Lasting Electrographic Footprint of Familial Hemiplegic Migraine (P7-12.005)

Abstract

<h3>Objective:</h3> We describe a case of familial hemiplegic migraine whose EEG showed uni-hemispheric slowing during the episode and weeks following it. <h3>Background:</h3> Electroencephalograms (EEGs) are not routinely done in the context of a migraine diagnosis. EEG abnormalities have been reported in pediatric migraines including slow activity that is diffuse, lateralized or focal. Specific to hemiplegic migraine, slowing has been described in the hemisphere contralateral to the hemiplegic limb. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A twelve-year-old, previously healthy, right-handed girl presented to the emergency department with sudden onset right arm weakness, aphasia and confusion. Altered mentation, expressive aphasia and right hemiparesis were noted. She underwent emergent MRI brain for concerns of acute stroke, which ruled out the same. Continuous EEG monitoring showed marked left hemispheric slowing but no focal seizures. For suspicion of complex hemiplegic migraine, she received a combination of ketorolac, diphenhydramine and prochlorperazine. This led to resolution of weakness and aphasia, along with return to baseline mentation. However, left hemispheric slowing persisted on EEG even at the time of discharge. Two weeks later, a repeat routine EEG showed continued slowing in the left occipital region, while patient clinically continued to function at baseline and had not had any further episodes. Four weeks after the original event, EEG returned to symmetric brain activity with no other abnormalities. Subsequently, family shared that patient’s mother and maternal aunt experience symptoms consistent with hem legic migraines, but had never been formally diagnosed. With this crucial information, we proceeded with genetic testing which revealed a mutation in the ATP1A2 gene, establishing the diagnosis as Familial Hemiplegic Migraine (FHM). <h3>Conclusions:</h3> With limited literature on EEG abnormalities seen in pediatric migraines, specifically familial hemiplegic migraines, our case is the first report of EEG changes persisting for weeks beyond the resolution of symptoms from an acute episode. <b>Disclosure:</b> Dr. Ahmed Khan has nothing to disclose. Cynthia Morris has nothing to disclose. Dr. Goretzke has nothing to disclose.