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Hussain SA, Heesch J, Weng J, Rajaraman RR, Numis AL, Sankar R. Potential induction of epileptic spasms by nonselective voltage-gated sodium channel blockade: Interaction with etiology. Epilepsy Behav 2021; 115:107624. [PMID: 33341392 DOI: 10.1016/j.yebeh.2020.107624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Epileptic spasms are often preceded by focal (or multifocal) seizures. Based on a series of case reports suggesting that carbamazepine and oxcarbazepine may induce epileptic spasms, we set out to rigorously evaluate the potential association between exposure to voltage-gated sodium channel blockade and latency to epileptic spasms. METHODS We identified 50 cases (children with focal seizures and evolution to epileptic spasms) and 50 controls (children with focal seizures without evolution to epileptic spasms). For each patient, we reviewed all sequential neurology encounters between onset of epilepsy and emergence of epileptic spasms. For each encounter we recorded seizure-frequency and all anti-seizure therapy exposures. Using multivariable Cox proportional hazards regression, we evaluated the association between voltage-gated sodium channel exposure (carbamazepine, oxcarbazepine, lacosamide, or phenytoin) and latency to epileptic spasms onset, with adjustment for etiology and seizure-frequency. RESULTS Latency to epileptic spasms onset was independently associated with exposure to sodium channel blockade (hazard ratio = 2.4; 95% CI 1.1-5.2; P = 0.03) and high-risk etiology (hazard ratio = 2.8; 95% CI 1.5-5.1; P = 0.001). With assessment for interaction between sodium channel blockade and etiology, we identified an estimated 7-fold increased risk of epileptic spasms with the combination of sodium channel blockade and high-risk etiology (hazard ratio = 7.0, 95% CI 2.5-19.8; P < 0.001). CONCLUSION This study suggests that voltage-gated sodium channel blockade may induce epileptic spasms among children at risk on the basis of etiology. Further study is warranted to replicate these findings, ascertain possible drug- and dose-specific risks, and identify potential mechanisms of harm.
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Affiliation(s)
- Shaun A Hussain
- Division of Pediatric Neurology, David Geffen School of Medicine and UCLA Mattel Children's Hospital, Los Angeles, CA, United States.
| | - Jaeden Heesch
- Division of Pediatric Neurology, David Geffen School of Medicine and UCLA Mattel Children's Hospital, Los Angeles, CA, United States
| | - Julius Weng
- Division of Pediatric Neurology, David Geffen School of Medicine and UCLA Mattel Children's Hospital, Los Angeles, CA, United States
| | - Rajsekar R Rajaraman
- Division of Pediatric Neurology, David Geffen School of Medicine and UCLA Mattel Children's Hospital, Los Angeles, CA, United States
| | - Adam L Numis
- Departments of Neurology and Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, United States
| | - Raman Sankar
- Division of Pediatric Neurology, David Geffen School of Medicine and UCLA Mattel Children's Hospital, Los Angeles, CA, United States
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Liao J, Huang T, Srour M, Xiao Y, Chen Y, Lin S, Chen L, Hu Y, Men L, Wen J, Li B, Wen F, Xiong L. Status Epilepticus Manifested as Continuous Epileptic Spasms. Front Neurol 2020; 11:65. [PMID: 32117026 PMCID: PMC7034528 DOI: 10.3389/fneur.2020.00065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/17/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: The etiology and outcome of status epilepticus with continuous epileptic spasms have not been fully understood; and only rare cases have been reported in the literature. Here, we described 11 children, who manifested continuous epileptic spasms with various etiologies and different outcomes. Methods: This is a case series study designed to systematically review the charts, video-electroencephalography (video-EEG), magnetic resonance images, and longitudinal follow-up of patients who presented continuous epileptic spasms lasting more than 30 min. Results: Median age at onset was 2 years old, ranging from 2 months to 5.6 years. The etiology of continuous epileptic spasms for these 11 cases consisted of not only some known electro-clinical epilepsy syndromes like West Syndrome and Ohtahara Syndrome, but also secondary symptomatic continuous epileptic spasms, caused by acute encephalitis or encephalopathy, which extends the etiological spectrum of continuous epileptic spasms. The most characteristic feature of these 11 cases was prolonged epileptic spasms, lasting for a median of 13.00 days (95% CI: 7.26-128.22 days). The interictal EEG findings typically manifested as hypsarrhythmia or its variants, including burst suppression. Hospital stays were much longer in acute symptomatic cases than in primary epileptic syndromic cases (59.67 ± 50.82 vs. 15.00 ± 1.41 days). However, the long-term outcomes were extremely poor in the patients with defined electro-clinical epilepsy syndromes, including severe motor and intellectual developmental deficits (follow-up of 4.94 ± 1.56 years), despite early diagnosis and treatment. Continuous epileptic spasms were refractory to corticosteroids, immuno-modulation or immunosuppressive therapies, and ketogenic diet. Conclusion: Continuous epileptic spasms were associated with severe brain impairments in patients with electro-clinical syndromes; and required long hospital stays in patients with acute symptomatic causes. We suggest to include continuous epileptic spasms in the international classification of status epilepticus, as a special form. Further investigations are required to better recognize this condition, better understand the etiology, as well as to explore more effective treatments to improve outcomes.
