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Yang Z, Xue J, Li H, Qian P, Liu X, Jiang Y, Zhang Y. Early childhood myoclonic epilepsy: An independent genetic generalized epilepsy with myoclonic seizures as the main seizure type. Clin Neurophysiol 2017; 128:1656-1663. [PMID: 28738275 DOI: 10.1016/j.clinph.2017.06.244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/21/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To elucidate the characteristics of the myoclonic seizures alone, or predominant myoclonus combined with generalized tonic-clonic seizures (GTCS) and/or absences, in early childhood, and discuss its classification. METHODS Forty-two children were retrospectively recruited between January 2006 and June 2015. RESULTS The mean age of seizure onset was 40.5months. They were divided into 4 groups: myoclonic seizures alone; predominant myoclonus combined with GTCS; predominant myoclonus combined with absences; predominant myoclonus combined with both GTCS and absences. Interictal EEG showed generalized spike- or polyspike-wave discharges at 2-4Hz. Seizures were controlled in 22 patients at a mean age of 60.5months. The psychomotor development was normal (30/37) or mildly delayed (7/37). CONCLUSIONS We reported a cohort of patients with early childhood myoclonic epilepsy (ECME), with the following characteristics: Seizures started below 5years old in otherwise normal children; Seizure types included myoclonic seizures alone or combined with GTCS and/or absences; Febrile or afebrile GTCS might appear firstly; Interictal EEG showed generalized spike- or polyspike-wave; Seizures usually were in remission before adolescence with normal development or mild cognitive or behavioral deficits in most. SIGNIFICANCE ECME might be an independent epileptic syndrome not established by International League Against Epilepsy (ILAE) previously.
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Affiliation(s)
- Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Jiao Xue
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hui Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ping Qian
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoyan Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Burns TG, Ludwig NN, Tajiri TN, DeFilippis N. Cognitive and behavioral outcomes among seizure-controlled children with partial epilepsy on antiepileptic drug monotherapy. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 7:52-60. [DOI: 10.1080/21622965.2016.1241177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Natasha N. Ludwig
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | | | - Nick DeFilippis
- Georgia School of Professional Psychology, Atlanta, Georgia, USA
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Koutroumanidis M, Tsiptsios D, Kokkinos V, Kostopoulos GK. Focal and generalized EEG paroxysms in childhood absence epilepsy: topographic associations and distinctive behaviors during the first cycle of non-REM sleep. Epilepsia 2012; 53:840-9. [PMID: 22360352 DOI: 10.1111/j.1528-1167.2012.03424.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To better understand the nature of the focal spike-wave discharges (FSWDs) and focally led generalized spike-wave discharges (GSWDs) in typical childhood absence epilepsy (CAE) and by implication their nosologic and taxonomic significance. METHODS Twenty-four abnormal video-electroencephalography (EEG) studies from 13 consecutive children with CAE and good response to appropriate antiepileptic drugs (AEDs) were analyzed. We studied the association between the topography of absence onset and the ictal automatisms, and the topographic correlation between FSWDs and GSWDs and their respective behavior during hyperventilation and the different states of phasic and nonphasic non-rapid eye movement (NREM) sleep. GSWDs were considered as of "focal" onset if a lead-in could be visibly recognized at a paper speed of 60 mm/s, and were classified by their topography. KEY FINDINGS (1) Multifocal absences occurred in 10 children; anterior onset was noted in 81 absences (73.6%) from 12 children and posterior in 18 (16.4%) from 7 children; there was no association between topography of absence onset and ictal automatisms; (2) FSWDs occurred in 85% of children and were multifocal in 73% of them; 85% of FSWDs were anterior and 14% posterior; (3) there was good topographic association between FSWDs and the leading spike of GSWDs of "focal" onset in all children with FSWDs; (4) both FSWDs and GSWDs increased during hyperventilation; (5) FSWDs occurred mainly during noncyclical NREM sleep and during periods of reduced vigilance of cyclical NREM sleep, whereas GSWDs occurred during the periods of enhanced vigilance of NREM sleep; GSWDs occurred significantly more frequently than FSWDs at the transition from reduced to enhanced vigilance of NREM sleep. SIGNIFICANCE Our findings suggest that in CAE focal EEG paroxysms reflect a system of multifocal nonlocalizing electrically unstable cortical areas that under the facilitatory influence of exogenous or endogenous factors like sleep instability can foster a corticothalamic response of sufficient strength to generate 3-Hz GSWDs that are conditionally sustainable and potentially ictal. FSWDs can be viewed as incomplete forms of the GSWDs; together they define the EEG identity of idiopathic "generalized" epileptogenesis.
