1
|
Roa JD, Camacho-Cruz J, Pérez-Osorio L, Castillo AM, Saavedra-Gutierrez G. Self-limited epilepsy with autonomic seizures: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231169573. [PMID: 37151738 PMCID: PMC10154998 DOI: 10.1177/2050313x231169573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/26/2023] [Indexed: 05/09/2023] Open
Abstract
Self-limited epilepsy with autonomic seizures, formerly known as benign occipital epilepsy of childhood or Panayiotopoulos syndrome is a focal epilepsy that is part of the epileptic syndromes with onset during childhood. The objective of this report is to raise awareness about its importance and describe the clinical manifestations, timely diagnosis, and treatment. A pediatric patient admitted with gastrointestinal manifestations is presented. The autonomic manifestations must be considered as part of the clinical spectrum that includes this disease and the digestive and autonomic manifestations that mask the diagnosis, sometimes even in the absence of motor seizures themselves. Electroencephalographic confirmation was performed, avoiding cataloging it in other differential diagnoses.
Collapse
Affiliation(s)
- Juan David Roa
- Department of Pediatric Neurology, Faculty of
Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de
Bogota-Hospital San José, Bogotá D.C., Colombia
| | - Jhon Camacho-Cruz
- Department of Pediatrics, Faculty of
Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de
Bogota-Hospital San José, Bogotá D.C., Colombia
- Jhon Camacho-Cruz, Department of Pediatrics,
Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de
Cirugía de Bogota-Hospital San José, Sede Centro (edificio docente), Cra 19 No. 8A – 32,
Bogotá D.C. 111411, Colombia.
| | - Laura Pérez-Osorio
- Department of Pediatrics, Faculty of
Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de
Bogota-Hospital San José, Bogotá D.C., Colombia
| | - Ana Maria Castillo
- Department of Pediatrics, Faculty of
Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de
Bogota-Hospital San José, Bogotá D.C., Colombia
| | - Gabriela Saavedra-Gutierrez
- Department of Pediatrics, Faculty of
Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Sociedad de Cirugía de
Bogota-Hospital San José, Bogotá D.C., Colombia
| |
Collapse
|
2
|
Bernat DJ, Albert D, Cass J. Case Study: Neuropsychological and Electroencephalogram Findings in Suspected Panayiotopoulos Syndrome. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2022. [DOI: 10.1007/s40817-022-00136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
3
|
Baggio M, Toffoli L, Da Rold M, Duma GM, Mento G, Morao V, Danieli A, Bonanni P. Neuropsychological and behavioral profiles of self-limited epileptic syndromes of childhood: a cross-syndrome comparison. Child Neuropsychol 2022; 28:878-902. [PMID: 35086426 DOI: 10.1080/09297049.2022.2028754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood epilepsy with centro-temporal spikes (CECTS), Childhood absence epilepsy (CAE) and Panayiotopoulos syndrome (PS) are some of the most common pediatric epileptic syndromes. Despite the relatively benign (self-limited) course of epilepsy, current evidence suggests that these conditions are associated with an increased risk of neuropsychological and behavioral comorbidities. This study provides a cross-epileptic syndromes' comparison reporting on the cognitive and behavioral profile of a cohort of 32 children with CECTS (n = 14), CAE (n = 10) and PS (n = 8), aged 6 to 15 years old. Frequent, although often subclinical cognitive difficulties involving attention, executive functions and academic abilities were found in children with CECTS and CAE, and to a lesser extent in PS. Internalizing symptoms (particularly anxiety) were more common in the PS group compared to CECTS and CAE based on parental reports. Correlational analysis revealed a significant correlation between phonemic fluency and seizure-free interval at the time of evaluation, suggesting a beneficial effect of epilepsy remission on this executive function measure in all the three groups. These results add to existing literature providing further detail on neuropsychological and behavioral peculiarities of children with CECTS, CAE, and PS. Moreover, the need for neuropsychological assessment as part of the standard childhood epilepsy evaluation is stressed. The results are discussed in the context of the current literature, highlighting areas of consensus and controversies related to the clinical management of these epileptic syndromes as well as directions for future research.