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Affiliation(s)
- Jianxiang Liao
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Tieshuan Huang
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Myriam Srour
- Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Yuhan Xiao
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Yan Chen
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Sufang Lin
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Li Chen
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Yan Hu
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Lina Men
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Jialun Wen
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Bing Li
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Feiqiu Wen
- Shenzhen Children's Hospital Affiliated With China Medical University, Shenzhen, China
| | - Lan Xiong
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- *Correspondence: Lan Xiong
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Xu C, Yu T, Zhang G, Rajah GB, Wang Y, Li Y. Concordance between the interictal focal EEG pattern and MRI lesions as a predictor of a favorable surgical outcome in patients with epileptic spasms: a Chinese study. J Neurosurg Pediatr 2019; 23:422-431. [PMID: 30717039 DOI: 10.3171/2018.10.peds18380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the electro-clinical features, etiology, treatment, and postsurgical seizure outcomes in patients with intractable epileptic spasms (ESs). METHODS The authors retrospectively studied the medical records of all patients who had presented with medically intractable ESs and had undergone surgery in the period between October 2009 and August 2015. The interictal electroencephalography (EEG) pattern, MRI studies, magnetoencephalography findings, and postsurgical seizure outcomes were compared. RESULTS Twenty-six patients, 12 boys and 14 girls (age range 3-22 years), were eligible for study inclusion. Of these 26 patients, 84.6% (22) presented with multiple seizure types including partial seizures (PSs) independent of the ESs (30.8%); ESs followed by tonic seizures (30.8%); myoclonic seizures (19.2%); tonic seizures (19.2%); ESs followed by PSs (19.2%); focal seizures with secondary generalization (15.4%); atypical absence (11.5%); PSs followed by ESs (7.7%); and myoclonic followed by tonic seizures (7.7%). Seventeen patients underwent multilobar resection and 9 underwent unilobar resection. At the last follow-up (mean 36.6 months), 42.3% of patients were seizure free (outcome classification [OC] 1), 23.1% had > 50% reduction in seizure frequency (OC2-OC4), and 34.6% had < 50% reduction in seizure frequency or no improvement (OC5 and OC6). Predictors of favorable outcomes included an interictal focal EEG pattern and concordance between interictal EEG and MRI-demonstrated lesions (p = 0.001 and 0.004, respectively). CONCLUSIONS A favorable surgical outcome is achievable in a highly select group of patients with ESs secondary to structural lesions. Interictal EEG can help in identifying patients with the potential for favorable resective outcomes.
