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Klin Monbl Augenheilkd 2001; 218(9): 595-602
DOI: 10.1055/s-2001-17636
ÜBERSICHT

Georg Thieme Verlag Stuttgart · New York

Visuelle Aura: Differenzialdiagnose zwischen Migräne und Epilepsie[1]

Differential diagnosis of visual aura in migraine and epilepsyAndreas Schulze-Bonhage
  • Sektion Prächirurgische Epilepsiediagnostik am Neurozentrum der Universität Freiburg, Breisacher Str. 64, 79102 Freiburg
  • (Dir.: Prof. Dr. J. Zentner), E-mail: schulzeb@nz.ukl.uni-freiburg.de
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Publication History

Publication Date:
05 October 2001 (online)

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Zusammenfassung

Visuelle Phänomene wie die Wahrnehmung von Lichtblitzen, verzerrten Objektkonturen oder auch Skotome können Ausdruck ophthalmologischer Erkrankungen sein, kommen jedoch auch als zentralnervös generierte Phänomene („Auren”) bei Vorliegen einer Migräne oder Epilepsie vor. Nachfolgende Hemikranien gelten als charakteristisch für eine Migräne, gestatten jedoch im Einzelfall oft keine sichere Abgrenzung von postiktalen Kopfschmerzen bei Patienten mit fokaler Epilepsie. Eine detaillierte Analyse der Auren gestattet hingegen in aller Regel eine Zuordnung von Episoden als Migräneaura oder einfach partieller epileptischer Anfall.Die höhere Ausdifferenzierung visueller Phänomene mit Farbigkeit, Bewegung und komplexeren visuellen Phänomenen ist ein wesentliches Charakteristikum der Aktivierung von Neuronenverbänden während epileptischer Auren. Die höhere Ausbreitungsgeschwindigkeit transsynaptisch propagierter epileptischer Entladungen und eine raschere postiktale Inaktivierung durch Hyperpolarisation bedingen einen rascheren zeitlichen Verlauf der epileptischen Aura im Vergleich zur Migräne-Aura, die aus einer sich per diffusionem ausbreitenden Depolarisationswelle resultiert. Die Diagnose einer Epilepsie wird klinisch wesentlich gestützt durch positive motorische Phänomene oder den Übergang in komplex-partielle Anfälle, z. B. im Rahmen einer Ausbreitung epileptischer Aktivität in den Temporallappen; sekundär generalisierte tonisch-klonische Anfälle können hingegen in seltenen Fällen auch nach einer Migräne-Aura auftreten.Als wichtigste apparative Zusatzuntersuchung kann das interiktale und iktale EEG zum Nachweis einer epileptischen Genese beitragen, die Sensitivität des EEGs für den Nachweis interiktaler epilepsietypischer Potenziale oder für den Nachweis von Anfallsmustern ist jedoch besonders bei fehlender Ausbreitung der iktalen Aktivität begrenzt. In Ausnahmefällen kann es sinnvoll sein, iktale Perfusionsmessungen zur Differenzialdiagnose hinzuzuziehen.

Visual phenomena like lightnings, disturbed contours of objects, or skotoma, can be due to ophthalmological diseases, but can also occur as symptoms generated by the central nervous system („aura”) in migraine or epilepsy. A subsequent hemicrania is considered as a hallmark of migraine, but in many cases does not allow for a certain distinction from postictal headaches in patients with focal epilepsy. A detailed analysis of the aura does, however, provide sufficient information for classifying the disorder as an aura in migraine or as a simple partial epileptic seizure in most cases.The higher degree of differentiation of visual phenomena including colour, movement, and complex visual phenomena, is characteristic of the activation of neuronal circuits during an epileptic aura. The higher speed of transsynaptic propagation of epileptic discharges and postictal inactivation causes a more rapid time-course of the epileptic aura as compared to a migraine aura resulting from a depolarization spreading by diffusion. Clinically, the diagnosis of epilepsy is supported by additional positive motor phenomena or by a transition into a complex partial seizure, e. g. when epileptic activity spreads into a temporal lobe. Secondarily generalized seizures, however, may also occur in patients with migraine.Interictal and ictal EEG recordings can be important to prove an epileptic origin, but their sensitivity is low if ictal discharges remain limited to a small brain area. In rare cases, measurements of ictal cerebral perfusion can contribute to the differential diagnosis.

