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correspondence

Indian Pediatr 2012;49: 501

Migraine Variant


I read with interest the case reported by Chakravarty and Mukherjee labeled as a migraine variant [1]. They describe a 4 year old boy with delayed expressive language development and episodic focal motor and language deficits lasting 10 minutes to 3 days. Many inborn errors of metabolism can have such a presentation in childhood even in the absence of overt changes on brain magnetic resonance (MR) imaging including organic acidemias (methylmalonic, propionic and isovaleric), maple syrup urine disease, ornithine transcarbamylase (OTC) deficiency, and, hydroxyl-methyl-glutaryl CoA lyase deficiency [2]. Particularly in boys, OTC deficiency is an important consideration. Lack of appropriate metabolic investigations to screen for these disorders and MR spectroscopy, together with absence of headache in the child, makes the diagnosis doubtful, at best.

Ravindra Arya

Division of Neurology,
Cincinnati Children’s Hospital Medical Center,
Cincinnati, Ohio
Email: [email protected]

References

1. Chakravarty A, Mukherjee M. Sporadic hemiplegic migraine. Indian Pediatr. 2012;49:150.

2. Saudubray J-M, Charpentier C. Clinical Phenotypes: Diagnosis/ Algorithms In: Scriver CR, Sly WS, Childs B, Beaudet AL, Valle D, Kinzler KW, et al., editors. The Metabolic and Molecular Bases of Inherited Disease. 8th ed: McGraw-Hill Professional; 2000.
 

Reply

The child is under review for several months now  and is doing well. His speech has also improved. There has been no further episode of any focal neurological problem. These would exclude any underlying metabolic disorder.

Ambar Chakravarty

Email: [email protected]

 

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