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EDITORIAL
Year : 2010  |  Volume : 58  |  Issue : 4  |  Page : 512-513

Sporadic hemiplegic migraine in children


Department of Developmental Neurology, Medical University of Gdansk, Poland

Date of Acceptance21-Jul-2010
Date of Web Publication24-Aug-2010

Correspondence Address:
Karolina Pienczk-Reclawowicz
Department of Developmental Neurology, Medical University of Gdansk, Debinki Street 7, 80-952 Gdansk
Poland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.68659

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How to cite this article:
Pienczk-Reclawowicz K, Pilarska E, Lemka M. Sporadic hemiplegic migraine in children. Neurol India 2010;58:512-3

How to cite this URL:
Pienczk-Reclawowicz K, Pilarska E, Lemka M. Sporadic hemiplegic migraine in children. Neurol India [serial online] 2010 [cited 2019 Aug 23];58:512-3. Available from: http://www.neurologyindia.com/text.asp?2010/58/4/512/68659


Sporadic hemiplegic migraine (SHM) is a rare disorder, especially in the pediatric population. The only differentiating feature between sporadic hemiplegic migraine and familial hemiplegic migraine (FHM) is family history (first- or second-degree) of similar headaches. There are no characteristic clinical features that distinguish between the two. The diagnostic criteria for SHM have been established in 2004 by the International Headache Society. [1] However, the diagnosis remains problematic and one of exclusion as has been highlighted by Chakravarty and Sen [2] in this issue of the journal. For recognizing SHM, one should take into consideration other mimics, which include a host of disorders: stroke; postictal Todd's palsy; the syndrome of headache, transient neurologic deficit and lymphocytosis of cerebrospinal fluid (HaNDL); mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) [3] ; and autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). [4] In younger children, SHM attacks need to be differentiated from alternating hemiplegia of childhood (AHC). [5] The prevalence of SHM in patients with  Sturge- Weber syndrome More Details More Details is higher than in general population; however, the cause of this phenomenon is uncertain. [6]

The diagnosis of FHM may be supported with genetic testing. Three major mutations of genes (CACNA1A, ATP1A2 and SCNA1A genes) responsible for FHM occurrence encode three different ion channels. These mutations account for 50% to 70% of published FHM cases. Recent analysis by de Vries et al.[7] of 40 patients with SHM revealed that in some of the SHM patients also, these mutations may occur (most often, ATP1A2 mutation), thus suggesting common pathogenic mechanism for both FHM and SHM.

Jen et al.[8] suggested that hemiplegic migraine should be considered in every child with prolonged hemiplegic symptoms, as well as in adults. SHM in children may be complicated with persistent aura without cerebral infarction, [9] and dramatic complications may lead (however, infrequently) to migrainous infarction. [10],[11] The treatment of acute SHM attacks, as well as prevention, in children remains an unresolved issue due to rarity of the disease and lack of randomized controlled trials. Thus, the management is based on the management principles of migraine with aura.

To date, there is still scarcity of data on distinction of the course of SHM in children and adults. Reporting cases of SHM, especially those with unusual course, is of high importance. [2] Enriching the diagnosis of childhood-onset SHM with genetic testing would help to define its phenotypic variety.

 
  References Top

1.Headache Classification Committee. The international classification of headache disorders, 2nd ed. Cephalalgia 2004;24:1-160.  Back to cited text no. 1      
2.Chakravarty A, Sen A. Sporadic hemiplegic migraine in children: Report of two new cases. Neurol India 2010;58:648-50.   Back to cited text no. 2    Medknow Journal  
3.Ohno K, Isotani E, Hirakawa K. MELAS presenting as migraine complicated by stroke. Neuroradiology 1997;39:781-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Sathe S, DePeralta E, Pastores G, Kolodny EH. Acute confusional migraine may be a presenting feature of CADASIL. Headache 2009;49:590-6.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Swoboda KJ, Kanavakis E, Xaidara A, Johnson JE, Leppert MF, Schlesinger-Massart MB. Alernating hemiplegia of childhood or familial hemiplegic migraine?: A novel ATP1A2 mutation. Ann Neurol 2004;55:884-7.  Back to cited text no. 5      
6.Klapper J. Headache in Sturge-Weber syndrome. Headache 1994;34:521-2.  Back to cited text no. 6  [PUBMED]    
7.de Vries B, Freilinger T, Vanmolkot KR, Koenderink JB, Stam AH, Terwindt GM, et al. Systemic analysis of three FHM genes in 39 sporadic patients with hemiplegic migraine. Neurology 2007;69:2170-6.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Jen JC, Klein A, Boltshauser E, Cartwright MS, Roach ES, Mamsa H, et al. Prolonged hemiplegic episodes in children due to mutations in ATP1A2. J Neurol Neurosurg Psychiatry 2007;78:523-6.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Lemka M, Pienczk-Reclawowicz K, Pilarska E, Szmuda M. Cessation of sporadic hemiplegic migraine attacks after patent foramen ovale closure. Dev Med Child Neurol 2009;51:923-4.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Rossi LN, Penzien JM, Deonna TH, Goutieres F, Vasella F. Does migraine-related stroke occur in childhood? Dev Med Child Neurol 1990;32:1005-21.  Back to cited text no. 10      
11.Ribeiro RT, Pinto MM, Villa TR, Gamba LT, Tengan CH, de Souza Carvalho D. Migrainous infarction as a complication of sporadic hemiplegic migraine in childhood. Arq Neuropsiquiatr 2009;67:906-8.  Back to cited text no. 11      



This article has been cited by
1 Sporadic hemiplegic migraine
Chakravarty, A. and Mukherjee, M.
Indian Pediatrics. 2012; 49(2): 150-151
[Pubmed]



 

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