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Affiliation(s)
- Cuiping Xu
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Tao Yu
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Guojun Zhang
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
| | - Gary B Rajah
- 3Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Yuping Wang
- 4Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Yongjie Li
- Departments of1Functional Neurosurgery and
- 2Beijing Institute of Functional Neurosurgery, Beijing, People's Republic of China; and
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Akiyama T, Akiyama M, Kobayashi K, Okanishi T, Boelman CG, Nita DA, Ochi A, Go CY, Snead OC, Rutka JT, Drake JM, Chuang S, Otsubo H. Spatial relationship between fast and slow components of ictal activities and interictal epileptiform discharges in epileptic spasms. Clin Neurophysiol 2015; 126:1684-91. [DOI: 10.1016/j.clinph.2014.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/18/2014] [Accepted: 12/09/2014] [Indexed: 11/30/2022]
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Alshafai L, Ochi A, Go C, McCoy B, Hawkins C, Otsubo H, Snead OC, Rutka J, Widjaja E. Clinical, EEG, MRI, MEG, and surgical outcomes of pediatric epilepsy with astrocytic inclusions versus focal cortical dysplasia. Epilepsia 2014; 55:1568-75. [PMID: 25169867 DOI: 10.1111/epi.12756] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Astrocytic inclusions (AIs) have been identified on histologic specimens of patients with early onset seizures, and the proteomic contents have been described. The aim of this study was to compare the clinical, electroencephalography (EEG), magnetoencephalography (MEG), magnetic resonance imaging (MRI), and surgical outcomes of AIs relative to focal cortical dysplasia (FCD). METHODS We assessed the clinical manifestations, semiology, ictal and interictal features on video-EEG, MEG, MRI features, and surgical outcomes of children with histologically proven AIs compared to FCD. RESULTS Six children had AIs and 27 had FCD. Children with AIs had an earlier age at seizure onset, periodic spasms (all children), and interictal epileptiform discharges consisting of a mixture of generalized or diffuse hemispheric slow waves, sharp waves, spikes and polyspikes. Children with FCD were less likely to have spasms (4/27 [15%]), and the morphology of the diffuse hemispheric or generalized discharges were different from those of AI, consisting of spike-and-waves, polyspike-and-waves, sharp-and-slow waves, and paroxysmal fast activity. Patients with AIs were less likely to have tightly clustered MEG spike sources (3/6 [50%] vs. 23/27 [85%]), and more likely to demonstrate abnormal sulcation and gyration pattern (4/6 [67%] vs. 2/27 [7%]) and gray matter heterotopia (2/6 [33%] vs. 0/27 [0%]) than patients with FCD. Four children with AIs had resection and two had biopsy but did not undergo resection. Children with AIs had lower rates of seizure freedom after surgery compared to FCD (1/4 [25%] vs. 15/27 [56%], respectively). SIGNIFICANCE Although there were some similarities between AIs and FCD, patients with AIs were more likely to present with early onset periodic spasms, have unusual interictal epileptiform discharges, abnormal sulcation, gyration pattern, and gray matter heterotopia, and were less likely to be seizure free following surgical resection relative to FCD. Further study with a larger sample size is needed to validate our findings.
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Affiliation(s)
- Laila Alshafai
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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Kobayashi K, Miya K, Akiyama T, Endoh F, Oka M, Yoshinaga H, Ohtsuka Y. Cortical contribution to scalp EEG gamma rhythms associated with epileptic spasms. Brain Dev 2013; 35:762-70. [PMID: 23410838 DOI: 10.1016/j.braindev.2012.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 12/16/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
Abstract
The cortical contribution for the generation of gamma rhythms detected from scalp ictal EEG was studied in unique cases of epileptic spasms and a review of the related literature was conducted. Ictal scalp gamma rhythms were investigated through time-frequency analysis in two cases with a combination of focal seizures and spasms and another case with spasms associated with cortical dysplasia. In the two patients with combined seizures, the scalp distribution of ictal gamma rhythms was related to that of focal seizure activity. In the third patient, an asymmetric distribution of the ictal scalp gamma rhythms was transiently revealed in correspondence to the dysplasic cortex during hormonal treatment. Therefore, the dominant region of scalp gamma rhythms may correspond to the epileptogenic cortical area. The current findings have reinforced the possibility of the cortical generation of ictal scalp gamma rhythms associated with spasms. The detection of high frequencies through scalp EEG is a technical challenge, however, and the clinical significance of scalp gamma rhythms may not be the same as that of invasively recorded high frequencies. Further studies on the pathophysiological mechanisms related to the generation of spasms involving high frequencies are necessary in the future, and the development of animal models of spasms will play an important role in this regard.
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Affiliation(s)
- Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan.
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7
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Epileptic spasms in tuberous sclerosis complex. Epilepsy Res 2013; 106:200-10. [PMID: 23796861 DOI: 10.1016/j.eplepsyres.2013.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/26/2013] [Accepted: 05/13/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To characterize epileptic spasms (ES) occurring after the age of two years in patients with tuberous sclerosis complex (TSC), particularly treatment response to vigabatrin (VGB), which is extremely effective for infantile spasms (IS) in TSC. METHODS The authors retrospectively reviewed 19 patients with TSC and ES. Medical records were assessed for clinical and treatment data, neurocognitive, EEG, MRI data, and genetic analyses. RESULTS Of 391 patients with TSC, 19 (4.8%) had ES. Of those with detailed clinical data, six had infantile spasms that persisted after 2 years old, six recurred after an initial remission of infantile spasms (range 2-24 years old), and four occurred de novo over the age of two (range 2-20 years old). All concurrently had other seizure types. One had hypsarrhythmia on EEG. All had brain MRI stigmata typical of TSC. Thirteen had a mutation in TSC2, and one in TSC1. Six patients became spasm-free with medication treatment, including four with VGB, one with VGB in combination with the low glycemic index dietary treatment, and one with felbamate. Five became spasm-free after epilepsy surgery. VGB was not effective for seven patients. The majority continued to have refractory epilepsy. CONCLUSIONS ES are not uncommon in patients with TSC, especially those with TSC2 mutations. ES in TSC occur in the setting of other seizure types and refractory epilepsy. Hypsarrhythmia is rare. VGB can be effective, but the success of VGB for ES in TSC is not equivalent to that of IS in TSC.