Collapse
Affiliation(s)
- Martina Baggio
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Lisa Toffoli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Martina Da Rold
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Gian Marco Duma
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Department of General Psychology, University of Padova, Italy
| | - Giovanni Mento
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy.,Padova Neuroscience Center (PNC), University of Padova, Italy
| | - Veronica Morao
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Alberto Danieli
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Irccs "E. Medea," Conegliano, Treviso, Italy
| |
Collapse
|
4
|
Duma GM, Danieli A, Morao V, Da Rold M, Baggio M, Toffoli L, Zanatta A, Vettorel A, Bonanni P, Mento G. Implicit cognitive flexibility in self-limited focal epilepsy of childhood: An HD-EEG study. Epilepsy Behav 2021; 116:107747. [PMID: 33493810 DOI: 10.1016/j.yebeh.2020.107747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
Self-limited focal epilepsy of childhood (SFEC) is often related to mild impairments in several neuropsychological domains, including cognitive flexibility, which is generally considered a process requiring volition and attention. However, recent evidence showed that it can be implicitly adjusted exploiting simple 'stimulus-response' associations as for example, the probability of the stimulus occurrence. Here, we evaluated the capability to implicitly extract environmental patterns of regularities and use them to flexibly adjust proactive control motor control. We tested 21 children with epilepsy (total IQ > 80; 13 with Childhood epilepsy with centro-temporal spikes, 8 with Panayiotopoulos syndrome (PS); 5-13 years old) compared to a healthy age-matched control group (32 participants). We used the Dynamic Temporal Prediction (DTP) task to investigate how behavioral performance is implicitly shaped by the manipulation of the stimulus occurrence probability over time. We recorded EEG to identify neural markers to differentiate the two groups. SFEC group showed a reduction in accuracy (p = .0013) and response speed (p < .001) as well as an absence of response adjustment (p = .65) in relation to the implicit changes in stimulus probability occurrence, in comparison to the control group. The epilepsy group performance in the DTP showed a significant correlation with the phonemic fluency (r = -0.50) and the Perseverations index of the CPT test (r = 0.53). Finally, children with SFEC did not show the modulation of the contingent negative variation (CNV) evoked potential. Overall, children with SFEC showed poor implicit flexibility compared to a control group. This pattern is individually related to high-level executive function, suggesting to extend neuropsychological assessment to the implicit domain.
Collapse
Affiliation(s)
- Gian Marco Duma
- Department of General Psychology, University of Padova, Italy; Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy.
| | - Alberto Danieli
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Veronica Morao
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Martina Da Rold
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Martina Baggio
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Lisa Toffoli
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Arianna Zanatta
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Airis Vettorel
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Paolo Bonanni
- Scientific Institute, IRCCS "E. Medea", Association "La Nostra Famiglia", Conegliano (TV), Italy
| | - Giovanni Mento
- Department of General Psychology, University of Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Italy
| |
Collapse
|
5
|
Fonseca Wald ELA, Debeij-Van Hall MHJA, De Jong E, Aldenkamp AP, Vermeulen RJ, Vles JSH, Klinkenberg S, Hendriksen JGM. Neurocognitive and behavioural profile in Panayiotopoulos syndrome. Dev Med Child Neurol 2020; 62:985-992. [PMID: 32608507 DOI: 10.1111/dmcn.14417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine neurocognitive performance and behavioural problems in children with Panayiotopoulos syndrome. METHOD All 18 children (10 females, 8 males; mean age 4y 7mo; SD 1y 10mo) diagnosed with Panayiotopoulos syndrome at the Kempenhaeghe Epilepsy Center in the Netherlands between 2010 and 2017 were analysed retrospectively. All underwent a neuropsychological/behavioural assessment, an academic assessment, and a 24-hour electroencephalogram. RESULTS Mean full-scale IQ (93.5; range 76-123; p=0.04) and performance IQ (93.2; range 76-126; p=0.04) were within the normal range, although significantly lower compared to the normative mean. Verbal IQ (96.3; range 76-118) and processing speed (96.1; range 74-114) were not significantly lower. Simple auditory/visual reaction times, visual attention, visual-motor integration, and verbal memory were significantly lower compared to normative values. On average, patients with Panayiotopoulos syndrome were 8 months behind in arithmetic speed and 11 months behind in reading speed for the number of months in school. Behavioural questionnaires revealed significantly higher scores on reported internalizing behavioural problems. INTERPRETATION Children with Panayiotopoulos syndrome demonstrated diffuse cognitive dysfunction in full-scale IQ, performance IQ, visual attention, visual-motor integration, and verbal memory. A high incidence of internalizing behavioural problems was reported. This strongly suggests neuropsychological and behavioural comorbidity in children with Panayiotopoulos syndrome. WHAT THIS PAPER ADDS Children with Panayiotopoulos syndrome are at risk for cognitive deficits in various cognitive domains. Children with Panayiotopoulos syndrome are also prone to internalizing behavioural problems. Mild-to-severe academic underachievement was present in more than half of the children with Panayiotopoulos syndrome.