Schlüsselwörter

Migräne - Epilepsie - visuelle Aura - Semiologie

Key words

migraine - epilepsy - visual aura - semiology

1 Manuskript erstmalig eingereicht am 26. 6. 01 und in der vorliegenden Form angenommen.

Literatur

1 Manuskript erstmalig eingereicht am 26. 6. 01 und in der vorliegenden Form angenommen.

  • 01 Alberca  R. Epilepsia y jaqueca.  Rev Neurol. 1998;;  26: 251-255.
    Google Scholar
  • 02 D'Allessandro  R D, Sacquegna  P, Lugaresi  E. Headache after partial complex seizures. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 273-278.
    Google Scholar
  • 03 Andermann  F. Migraine and epilepsy: an overview. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 405-422.
    Google Scholar
  • 04 Andermann  E, Andermann  F. Migraine-epilepsy relationship: epidemiological and genetic aspects. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 281-291.
    Google Scholar
  • 05 Andermann  F, Zifkin  B. The benign occipical epilepsies of childhood: an overview of the idiopathic syndromes and of the relationship to migraine.  Epilepsia. 1998;;  39 (suppl. 4): S9-S23.
    Google Scholar
  • 06 Basser  L S. The relation of migraine and epilepsy.  Brain. 1969;;  92: 285-300.
    Google Scholar
  • 07 Bien  C G, Benninger  F O, Urbach  H, Schramm  J, Kurthen  M, Elger  C E. Localizing value of epileptic visual auras.  Brain. 2000;;  123: 244-253.
    Google Scholar
  • 08 Bladin  P F. The association of benign rolandic epilepsy with migraine. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 145-152.
    Google Scholar
  • 09 Blume  W T, Young  G B. Ictal pain: unilateral, cephalic, and abdominal. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 235-247.
    Google Scholar
  • 10 DeBenedettis  G, Ferrari Da Passona  C, Granata  G, Lorenzetti  A. CBF changes during headache-free periods and spontaneous/induced attacks in migraine with and without aura: a TCD and SPECT comparison study.  J Neurosurg Sci. 1999;;  43: 141-146.
    PubMedGoogle Scholar
  • 11 Devinsky  O, Frasca  J, Pacia  S V, Luciano  D J, Paraiso  J, Doyle  W. Ictus emeticus: further evidence of nondominant temporal involvement.  Neurology. 1995;;  45: 1158-1160.
    PubMedGoogle Scholar
  • 12 Dvorkin  G S, Andermann  F, Carpenter  S, et al. Classical migraine, intractable epilepsy and multiple strokes: a syndrome related to mitochondrial encephalomyopathy. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 203-232.
    Google Scholar
  • 13 Ely  F A. The migraine-epilepsy syndrome.  Arch Neurol Psychiatr. 1930;;  : 943-949.
    PubMedGoogle Scholar
  • 14 Ettinger  A B, Weisbrot  D M, Nolan  E, Devinsky  O. Postictal symptoms help distinguish patients with epileptic seizures from thoses with non-epileptic seizures.  Seizure. 1999;;  8: 149-151.
    CrossrefPubMedGoogle Scholar
  • 15 Friberg  L, Olsen  T S, Roland  P E, Lassen  N A. Focal ischaemia caused by insability of cerebrovascular tone during attacks of hemiplegic migraine.  Brain. 1987;;  110: 917-934.
    PubMedGoogle Scholar
  • 16 Gardner  K, Barmada  M M, Ptacek  L J, Hoffman  E P. A new locus for hemiplegic migraine maps to chromosome 1q31.  Neurology. 1997;;  49: 1231-1238.
    PubMedGoogle Scholar
  • 17 Gastaut  H. A new type of epilepsy: benign partial epilepsy of childhood with occipital spike-waves.  Clin Electroencephalogr. 1982;;  13: 13-22.
    PubMedGoogle Scholar
  • 18 Gastaut  H. Épilepsie bénigne de lénfance avec paroxysmes occipitaux. In: Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P, eds. Les syndromes épileptiques de l'enfant et de l'adolescent. John Libbey Eurotext, Paris; 1984; : p. 163-174.
    Google Scholar
  • 19 Van Gelder  N M. Calcium mobility and glutamic acid release associated with EEG abnormalities, migraine and epilepsy. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 367-378.
