and treatment of children and adolescents with AM and compare with that of pediatric gastroenterologists and neurologists. Patients and Method: All AM cases (1-18 years) from a USA hospital with diagnosis of abdominal migraine or its variants (ICD-9 346.2 or IC-10 G43.D, G43.D0, G43.D1) between 2011 and 2017 were reviewed. Information on diagnosis, interval from onset of symptoms, diagnostic criteria, diagnostic tests, treatment, and outcome were analyzed. Results: 69 medical records were identified. The mean age at diagnosis was 9.7 years, and 48% of patients were female. 50/69 (72.4%) patients were exclusively treated by a pediatric gastroenterologist and 10/69 (14.5%) exclusively by a pediatric neurologist. 6/69 (8.7%) were initially evaluated by gas troenterology and referred to neurology, and 2/69 (2.9%) were initially evaluated by neurology and then referred to gastroenterology. 3/10 (30%) of the AM diagnosed by neurologists did no report ab dominal pain (AP), however, all diagnoses made by gastroenterologists did (p = 0.0035). 5/50 (10%) of the gastroenterology medical records and no neurology medical records mentioned Rome criteria. Conclusions: Most of the children were diagnosed by pediatric gastroenterologists. Gastroenterolo gists rarely use the Rome criteria. Patients evaluated by neurologists are frequently diagnosed with AM even without AP (a criterion that is required for its diagnosis). Education is recommended for the correct and timely diagnosis of AM.

Neurologic Etiology of Episodic Abdominal Pain: Epilepsy vs Migraine

The temporal lobe has a vital role in epilepsy, and is the most common lobe involved in focal onset seizures. Patients with temporal lobe epilepsy (TLE) usually have auras, an epigastric-rising sensation is the most common aura reported. Semiology of TLE is abdominal pain. Thus, TLE has to be suspected in patients with unexplained episodic paroxysmal abdominal pain associated with symptoms such as loss or changing of consciousness, and migraine-like symptoms. This case reports a 14-year-old boy who has been diagnosed with abdominal migraine for 7 years. He initially presented with episodic severe abdominal pain and right-sided headache. The abdominal pain is periumbilical, and not associated with vomiting or diarrhea. There are no other gastrointestinal complaints, and all the abdominal investigations were negative. Drugs were of no significance on the long term. Recently, the patient was found to have a benign brain tumor, and correlation with an electroencephalography (EEG) that gave abnormal results due to the presence of bilateral spike-and-wave discharges confirmed the diagnosis of temporal lobe epilepsy manifested by abdominal pain. Our patient did not fulfill the International Classification of Headache Disorders Third Edition (Beta Version) (ICHDIIIb) diagnostic criteria for abdominal migraine, although his case was reviewed by many physicians over the years. In conclusion, this case shows how important it is to follow the diagnostic criteria of diseases and disorders. It also focuses on how seizures can have a wide spectrum of manifestations. Thus, neurological causes have to always be on the differential diagnoses.

Topiramate induced bilateral acute angle closure glaucoma.

Topiramate is an anti-epileptic drug commonly used for the treatment of abdominal migraine. Rare cases of acute myopia with secondary angle closure glaucoma have been reported due to topiramate therapy. An adult male was prescribed topiramate oral therapy for abdominal migraine. On the 4th day of treatment, he had blurring of vision and on ocular examination there was severe myopia, both the iridocorneal angles were closed and intraocular pressure (i.o.p) was 48mmHg. Diagnosis of drug induced bilateral acute angle closure glaucoma was made and treatment was started. Similar cases with topiramate were reported previously but it developed after 2 weeks of therapy. In our case it occurs on the 4th day of therapy. So physician should be aware of possible ocular side effects from the 1st day of therapy and to seek immediate ophthalmic investigation in the events.

A Child with Abdominal Pain, Headache, and Dizziness / 대한소아소화기영양학회지

Abdominal migraine is a syndrome characterized by recurrent episodes of paroxysmal abdominal pain and nausea or vomiting with wellness between episodes. It is often associated with a positive family history of migraine and no other apparent underlying disease. Abdominal epilepsy is an infrequent syndrome which occurs with gastrointestinal complaints caused by a seizure activity. It is characterized by paroxysmal onset of abdominal pain without visceral disorders, but comes along with the alteration of awareness during the attack and abnormal electroencephalogram findings. Like other epilepsies, this abdominal epilepsy is improved with anticonvulsant medication.

