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Objective: There are a handful of studies investigating peri-ictal headache (PIH) and its clinical associations in patients with idiopathic/genetic epilepsies (I/GE). This multi-center study aimed to investigate PIH, which is an ignored comorbid condition in patients with I/GE, by headache experts and epileptologists working together. Methods: The data were collected from a cross-sectional large study, using two structured questionnaires for headache and epilepsy features, fulfilled by neurologists. Headaches were classified according to the International Classification of Headache Disorders, third edition, whereas seizure and syndrome types were diagnosed according to International League Against Epilepsy criteria. The patients with a headache starting 24 hours before the onset of the seizure (preictal) or within 3 hours after the seizure (postictal) were defined as patients with PIH. We compared demographic and clinical differences between two groups of patients with and without PIH statistically and used ROC curves to determine a threshold of the total number of seizure triggers associated with the occurrence of PIH. Results: Among 809 (531 females, 65.6%) consecutive patients with I/GE, 105 (13%) patients reported PIH (22 preictal, 82 postictal headaches, and one with both types). Peri-ictal headache was more frequently reported by females and those having a family history of migraine or epilepsy, and it was significantly associated with lower rates of seizure freedom for more than five years, drug resistance, and use of polytherapy, remarkably. Moreover, ROC curves showed that having more than 3 seizure triggers was associated with the presence of PIH. Conclusion: Our findings revealed that PIH may be linked to poor outcomes in I/GEs and seems to be related to a lower ictal threshold precipitated by multiple triggers. Future prospective studies will illuminate the unknown underlying mechanisms and appropriate management strategies for PIH to improve the prognosis.

© 2022 International League Against Epilepsy.Objective: The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. Methods: Patients aged 6–40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. Results: Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, ≥5 headache attacks, duration of headache ≥ 24 months, headaches lasting ≥1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic–clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with ≥5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). Significance: Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies.

Amaç: Epilepsi iş gücü kaybı ve özürlülüğe yol açan kronik nörolojik bir hastalıktır. Uygun tıbbi ve cerrahi tedavilere rağmen sık nöbet geçiren hastaların sosyal açıdan korunması önemlidir. Bu çalışmada epilepsi hastalarının maluliyet değerlendirmesinde demografik ve klinik özelliklerin araştırılması amaçlandı. Gereç ve Yöntem: Bu çalışmada Antalya Eğitim ve Araştırma Hastanesi Sağlık Kurulu Bölümü’ne Ocak 2014-Ocak 2015 tarihleri arasında malulen emeklilik isteği ile başvuran hastalar geriye dönük olarak incelendi. Bulgular: Otuz biri (%79.5) erkek, sekizi (20.5) kadın olmak üzere toplam 39 hasta incelendi. Yaş ortalaması 41.8 olan hastaların ortalama epilepsi süreleri 20.4±12.6 (minimum 6 ay - maksimum 46 yıl) yıl idi. Sonuçta yedi (%17.9) hastanın emeklilik için uygun olduğuna karar verilirken 16 hastanın (%41) ise uygun kriterleri taşımadığı sonucuna varılmıştır. On dört (%35.9) hasta başvuru sonrası kontrollere gelmezken iki (%5.1) hastanın ise epilepsi hastası olmadığı saptanmıştır. Sonuç: Epilepsi hastalarının takibinde sadece tıbbi tedavi ile yetinmeyip hastaların sosyal hakları konusunda bilinçlenmelerine katkıda bulunmak ve yaşam kalitelerini artırmak uygun bir yaklaşımdır. Objectives: Epilepsy is a chronic disease resulting in the loss of labor and disability. Despite appropriate medical and surgical treatments, patients experiencing frequent seizures should be protected socially. This study aimed to investigate the demographic and clinical characteristics of disability in epilepsy patients. Methods: According to the decisions of the Health Board of Antalya Education and Research Hospital, patients followed-up by second stage hospitals or who had no follow-ups would be followed-up for at least three months with appropriate and adequate treatment than final decision would be given. Results: Thirty-nine patients (31 male, 8 female) were included into the study. The mean age was 41.8 years, duration of epilepsy was 20.4 ± 12.6 years (min. 6 months- max. 46 years). Ultimately, seven patients were suitable for disability retirement and 16 were not. Fourteen patients withdrew applications. Finally, it was understood that two patients had syncope attacks rather than epilepsy. Conclusion: During the follow-up of the patients with epilepsy, the management of medical therapy is not enough alone, we must educate the patients about their social benefits. Patients, who have frequent seizures that obstacle working, should be promoted socially and financially by the social state. However, this issue is open to abuse, people who deserve social benefits should be determined objectively.