    Google Scholar
  • 20 Gloor  P. Experiential phenomena of temporal lobe epilepsy.  Brain. 1990;;  113: 1673-1694.
    PubMedGoogle Scholar
  • 21 Gowers  W R. The borderland of epilepsy: faints, vagal attacks, vertigo, migraine, sleep symptoms and their treatment. Churchill, London; 1907.:
    Google Scholar
  • 22 Hansen  A J, Quistorff  B, Gjedde  A. Relationship between local changes in cortical blood flow and extracellular K+ during spreading depression.  Acta Physhiol Scand. 1980;;  109: 1-6.
    PubMedGoogle Scholar
  • 23 Hardebo  J E. A cortical excitatory wave may cause both the aura and the headache of migraine.  Cephalgia. 1992;;  12: 75-80.
    PubMedGoogle Scholar
  • 24 Hargreaves  R J, Shepheard  S L. Pathophysiology of migraine - new insights.  Can J Neurol Sci. 1999;;  26 (Suppl. 3): S12-S19.
    PubMedGoogle Scholar
  • 25 Hart  Y M, Andermann  F. Migraine Aura, Seizures, and Temporal lobe Epilepsy. In: H. Stefan, F. Andermann, P.Chauvel, and S. Shorvon (eds.) Advances in Neurology, Vol. 81. Lippincott, & Wilkins, Philadelphia; 1999;: p. 145-152.
    Google Scholar
  • 26 Hauser  W A, Annegers  J F, Kurland  L T. Prevalence of epilepsy in Rochester, Minnesota: 1940 - 1980.  Epilepsia. 1991;;  32: 429-445.
    PubMedGoogle Scholar
  • 27 Headache  Classification Committee of the International Headache Society. Slassification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain.  Cephalgia. 1988;;  8 (suppl. 7): 1-96.
    PubMedGoogle Scholar
  • 28 Isler  H, Wieser  H G, Egli  M. Hemicrania epileptica: synchronous ipsilateral ictal headache with migraine features. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : pp. 249-263.
    Google Scholar
  • 29 Jackson  H. Case illustrating the relation betwixt certain cases of migraine and epilepsy.  Lancet. 1875;;  : 244-245.
    PubMedGoogle Scholar
  • 30 Jensen  R, Brinck  T, Olesen  J. Sodium valpoate has a prophylactic effect in migraine without aura: a triple-blind, placebo-controlled crossover study.  Neurology. 1994;;  44: 647-651.
    PubMedGoogle Scholar
  • 31 Kommerell  G. Homonyme Gesichtsfeldstörungen bei Gefäßerkrankungen. In: Lund O-E, Waubke TN (eds): Gefäßerkrankungen des Auges. Enke, Stuttgart; 1983; : p. 16-22.
    Google Scholar
  • 32 Kommerell  G. Flimmerskotom. In: Lund OE, Waubke TN (eds) Okuläre Symptome und Strategien der Untersuchung. Enke, Stuttgart; 1987; : p. 28-34.
    Google Scholar
  • 33 Kraus  D. Migraine and epilepsy: a case for divorce. MSc thesis, Montreal, McGill University; 1978.:
    Google Scholar
  • 34 Lance  J W, Anthony  M. Some clinical aspects of migraine.  Arch Neurol. 1966;;  15: 356-361.
    PubMedGoogle Scholar
  • 35 Lapkin  M L, French  J H, Golden  G S, Rowan  A J. The EEG in childhood basilar artery migraine.  Neurology. 1977;;  27: 580-583.
    PubMedGoogle Scholar
  • 36 Lauritzen  M, Olsen  T X, Lassen  N A, Paulson  O B. Changes inregional cerebral blood flow during the course of classic migraine attacks.  Ann Neurol. 1983;;  13: 633-641.
    CrossrefPubMedGoogle Scholar
  • 37 Leao  A AP. Spreading depression of activity in the cerebral cortex.  J Neurophysiol. 1944;;  7: 359-390.
    PubMedGoogle Scholar
  • 38 Leao  A AP, Morrison  R S. Propagation of spreading cortical depression.  J Neurophysiol. 1945;;  8: 33-45.
    PubMedGoogle Scholar
  • 39 Lennox  W G, Lennox  M A. Epilepsy and related disorders. Little, Brown, Boston; 1960; : 451.
    Google Scholar
  • 40 Martinez  J VL, Specialli  J G. Migraine with visual aura versus occipital epilepsy.  Headache. 1997;;  37: 113.
    PubMedGoogle Scholar
  • 41 Matias-Guiu  J, Galiano  L, Vioque  J, Falip  R, Martin  R. A case-control study to evaluate the association of epilepsy and migraine.  Neuroepidemiology. 1992;;  11: 313-314.