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8
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Sueda K, Takeuchi F, Shiraishi H, Nakane S, Sakurai K, Yagyu K, Asahina N, Kohsaka S, Saitoh S. Magnetoencephalographic analysis of paroxysmal fast activity in patients with epileptic spasms. Epilepsy Res 2013; 104:68-77. [DOI: 10.1016/j.eplepsyres.2012.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 08/28/2012] [Accepted: 09/02/2012] [Indexed: 11/17/2022]
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9
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Endoh F, Kobayashi K, Hayashi Y, Shibata T, Yoshinaga H, Ohtsuka Y. Efficacy of topiramate for intractable childhood generalized epilepsy with epileptic spasms: with special reference to electroencephalographic changes. Seizure 2012; 21:522-8. [PMID: 22698380 DOI: 10.1016/j.seizure.2012.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Epileptic spasms (ES) beyond infancy are a highly refractory type of seizures that require the development of an effective treatment. We therefore studied the efficacy and safety of topiramate (TPM), which is a drug that is indicated to be effective for intractable childhood epilepsy, for ES. METHODS Out of 58 children with ES, we enrolled 33 patients treated with TPM at ≤ 12 years of age. The administration of TPM was limited to cases of epilepsies that were resistant to any other potent treatment. We retrospectively investigated the efficacy of TPM for seizures and changes in electroencephalogram (EEG) findings. RESULTS The median age at the start of TPM treatment was 5 years, 8 months. All patients had ES and 28 also had tonic seizures. As for the efficacy of TPM for all seizures, five patients became seizure-free and two had a ≥ 50% reduction in seizures. Seizure aggravation was observed in six patients. Of 29 patients whose EEG findings were compared before and during TPM treatment, nine showed EEG improvement with reduced epileptic discharges. Adverse effects were observed in 13 patients and included somnolence, anorexia, and irritability. In general, TPM was well tolerated. CONCLUSIONS TPM can be effective at suppressing very intractable ES in a proportion of patients who do not respond to any other treatment. The efficacy of TPM may be predictable based on EEG changes observed early in the course of treatment. TPM is promising for the treatment of extremely intractable childhood epilepsy and it has largely tolerable adverse effects.
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Affiliation(s)
- Fumika Endoh
- Department of Child Neurology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, 5-1 Shikatacho 2-chome, Kita-ku, Okayama 700-8558, Japan
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10
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Multiple band frequency analysis in a child of medial temporal lobe ganglioglioma. Childs Nerv Syst 2011; 27:479-83. [PMID: 20878525 DOI: 10.1007/s00381-010-1286-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
Abstract
We report a 1-year 6-month-old girl with ganglioglioma in the right medial temporal lobe who showed epileptic spasms in clusters. Spasms occasionally followed a dazed and fearful gaze. Interictal electroencephalography (EEG) showed diffuse bursts of slightly irregular high-voltage spikes and slow waves without hypsarrhythmia. The findings on ictal EEG, single-photon emission computed tomography, and F-18 fluorodeoxyglucose positron emission tomography indicated focus on the right medial temporal lobe. Ictal fast rhythmic activity analysis of scalp EEG by multiple band frequency analysis showed gamma rhythms at 65-80 Hz with a high spectral power around the tumor area. Epileptic spasms completely disappeared after tumor resection. These findings suggest that the cerebral cortex may be a source of epileptic spasms and indicate the possibility of usefulness of fast activity analysis in this condition.
