Neurológia pre prax 4/2012

Migraine or epilepsy – an outpatient paediatric neurologist’s dilemma

The author discusses the pitfalls of differential diagnosis between migraines, particularly those with aura, and idiopathic focal (partial) epilepsies, particularly benign, age-related ones. These diagnoses are among the most common in the outpatient practice of a paediatric neurologist. The author points out to the similarity of both entities in terms of medical history data, clinical presentations, and normal results of auxiliary examinations, including structural brain imaging, and highlights the similar therapeutic strategies and prognostic aspects. EEG remains a decisive examination tool for distinction; nevertheless, correct interpretation of ndings in terms of electroclinical correlation may not always be unequivocal. The author also emphasizes that diagnostic considerations may be greatly complicated by their concurrent presence or mutual transitions over time in the same patient, or by possible combinations with other non-epileptic seizures, which is not an uncommon occurrence in paediatric age. The above applies not only to clinical presentations that, particularly in the lowest age groups, are often atypical, with children being frequently unable to describe their complaints in a relevant way, but also to EEG patterns.

Keywords: migraine, epilepsy, differential diagnosis, paediatric age.