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Migraine Et épilepsie: Symptômes Cliniques Communs, Comorbidité Et Mécanismes Physiopathologiques

G. Demarquay, A. Montavont
Published 2010 · Philosophy

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RésuméLa migraine et l’épilepsie sont des pathologies fréquentes, ubiquitaires, évoluant sur un mode paroxystique. Leurs diagnostics se fondent essentiellement sur les données de l’interrogatoire qui permet généralement de distinguer les deux maladies. Certaines similitudes sont toutefois observées entre les deux pathologies. Ainsi, certains symptômes tels que les hallucinations visuelles sont rapportées lors des auras migraineuses et des crises occipitales. Chez l’enfant, certains symptômes végétatifs comme les vomissements sont fréquents lors des crises migraineuses, mais également lors de certaines crises d’épilepsie. Enfin, un lien temporel étroit peut être observé entre les deux pathologies. Les céphalées d’allure migraineuse sont en effet très fréquentes lors des crises d’épilepsie mais surviennent parfois avant ou pendant les crises. Plus rarement, les auras migraineuses sont suivies d’une crise d’épilepsie (migralepsie). Sur le plan physiopathologique, la mise en évidence de troubles de l’excitabilité corticale dans la maladie migraineuse et la découverte de mutations génétiques communes aux deux pathologies illustrent également les interactions pouvant exister entre les deux maladies. L’objectif de cette revue est de présenter les situations cliniques pouvant poser des problèmes diagnostiques entre les maladies migraineuses et épileptiques, ainsi que de présenter les principales hypothèses physiopathologiques pouvant expliquer les liens étroits observés entre les deux pathologies.AbstractMigraine and epilepsy appear as fundamentally different diseases at first sight. However, both of them are characterized by recurrent attacks of nervous system dysfunctions, with a return to baseline between attacks. They share some clinical characteristics such as trigger factors (visual stimuli, sleep deprivation, stress, menses, etc.), enhanced sensitivity for sensory input such as light and sound and transient neurological symptoms including visual, sensory or speech symptoms. The possible occurrence of migrainous headaches before, during some ictal phases of a partial seizure (hemicrania epileptica) or after any seizure (postictal headaches), and the precipitation of an epileptic attack by a typical migrainous aura (migralepsy) also illustrate the reciprocal influences between migraine and epilepsy. Moreover, the alterations of neuronal excitability observed in migraine patients emphasize the debate of a common pathogenic mechanism between the two diseases. The purpose of this review is to present the clinical and pathophysiological similarities between these two disorders.
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