Collapse
Affiliation(s)
- Eric L A Fonseca Wald
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Kempenhaeghe Epilepsy Center, Heeze, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | | | - Eline De Jong
- Kempenhaeghe Epilepsy Center, Heeze, the Netherlands
| | - Albert P Aldenkamp
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Kempenhaeghe Epilepsy Center, Heeze, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jos G M Hendriksen
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Kempenhaeghe Epilepsy Center, Heeze, the Netherlands
| |
Collapse
|
6
|
Akca Kalem S, Elmali AD, Demirbilek V, Oktem O, Yapici Z, Saltik S, Gokcay A, Dervent A, Baykan B. Panayiotopoulos syndrome and Gastaut syndrome are distinct entities in terms of neuropsychological findings. Epilepsy Behav 2019; 99:106447. [PMID: 31398558 DOI: 10.1016/j.yebeh.2019.106447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although the courses of self-limited focal epilepsies of childhood are considered as benign, a handful of studies suggested that these children may suffer from cognitive problems. Implementing tailor-made educational strategies would aid these children to reach their full potentials. Therefore, it is crucial to understand and differentiate the complete neuropsychological and behavioral profiles of these rather common syndromes. We aimed to examine the distinct cognitive and behavioral profiles of the Panayiotopoulos syndrome (PS) and the Gastaut syndrome (GS), comparatively. METHOD Twenty patients with PS, 20 patients with GS, and 20 healthy controls have been recruited. The testing protocol included Wechsler Intelligence Scale for Children-Revised, Conner's Continuous Performance Test, Verbal Fluency Test, Stroop Color and Word Test, Color Trails Test, Tower of London Test, Symbol Digit Modalities Test, California Verbal Learning Test-Children's Version, Rey Complex Figure Test, Benton Face Recognition Test, Benton Judgment of Line Orientation, Peabody Picture Vocabulary Test, Reading and Writing Test, Child Behavior Checklist, Conner's Parent Rating Scale-48, and Behavior Rating Inventory of Executive Function. Demographical, clinical, electrophysiological data, and imaging findings have also been evaluated. RESULTS With regard to intelligence, the patients with PS scored less in all scales compared to the healthy controls. However, only the performance IQ (intelligence quotient) scores differed significantly between the patient groups, with the patients with PS scoring lower than the patients with GS. Verbal memory problems were eminent in both of the patient groups; whereas, visual memory was impaired only in the group with PS. Psychomotor speed was affected in both groups. Reading problems were prominent only in the patients with PS. Writing and arithmetic skills were defective in both patient groups. There were no noteworthy behavioral problems in comparison to healthy subjects. CONCLUSION Using neuropsychological profiles, this study demonstrated that the GS and the PS are two distinct entities. Cognitive dysfunction is a more prominent and widespread feature of the patients with PS; whereas, the patients with GS suffer only from milder and isolated cognitive problems.
Collapse
Affiliation(s)
- Sukriye Akca Kalem
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ayse Deniz Elmali
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Veysi Demirbilek
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Oget Oktem
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Zuhal Yapici
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Sema Saltik
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Pediatrics, Istanbul, Turkey
| | - Ahmet Gokcay
- Ege University, Faculty of Medicine, Department of Neurology, Izmir, Turkey
| | - Aysin Dervent
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Betul Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| |
Collapse
|
7
|
Tran LH, Zupanc ML. Neurocognitive Comorbidities in Pediatric Epilepsy: Lessons in the Laboratory and Clinical Profile. Semin Pediatr Neurol 2017; 24:276-281. [PMID: 29249507 DOI: 10.1016/j.spen.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Children with epilepsy are at risk for a variety of neurocognitive comorbidities. Animal models have increased our understanding about the neurobiological mechanisms underlying the association between seizures and these comorbidities. This article starts with an overview of the current data on animal model research, studying the influence of early-life seizures, followed by a summary of potential cellular and molecular mechanisms by which seizures can affect cognitive development. We then describe specific abnormal neuropsychological profiles that accompany specific pediatric epilepsy syndromes. Finally, we offer a potential guideline to the treatment and management of children with epilepsy and its neurocognitive comorbidities.
Collapse
Affiliation(s)
- Lily H Tran
- Department of Pediatrics, Pediatric Comprehensive Epilepsy Program, University of California, Irvine, Children's Hospital of Orange County, Orange, CA.
| | - Mary L Zupanc
- Department of Pediatrics and Neurology, University of California, Irvine, Children's Hospital of Orange County, Orange, CA
| |
Collapse
|
8
|
Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol 2016; 12:465-76. [PMID: 27448186 DOI: 10.1038/nrneurol.2016.98] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
Collapse
Affiliation(s)
- Katherine C Nickels
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Michael J Zaccariello
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Lorie D Hamiwka
- Seattle Children's Hospital, MB.7.420 - Neurology, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Elaine C Wirrell
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| |
Collapse
|