Rinsho Shinkeigaku (Clinical Neurology)

Invited Review

Epileptic seizure and migraine attack: A revisit from the “Borderland of Epilepsy” to clinical implementation of infraslow activity/DC shifts in scalp EEG

Akio Ikeda, M.D., Ph.D., FACNS1), Kiyohide Usami, M.D., Ph.D.1)2), Daisuke Danno, M.D., Ph.D.3),Takao Takeshima, M.D., Ph.D.3) and Yoshihisa Tatsuoka, M.D., Ph.D.4)

1)Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine
2)Department of Clinical Laboratory, Kyoto University Hospital
3)Headache Center, Department of Neurology, Tominaga Hospital
4)Tatsuoka Neurology Clinic

Migraine attacks, especially ones with aura, have symptoms similar to epileptic seizures, and the two may sometimes be difficult to differentiate clinically. However, the characteristic minute-by-minute symptom development and progress within 60 min is useful for diagnosis. Although the details of its pathophysiology remain unsolved, cortical spreading depolarization (CSD) is one of the main pathogenetic factors. In epilepsy, clinical data have shown that ictal DC shifts could reflect impaired homeostasis of extracellular potassium by astrocyte dysfunction. Ictal DC shifts were found to be difficult to detect by scalp EEG, but can be clinically recorded from the seizure focus using wide-band EEG method. The similarity between DC shifts and CSD has been gaining attention from the neurophysiology point of view. The clinical implementation of infraslow activity/DC shifts analysis of scalp EEG is expected to elucidate further the pathophysiology of migraine, which may lie in the borderland of epilepsy.
Full Text of this Article in Japanese PDF (1977K)

(CLINICA NEUROL, 64: 383−389, 2024)
key words: cortical spreading depolarization, wide-band EEG, DC potentials, astrocyte

(Received: 10-Nov-23)