青少年偏头痛与癫痫的相关性

Correlations between Adolescent Migraine and Epilepsy

目的 探讨40岁以下青少年偏头痛与癫痫的相关性及鉴别诊断.方法 对64例11～40岁偏头痛患者的临床及脑电图资料进行分析.结果 女性占2/3.合并临床癫痫发作者18例,占28.13%.脑电图异常者38例;其中29例为偏头痛,异常率45.31%,8例为枕叶癫痫,1例为颞叶癫痫.4例普通型偏头痛伴癫痫发作,脑电图检查4次均正常.5例为基底动脉型偏头痛和复杂性偏头痛伴癫痫发作,脑电图检查明显异常.8例偏头痛靠脑电图异常误诊为“头痛性癫痫”.结论 青少年偏头痛脑电图常表现为非特异性异常或尖样放电.其异常率高达45.31%.偏头痛可并发临床癫痫发作,两者常以交叉重叠形式出现,但不能仅靠脑电图异常就诊断“头痛性癫痫”,必须结合临床与偏头痛严格鉴别再考虑判定,以免癫痫诊断扩大化.枕叶皮层同为有视觉先兆的偏头痛和枕叶癫痫发作的敏感区,两者常混淆不清,应严格鉴别.

[Objective] To explore the correlations between adolescent （under 40 years old） migraine and epilepsy and its diagnosis. [Methods] Analysis was made on the clinical and EEG data of 64 cases of migraine aged from 11 to 40. [Results] One third of the cases were females; 18 cases （28.13%） were complicated with epilepsy; 38 cases were found with abnormal EEG; 29 cases had migraine （45.31%） ; 8 cases were epilepsy of occipital lobe and 1 case was epilepsy of temporal lobe; the EEG of 4 patients of migraine combined with epilepsy was normal, while that of the 5 patients with epilepsy and basilar migraine or complicated migraine were obviously abnormal. 8 patients with migraine were misdiagnosed as ＂ epilepsy with headache＂ through the abnormal EEG. [ Conclusion]The EEG of adolescent migraine patients is often abnormal （45.31%）. Migraine is often combined with epilepsy, which it shouldn＇t be diagnosed as ＂epilepsy with headache＂ merely through the abnormal EEGs. We must clinically distinguish epilepsy and migraine in order to avoid misdiagnose. Occipital lobe is a sensitive area for migraine with visual aura and epilepsy of occipital lobe, which should be distinguished strictly.