    PubMedGoogle Scholar
  • 42 Mattsson  P, Lundberg  P O. Characteristics and prevalence of transient visual disturbances indicative of migraine visual aura.  Cephalgia. 1999;;  19: 479-484.
    PubMedGoogle Scholar
  • 43 Milner  P M. Note on a possible correspondence between the scotomas of migraine and spreading depression of Leao.  Electroenceph Clin Neurophysiol. 1958;;  10: 705.
    CrossrefPubMedGoogle Scholar
  • 44 Moskowitz  M A. Basic mechanisms in vascular headache.  Neurol Clin. 1990;;  8: 801-815.
    PubMedGoogle Scholar
  • 45 Niedermeyer  E. Migraine-triggered epilepsy.  Clin Electroenceph. 1993;;  24: 37-43.
    PubMedGoogle Scholar
  • 46 Norton  J W, Corbett  J J. Visual perceptual abnormalities: hallucinations and illusions.  Sem Neurol. 2000;;  20: 111-121.
    PubMedGoogle Scholar
  • 47 Ogunyemi  A, Adams  D. Migraine-like symptoms triggered by occipital lobe seizures: response to sumatriptan.  Can J Neurol Sci. 1998;;  25: 151-153.
    PubMedGoogle Scholar
  • 48 Olesen  J, Larsen  B, Lauritzen  M. Focal hyperemia followed by spreading oligemia and imparired activation of rCBF in classic migraine.  Ann Neurol. 1981;;  9: 344-352.
    CrossrefPubMedGoogle Scholar
  • 49 Olesen  J. Pathophysiological implications of migraine aura symptomatology. In: Olesen J, Edvinsson L (eds.) Basic mechanisms of headache. Elsevier, Amsterdam; 1988; : 353-363.
    Google Scholar
  • 50 Olesen  J, Friedberg  L, Olsen  T S, Iversen  H K, Lassen  N A, Andersen  A R, Karle  A. Timing and topography of cerebral blood flow, aura and headache during migraine attacks.  Ann Neurol. 1990;;  28: 791-798.
    CrossrefPubMedGoogle Scholar
  • 51 Ophoff  R A, Terwindt  G M, Vergouwe  M N, van Eijk  R, Oefner  P J, Hoffman  S MG, Lamerdin  J E, Mohrenweiser  H W, Bulman  D E, Ferrari  M, Haan  J, Lindhout  D, van Ommen  G-J B, Hofker  M MMH, Ferrari  M D, Frants  R R. Familialhemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2 + channel gene CACNL1A4.  Cell. 1996;;  87: 543-552.
    CrossrefPubMedGoogle Scholar
  • 52 Ottman  R, Lipton  R B. Comorbidity of migraine and epilepsy.  Neurology. 1994;;  44: 2105-2110.
    PubMedGoogle Scholar
  • 53 Ottman  R, Lipton  R B. Is the comorbidity of epilepsy and migraine due to a shared genetic susceptibility?.  Neurology. 1996;;  47: 918-924.
    PubMedGoogle Scholar
  • 54 Panayiotopoulos  C P. Difficulties in differentiating migraine and epilepsy based on clinical and EEG findings. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 31-46.
    Google Scholar
  • 55 Panayiotopoulos  C P. Benign childhood epilepsy with occipital paroxysms: a 15-year prospective clinical and electrographic study.  Ann Neurol. 1989;;  26: 51-56.
    CrossrefPubMedGoogle Scholar
  • 56 Panayiotopoulos  C P. Basilar migraine? Seizures, and severe epileptic EEG abnormalities.  Neurology. 1980;;  30: 1122-1125.
    PubMedGoogle Scholar
  • 57 Panayiotopoulos  C P. Elementary visual hallucinations in migraine and epilepsy.  J Neurol Neurosurg Psychiatry. 1994;;  57: 1371-1374.
    PubMedGoogle Scholar
  • 58 Panayiotopoulos  C P, Sharoqi  I A, Agathonikou  A. Occipital seizures imitating migraine aura.  J R Soc Med. 1997;;  90: 255-257.
    PubMedGoogle Scholar
  • 59 Panayiotopoulos  C P. Elementary visual hallucinations, blindness, and headache in idiopathic occipital epilepsy: differentiation from migraine.  J Neurol Neurosurg Psychiatry. 1999;;  66: 536-540.
    CrossrefPubMedGoogle Scholar
  • 60 Penfield  W, Perot  P. The brain's record of auditory and visual experience: a final summary and discussion.  Brain. 1963;;  86: 595-696.
    PubMedGoogle Scholar