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Affiliation(s)
- Michalis Koutroumanidis
- Department of Clinical Neurophysiology and Epilepsies, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
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Parisi P, Verrotti A, Paolino MC, Castaldo R, Ianniello F, Ferretti A, Chiarelli F, Villa MP. "Electro-clinical syndromes" with onset in paediatric age: the highlights of the clinical-EEG, genetic and therapeutic advances. Ital J Pediatr 2011; 37:58. [PMID: 22182677 PMCID: PMC3267655 DOI: 10.1186/1824-7288-37-58] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/19/2011] [Indexed: 12/13/2022] Open
Abstract
The genetic causes underlying epilepsy remain largely unknown, and the impact of available genetic data on the nosology of epilepsy is still limited. Thus, at present, classification of epileptic disorders should be mainly based on electroclinical features. Electro-clinical syndrome is a term used to identify a group of clinical entities showing a cluster of electro-clinical characteristics, with signs and symptoms that together define a distinctive, recognizable, clinical disorder. These often become the focus of treatment trials as well as of genetic, neuropsychological, and neuroimaging investigations. They are distinctive disorders identifiable on the basis of a typical age onset, specific EEG characteristics, seizure types, and often other features which, when taken together, permit a specific diagnosis which, in turn, often has implications for treatment, management, and prognosis. Each electro-clinical syndrome can be classified according to age at onset, cognitive and developmental antecedents and consequences, motor and sensory examinations, EEG features, provoking or triggering factors, and patterns of seizure occurrence with respect to sleep. Therefore, according to the age at onset, here we review the more frequently observed paediatric electro-clinical syndrome from their clinical-EEG, genetic and therapeutic point of views.
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Affiliation(s)
- Pasquale Parisi
- NESMOS Department, Chair of Pediatrics, Child Neurology, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa, 1035-1039, Rome,00189, Italy.
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A clinical and genetic study of 33 new cases with early-onset absence epilepsy. Epilepsy Res 2011; 95:221-6. [DOI: 10.1016/j.eplepsyres.2011.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/15/2011] [Accepted: 03/25/2011] [Indexed: 11/23/2022]
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Verrotti A, Agostinelli S, Olivieri C, Chiarelli F, Curatolo P. Early-onset pure absence epilepsy: a distinct epileptic syndrome. Acta Paediatr 2011; 100:647-50. [PMID: 21352361 DOI: 10.1111/j.1651-2227.2011.02213.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Early-onset pure absence epilepsy has not yet considered in the International League Against Epilepsy classification, but several reports have supported its existence as a distinct epileptic syndrome primarily manifesting with typical absences in early childhood. This review summarizes the current understanding on this epilepsy. CONCLUSIONS Early-onset pure absence epilepsy is a distinct epilepsy characterized by absences starting from a few months to 4 years of age, normal early psychomotor development, good antiepileptic drug seizure control and normal intellectual outcome.
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Verrotti A, Olivieri C, Agostinelli S, Coppola G, Parisi P, Grosso S, Spalice A, Zamponi N, Franzoni E, Iannetti P, Chiarelli F, Curatolo P. Long term outcome in children affected by absence epilepsy with onset before the age of three years. Epilepsy Behav 2011; 20:366-9. [PMID: 21227756 DOI: 10.1016/j.yebeh.2010.12.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 12/01/2010] [Accepted: 12/08/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The goal of this study was to define the long-term outcome of absence epilepsy presenting before the age of 3 years. METHODS We retrospectively studied the medical records of 40 children from eight neuropediatric centers in Italy with respect to the personal and family histories of epilepsy or febrile seizures, time of follow-up, cognitive functions, treatment, and outcome. RESULTS Forty patients were enrolled in this study. They all fulfilled the criteria for absence epilepsy with 3-Hz spike-wave complexes on the EEG, normal neurological examination, and no other seizures types. Seizure onset occurred between 24.1 and 36.0 months. There was a family history of epilepsy in 28%, and of febrile seizures in 13%. Thirty-three patients were treated with valproic acid (VPA), mostly used in monotherapy (26 patients) or in association with ethosuximide. At final follow-up, 33 patients were seizure free and 29 had normal EEGs. Thirty-four patients had a normal intelligence quotient (IQ), whereas 6 had a decreased IQ, mainly associated with poor control of seizures. CONCLUSION In our series, absence seizures presenting before the age of 3 appeared to have quite a good long-term clinical prognosis; the neuropsychological outcome was comparable to that of childhood epilepsy presenting after 3 years of age.
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Ma X, Zhang Y, Yang Z, Liu X, Sun H, Qin J, Wu X, Liang J. Childhood absence epilepsy: Elctroclinical features and diagnostic criteria. Brain Dev 2011; 33:114-9. [PMID: 20378290 DOI: 10.1016/j.braindev.2010.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 12/29/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the electroclinical features of children with childhood absence epilepsy (CAE) and discuss the diagnostic criteria for CAE. METHODS The video-electroencephalogram (VEEG) database in our hospital was searched using "absence seizures" and "3-Hz generalized spike and waves (GSW)" as key-words. Other epileptic syndromes with typical absence seizures were carefully excluded. Children meeting the CAE diagnostic criteria of the International League Against Epilepsy (ILAE) in 1989 were further evaluated with the diagnostic criteria proposed by Panayiotopoulos in 2005. RESULTS Totally 37 children met the 1989 ILAE criteria of CAE. The onset age of absence seizures ranged from 3 to 11 years. All patients had frequent absence seizures (5-60 times per day). Two patients (5.4%) had generalized tonic-clonic seizures. Hyperventilation induced absences in all patients. VEEG confirmed that 7 patients (18.9%) had only simple absences, 25 patients (67.6%) had only complex absences, and 5 patients (13.5%) had both simple and complex absences. Ictal EEG showed 3Hz GSW discharges in all patients. The seizure duration ranged from 3 to 40s. Four patients (10.8%) had two spikes per wave in ictal EEG. GSW fragments were found in 29 patients (78.4%) during sleep. Interictal polyspikes and waves were present in 17 patients (45.9%). Focal discharges predominantly in the anterior regions, were found in 22 patients (56.8%). Only 7 patients (18.9%) met the diagnostic criteria proposed by Panayiotopoulos in 2005. CONCLUSIONS Few patients meeting the 1989 ILAE diagnostic criteria for CAE meet the new diagnostic criteria proposed by Panayiotopoulos in 2005. The new criteria for CAE are too strict to appropriately classify some patients.