Multicenter clinical study of childhood periodic syndromes that are common precursors to migraine using new criteria of the International Classification of Headache Disorders (ICHD-II) / 소아과

PURPOSE: To evaluate the clinical features and characteristics of childhood periodic syndromes (CPS) in Korea using the new criteria of the International Classification of Headache Disorders (ICHD)-II. METHODS: The study was conducted at pediatric neurology clinics of five urban tertiary-care medical centers in Korea from January 2006 to December 2007. Patients (44 consecutive children and adolescents) were divided into three groups (cyclic vomiting syndrome [CVS], abdominal migraine [AM], and benign paroxysmal vertigo of childhood [BPVC]) by recurrent paroxysmal episodes of vomiting, abdominal pain, dizziness, and/or vertigo using the ICHD-II criteria and their characteristics were compared. RESULTS: Totally, 16 boys (36.4%) and 28 girls (63.6%) were examined (aged 4-18 yr), with 20 CVS (45.5%), 8 AM (18.2%), and 16 BPVC (36.4%) patients. The mean age at symptom onset was 6.3+/-3.6 yr, 8.5+/-2.7 yr, and 8.5+/-2.9 yr in the CVS, AM, and BPVC groups, respectively, showing that symptoms appeared earliest in the CVS group. The mean age at diagnosis was 8.0+/-3.4 yr, 10.5+/-2.6 yr, and 10.1+/-3.2 yr the CVS, AM, and BPVC groups, respectively. Of the 44 patients, 17 (38.6%) had a history of recurrent headaches and 11 (25.0%) showed typical symptoms of migraine headache, with 5 CVS (25.0%), 2 AM (25.0%), and 4 BPVC (25.0%) patients. Family history of migraine was found in 9 patients (20.4%): 4 in the CVS group (20.0%), 2 in the AM group (25.0%), and 3 in the BPVC group (18.8%). CONCLUSION: The significant time lag between the age at symptom onset and final diagnosis possibly indicates poor knowledge of CPS among pediatric practitioners, especially in Korea. A high index of suspicion may be the first step toward caring for these patients. Furthermore, a population-based longitudinal study is necessary to determine the incidence and natural course of these syndromes.

Multicenter clinical study of childhood periodic syndromes that are common precursors to migraine using new criteria of the International Classification of Headache Disorders (ICHD-II) / 소아과

PURPOSE: To evaluate the clinical features and characteristics of childhood periodic syndromes (CPS) in Korea using the new criteria of the International Classification of Headache Disorders (ICHD)-II. METHODS: The study was conducted at pediatric neurology clinics of five urban tertiary-care medical centers in Korea from January 2006 to December 2007. Patients (44 consecutive children and adolescents) were divided into three groups (cyclic vomiting syndrome [CVS], abdominal migraine [AM], and benign paroxysmal vertigo of childhood [BPVC]) by recurrent paroxysmal episodes of vomiting, abdominal pain, dizziness, and/or vertigo using the ICHD-II criteria and their characteristics were compared. RESULTS: Totally, 16 boys (36.4%) and 28 girls (63.6%) were examined (aged 4-18 yr), with 20 CVS (45.5%), 8 AM (18.2%), and 16 BPVC (36.4%) patients. The mean age at symptom onset was 6.3+/-3.6 yr, 8.5+/-2.7 yr, and 8.5+/-2.9 yr in the CVS, AM, and BPVC groups, respectively, showing that symptoms appeared earliest in the CVS group. The mean age at diagnosis was 8.0+/-3.4 yr, 10.5+/-2.6 yr, and 10.1+/-3.2 yr the CVS, AM, and BPVC groups, respectively. Of the 44 patients, 17 (38.6%) had a history of recurrent headaches and 11 (25.0%) showed typical symptoms of migraine headache, with 5 CVS (25.0%), 2 AM (25.0%), and 4 BPVC (25.0%) patients. Family history of migraine was found in 9 patients (20.4%): 4 in the CVS group (20.0%), 2 in the AM group (25.0%), and 3 in the BPVC group (18.8%). CONCLUSION: The significant time lag between the age at symptom onset and final diagnosis possibly indicates poor knowledge of CPS among pediatric practitioners, especially in Korea. A high index of suspicion may be the first step toward caring for these patients. Furthermore, a population-based longitudinal study is necessary to determine the incidence and natural course of these syndromes.