  • 61 Plant  G T. The fortification spectra of migraine.  BMJ. 1986;;  293: 1613-1617.
    PubMedGoogle Scholar
  • 62 Rosi  P G, Santucci  M, Gobbi  G, D'Allessandro  R, Saquegna  T. Epidemiological study of migraine in epileptic patients. In: Andermann F, Lugaresi E (eds.) Migraine and epilepsy. Butterworths, Boston; 1987; : p. 313-324.
    Google Scholar
  • 63 Russel  M B, Olesen  J. A nosographic analysis of the migraine aura in a general population.  Brain. 1996;;  119: 355-361.
    PubMedGoogle Scholar
  • 64 Salanova  V, Andermann  F, Olivier  A, Rasmussen  T, Quesney  L F. Occipical lobe epilepsy: electroclinical manifestations, electrocorticography, cotrical stimulation and outcome in 42 patients treated between 1930 and 1991.  Brain. 1992;;  115: 1655-1680.
    CrossrefPubMedGoogle Scholar
  • 65 Sanchez del Rio  M, Bakker  D, Wu  O, Agosti  R, Mitsikostas  D D, Ostergaard  L, Wells  W A, Rosen  B R, Sorensen  G, Moskowitz  M A, Cutrer  F M. Perfusion weighted imaging during migraine: spontaneous visual aura and headache.  Cephalgia. 1999;;  19: 701-707.
    PubMedGoogle Scholar
  • 66 Sand  T. EEG in migraine: a review of the literature.  Funct Neurol. 1991;;  6: 7-22.
    PubMedGoogle Scholar
  • 67 Sander  J WAS, Shorvon  S D. Epidemiology of the epilepsies.  J Neurol Neurosurg Psychiatry. 1996;;  61: 433-443.
    PubMedGoogle Scholar
  • 68 Shahar  E, Desatnik  H, Brand  N, Straussberg  R, Hwang  P A. Epileptic blindness in children: a localizing sign of various epileptic disorders.  Clin Neurol Neurosurg. 1996;;  98: 237-241.
    CrossrefPubMedGoogle Scholar
  • 69 Sieveking  E H. On epilepsy and epileptiform seizures. John Churchill, London; 1858.:
    Google Scholar
  • 70 Stewart  W F, Lipton  R B. Migraine headache. Epidemiology and health care utilization.  Cephalgia. 1993;;  13 (Suppl 12): 41-46.
    PubMedGoogle Scholar
  • 71 Todd  P A, Benfield  P. Flunarizine: a reappraisal of ist pharmacological properties and therapeutic use in neurological disorders.  Drugs. 1989;;  38: 481-499.
    PubMedGoogle Scholar
  • 72 Twomey  J A, Abbot  R J, Franks  A J, Burt  A A, Hakin  N J. Status epilepticus complicating migraine.  Acta Neurol Scand. 1988;;  77: 335-338.
    PubMedGoogle Scholar
  • 73 Vaphides  M S, Celesia  G G, Brigell  M G. Positive spontaneous visual phenomena limited to the hemianopic field in lesions of central visual pathways.  Neurology. 1996;;  47: 408-417.
    PubMedGoogle Scholar
  • 74 Velioglu  S K, Ozmenoglu  M. Migraine-related seizures in an epileptic population.  Cephalgia. 1999;;  19: 797-801.
    PubMedGoogle Scholar
  • 75 Walker  M C, Smith  S JM, Sisodiya  S M, Shorvon  S D. Case of simple partial status epilepticus in occipital lobe misdiagnosed as migraine: clinical, electrophysiological, and magnetic resonance imaging characteristics.  Epilepsia. 1995;;  36: 1233-1236.
    PubMedGoogle Scholar
  • 76 Waters  W E, O'Connor  P J. Prevalence of migraine.  J Neurol Neurosurg Psychiatry. 1975;;  38: 613-616.
    PubMedGoogle Scholar
  • 77 Weiller  C, May  A, Limmroth  V, et al. Brain stem activation in spontaneous human migraine attacks.  Nature Med. 1995;;  1: 658-660.
    PubMedGoogle Scholar
  • 78 Welch  K MA. Pathogenesis of migraine.  Sem Neurol. 1997;;  17: 335-341.
    PubMedGoogle Scholar
  • 79 Williamson  P D, Thadani  V M, Darcey  T M, Spencer  D D, Spencer  S S, Mattson  R H. Occipital lobe epilepsy: clinical characteristics, seizure spread patterns, and result of surgery.  Ann Neurol. 1992;;  31: 3-13.
    CrossrefPubMedGoogle Scholar
  • 80 Woods  R P, Iacoboni  M, Mazziotta  J C. Bilateral spreading cerebral hypoperfusion during spontaneous migraine headache.  NEJM. 1994;;  331: 1689-1692.
    CrossrefPubMedGoogle Scholar
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