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Affiliation(s)
- Xiuwei Ma
- Department of Pediatrics, Peking University First Hospital, Xicheng District, Beijing, PR China
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Caraballo RH, Darra F, Fontana E, Garcia R, Monese E, Dalla Bernardina B. Absence seizures in the first 3 years of life: an electroclinical study of 46 cases. Epilepsia 2011; 52:393-400. [PMID: 21269284 DOI: 10.1111/j.1528-1167.2010.02926.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Early onset absence seizures have been considered a rare heterogeneous group with a poor prognosis. Only few patients may be categorized into well-known syndromes. We have evaluated electroclinical features, evolution, and the nosologic boundaries of early onset absence seizures. METHODS Forty-six neurologically normal patients with absence seizures associated with bilateral, synchronic, or asynchronic, and symmetric or asymmetric spike-and-wave paroxysms with onset in the first 3 years of life were included. Patients with abnormal neurologic examination and brain imaging were excluded from the study. KEY FINDINGS In our study, 39 patients met the clinical and electroencephalography (EEG) criteria of well-defined epileptic syndromes. Childhood absence epilepsy was found in 11 patients, benign myoclonic epilepsy in infancy in 18 patients, eyelid myoclonic epilepsy in 4, and epilepsy with myoclonic absences in 6. We did not find clinical and EEG criteria of well-recognized epileptic syndromes in seven children. Nine of 11 patients with simple absence seizures became seizure free. All these patients had normal neurologic and neuropsychological evaluations. Of the 35 patients who had absence seizures associated with myoclonic seizures, 20 became seizure free. Fifteen of 35 children continue having seizures. At the last visit, 20 of these 35 patients had normal neurologic and neuropsychological evaluations, 11 presented with mild mental retardation, and 4 with severe mental retardation. SIGNIFICANCE Epilepsies with absence seizures of early onset are relatively uncommon. Most of the patients had well-defined epileptic syndromes with a variable evolution. The evolution depended on the epileptic syndromes.
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Affiliation(s)
- Roberto Horacio Caraballo
- Department of Neurology, Hospital Nacional de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina.
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Shahar E, Genizi J, Nevo Y, Kaufman R, Cabot S, Zelnik N. Typical absence epilepsy presenting prior to age of 3 years: an uncommon form of idiopathic generalized epilepsy. Eur J Paediatr Neurol 2007; 11:346-52. [PMID: 17500018 DOI: 10.1016/j.ejpn.2007.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 02/22/2007] [Accepted: 02/26/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE An attempt to allocate patients with the clinical features and electroencephalography (EEG) abnormalities of typical absence epilepsy presenting before the age of 3 years, similar to childhood and juvenile absence epilepsy (JAE) and delineate the clinical manifestations, EEG abnormalities, therapy and outcome of such an epileptic disorder by conducting a nationwide survey. RESULTS Overall, eight infants, six males and two females, abided by the inclusion criteria of typical absence epilepsy: They were born after an unremarkable pregnancy and labor presenting at the age of 12-34 months (mean: 19.6 months) with frequent absences time-linked with an EEG demonstrating generalized occasionally irregular epileptiform discharges of 3-4 Hz spike/wave and normal background activity along with an electrographic photosensitive response in one patient. Neurological examination was intact in all infants. All eight infants were initially treated with valproic acid, of whom seven immediately responded and one had increase in frequency and duration of absences completely aborted with treatment of lamotrigine. Three relapsed after termination of therapy of whom two again presented with recurrent absences and another one with generalized tonic-clonic seizures and as such these children had virtually transformed into a later form of idiopathic generalized epilepsy (IGE) during childhood. All eight patients are seizure-free, seven still on therapy; seven children within a follow-up period of 2-7 years and the most recently diagnosed infant for 6 months. Cognitive skills were found normal in all children within the low normal range in three children with short attention and concentration spans. CONCLUSION The data presented here delineate a very rare form of idiopathic benign generalized epilepsy presenting with typical absences before age of 3 years and a favorable outcome, similar to childhood and JAE, recognized as distinct IGE syndromes by the International League Against Epilepsy (ILAE) classification.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel.
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