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11
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Clinical study of West syndrome with PS and late-onset epileptic spasms. Epilepsy Res 2010; 89:82-8. [DOI: 10.1016/j.eplepsyres.2009.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/24/2009] [Accepted: 10/17/2009] [Indexed: 11/17/2022]
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12
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Ishikawa N, Tajima G, Kobayashi M. Epileptic spasms after stem cell transplantation for chronic Epstein-Barr virus infection. Pediatr Neurol 2009; 40:404-7. [PMID: 19380083 DOI: 10.1016/j.pediatrneurol.2008.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 11/05/2008] [Accepted: 11/19/2008] [Indexed: 11/19/2022]
Abstract
Stem cell transplantation has been performed for various diseases, contributing to a markedly improved prognosis in some cases. However, several complications, including posterior reversible encephalopathy syndrome, have been evident. Although posterior reversible encephalopathy syndrome was originally defined as a reversible disease, it has become clear that it is not reversible in all patients. Epstein-Barr virus causes a wide spectrum of neurologic disorders, including epilepsy. To our knowledge, Epstein-Barr virus was not previously reported to cause epileptic spasms. We describe a girl with epileptic spasms after posterior reversible encephalopathy syndrome associated with stem cell transplantation for chronic Epstein-Barr virus infection. Although direct correlation was not clarified, this is a rare case that may contribute to our understanding of the neurologic complications of stem cell transplantation for chronic Epstein-Barr virus infection.
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Affiliation(s)
- Nobutsune Ishikawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical Sciences, Minami-ku, Hiroshima, Japan.
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13
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Abstract
Epileptic spasms have been described as a paroxysmal epileptic seizure type that consists of a series of motor movements, involving sudden flexion or extension predominantly of axial and/or proximal limb muscles, occurring with a noticeable periodicity, outside the age of infantile spasms, but have otherwise not been well characterized or described. The purpose of this study was to evaluate patients with epileptic spasms to describe the etiology and best treatment regimen for this seizure type. Twenty-eight children fit the selection criteria for this study, and their charts and electroencephalography (EEG) results were reviewed. Data regarding onset of seizures, characteristics of seizures, duration of seizures, activity at onset, treatments tried and/or failed, genetic or metabolic workup, and results of any imaging studies were collected. The results indicate that the genetic and metabolic workups that were done were most often negative or unrevealing. In addition, treatment regimens varied greatly from patient to patient, and it is evident that these seizures are refractory to many standard anticonvulsants, as well as the ketogenic diet. The results of imaging from this series point to a variety of structural abnormalities that could possibly explain a structural versus metabolic etiology for epileptic spasms. In conclusion, epileptic spasms remain an elusive seizure type to classify, diagnose, and treat. The results of the current series show a relationship between structural abnormalities on magnetic resonance imaging (MRI) and resultant epileptic spasms, which has further implications regarding surgical treatment of these seizures as opposed to the traditional treatment with anticonvulsants, to which epileptic spasms remain refractory.
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Affiliation(s)
- Joshua Goldstein
- Children's Memorial Hospital Epilepsy Center, McGaw Medical Center/Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
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14
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Watanabe Y, Ogihara M, Hoshika A. Cluster of epileptic spasms preceded by focal seizures observed in localization-related epilepsy. Brain Dev 2007; 29:571-6. [PMID: 17482399 DOI: 10.1016/j.braindev.2007.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 03/11/2007] [Accepted: 03/18/2007] [Indexed: 11/16/2022]
Abstract
This study observed six cases of localization-related epilepsy (LRE) with a cluster of epileptic spasms (ES) preceded by focal seizures (FS), defined as FS-ES. Initially, the FS was observed at a mean age 13 months; subsequently FS-ES occurred at the mean age 6 years and 3 months. The average duration from FS to FS-ES was 5 years and 1 month. All cases showed plural types of seizure (more than 2), severe mental retardation, multifoci in an interictal electroencephalogram (EEG), and abnormal findings of brain magnetic resonance imaging or computed tomography. Moreover, it was noted that high-voltage spikes were observed in the occipital area in rapid eye movements sleep on overnight EEG. According to a long-term follow-up study (average 13 years and 4 months), the 6 cases with FS-ES were divided into two types of prognosis. In 2 cases of neural cell migration disorder, the FS-ES could be detected, but in 4 cases of cerebral disorder after birth, it had disappeared. To predict a risk factor for LRE with FS-ES, six cases of FS-ES were compared with 27 cases of LRE without FS-ES. As a result of this study, there is a possibility that infants with severe brain damage may thus demonstrate frequent partial seizures and subsequently develop FS-ES.
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Affiliation(s)
- Yoshiaki Watanabe
- Department of Pediatrics, Tokyo Medical University, 6-7-1 Nishishin-Jyuku, Tokyo 160-0023, Japan.
