High risk of developing subsequent epilepsy in young adults with migraine: a nationwide population-based cohort study in Taiwan.

BACKGROUND AND PURPOSE: This study evaluated the effect of migraine on the subsequent development of epilepsy. METHODS: A total of 10,016 patients diagnosed with migraine [ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) 346] during the period between 2000 and 2009 who were aged older than 20 years were identified as the migraine cohort. A comparison cohort including 40 064 people were enrolled in this study. We calculated the adjusted hazard ratio (aHR) for developing epilepsy (ICD-9-CM 345) in the two cohorts after adjusting for age, sex and comorbidities. Kaplan-Meier analysis was used to measure the cumulative epilepsy incidence, and the log-rank test was used to estimate the differences between two curves. RESULTS: The cumulative incidence of epilepsy was significantly high in the migraine cohort. The aHR for developing epilepsy in the migraine cohort was 1.85 (95% CI = 1.22-2.81). The aHR for developing epilepsy in the female migraineurs was significantly different compared with that of the non-migraine cohort (aHR = 2.04, 95% CI = 1.20-3.48) and male migraineurs (aHR = 1.53, 95% CI = 0.78-3.00). The incidence of developing epilepsy was increased in patients aged 20-44 years, yielding an aHR of 2.14 (95% CI = 1.24-3.68). The comorbidity-specific aHR for developing epilepsy associated with migraine was 2.33 (95% CI = 1.25-4.34) in patients without any comorbidities, and 1.73 (95% CI = 1.02-2.93) in those with comorbidities. CONCLUSION: This population-based retrospective cohort study revealed a significant increase in subsequent epilepsy risk in young adults with migraine.

Temporo-spatial analyses define epileptogenic and functional zones in a case of Dyke-Davidoff-Masson syndrome.

Dyke-Davidoff-Masson syndrome (DDMS) is a rare epilepsy syndrome that is characterized by cerebral hemiatrophy, homolateral skull hyperplasia, hyperpneumatization of the paranasal sinuses, seizures with or without mental retardation, and contralateral hemiparesis. We describe a case of DDMS in a 40-year-old female who had complex partial seizures with occasional secondary generalization since the age of 4 years. Her seizure frequency was 10-20 seizures/month even though she took four antiepileptic drugs. We applied magnetic resonance imaging (MRI), positron emission tomography (PET), functional MRI, and invasive electroencephalography (EEG) to define her epileptogenic and functional zones. Brain MRI showed prominent atrophy in the left frontal dorsal and lateral regions and mild atrophy of the left superior temporal gyrus and left parietal gyri. Interictal PET revealed decreased glucose metabolism in the atrophic regions. Functional MRI demonstrated that the inferior frontal and inferior parieto-occipital regions of the right hemisphere were activated by language testing. Invasive EEG revealed that the left lateral temporal lobe was the sole source of her seizures. Our results imply that the "metabolic border zone" rather than the atrophic region plays an important role in seizure activity, and that reorganization of functional zones occur after cerebral damage early in life.

CNS Clostridium perfringens infection: a rare complication of preoperative embolization of meningioma.

Gas gangrene is a severe form of gangrene (tissue death) that usually is caused by Clostridium perfringens. It generally occurs at the site of trauma or a recent surgical wound. We report the case of a 45-year-old woman with sphenoid-ridged meningioma who received preoperative transarterial embolization with polyvinyl alcohol. The patient later developed an intratumoral C perfringens infection and died despite intensive medical care. The case represents an extremely rare complication following transarterial embolization of meningioma.