Abstract
Authors’ reply
Dear Sir We have read the interesting remarks of Dr Stone. We agree about the importance of psychiatric disorders in the differential diagnosis and we have tried to exclude them by accurate psychological examinations (1). We are aware that the psychiatric disorder cannot be excluded by the only negative psychological examination, just as epilepsy cannot be exclude in an absolute manner by the negative ictal EEG recording, but the brief duration of symptoms does not allow further elucidation.
However, in our opinion the patient's migraine history, the gradual progression of appearance and disappearance of symptomatology and also the scientific literature (see recent report (2) about ‘neurological disconnection’ during migraine aura attack), make the ‘alien hand’ migrainous pathogenesis more likely.
Finally, in order to be concise, we focused on the differential diagnosis between migraine and epilepsy as they are more common disorders responsible for transient neurological symptoms in childhood.
Further observations will surely help us to classify the ‘alien hand’ and its possible pathogenesis.