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Akiyama T, Ohtsuka Y, Takata T, Hattori J, Kawakita Y, Saito K. The mildest known case of Fukuyama-type congenital muscular dystrophy. Brain Dev 2006; 28:537-40. [PMID: 16603329 DOI: 10.1016/j.braindev.2006.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 02/03/2006] [Accepted: 02/07/2006] [Indexed: 10/24/2022]
Abstract
We present a 14-year-old boy with Fukuyama-type congenital muscular dystrophy (FCMD) who shows the mildest muscle weakness ever reported with this affliction and exceptionally mild mental retardation, but who has intractable epilepsy. Magnetic resonance imaging showed the typical abnormalities of FCMD. Molecular genetic analyses revealed a 3 kb insertion mutation in the fukutin gene heterozygously. We could find no mutation in the coding region of the fukutin gene in the chromosome without a 3 kb insertion. The most probable mechanism of clinical manifestation in this patient could be either a mutation in the noncoding regions of the fukutin gene on the chromosome without the ancestral founder haplotype of FCMD, or an error in the process of transcription or translation. Another possibility is the abnormalities in other genes involved in the glycosylation of alpha-dystroglycan, such as Fukutin-related protein and LARGE genes.
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Affiliation(s)
- Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Ohtsuka Y, Yoshinaga H, Kobayashi K, Ogino T, Oka M, Ito M. Diagnostic issues and treatment of cryptogenic or symptomatic generalized epilepsies. Epilepsy Res 2006; 70 Suppl 1:S132-40. [PMID: 16815681 DOI: 10.1016/j.eplepsyres.2005.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 11/07/2005] [Accepted: 11/07/2005] [Indexed: 11/27/2022]
Abstract
To clarify the diagnostic issues and treatment of patients with cryptogenic or symptomatic generalized epilepsies, not including West syndrome (WS), we investigated electroclinical change during the clinical course, and treatment effects in these patients. The selection criteria were minor generalized seizures as their main seizure type and diffuse epileptic discharges as their main EEG findings. Regarding EEG, we included EEGs that predominantly displayed multifocal spike-waves because of the inclusion of severe epilepsy with multiple independent spike foci (SE-MISF). We divided the subjects into two groups according to their main seizure types: Group A (54 patients) with brief tonic seizures and Group B (24 patients) with myoclonic seizures and/or atypical absences. The main epileptic syndromes were considered to be Lennox-Gastaut syndrome and SE-MISF in Group A, and epilepsy with myoclonic-astatic seizures in Group B. A history of WS was often seen in Group A, but it was exceptional in Group B. During the clinical course, seizure types did not basically change in Group A. EEG patterns were changeable in both groups. Although there was some overlap in electroclinical manifestations among epileptic syndromes, a transition between the two groups was not seen. High-dose valproate and ethosuximide were the most effective in Groups A and B, respectively. Long-term prognosis was significantly more favorable in Group B than in Group A.
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Affiliation(s)
- Yoko Ohtsuka
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Okayama, Japan.
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Yamatogi Y, Ohtahara S. Multiple independent spike foci and epilepsy, with special reference to a new epileptic syndrome of "severe epilepsy with multiple independent spike foci". Epilepsy Res 2006; 70 Suppl 1:S96-104. [PMID: 16829042 DOI: 10.1016/j.eplepsyres.2006.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Revised: 01/11/2006] [Accepted: 01/11/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Markand and Blume first realized the specificity of the EEG pattern of multiple independent spike foci (MISF) in the late 1970s; its close relation with hypsarrhythmia and slow spike-waves, extensive bilateral brain lesion, and intractable seizures. But they did not recognize it as an epileptic syndrome. On the other hand, the authors had been taken notice of severe epilepsy with MISF (SE-MISF) as a peculiar clinico-electrical entity showing "generalized seizures", and pointed out its close relation to Lennox-Gastaut syndrome (LGS) from the long-term follow-up of LGS. SUMMARY POINTS SE-MISF is characterized by (1) interictal EEG showing multiple independent spike foci (three or more foci in both hemisphere, i.e. at least one in each hemisphere) and diffuse slowing of the background activity. Diffuse epileptic discharges are rare. (2) The main seizure type is frequent generalized minor seizures, often tonic spasms. (3) Mutual transition is often observed between the age-dependent epileptic encephalopathies, i.e. Ohtahara syndrome, West syndrome and LGS. (4) The age at epilepsy onset is early, but the onset of SE-MISF is variable. (5) It is often associated with mental retardation and neurological abnormalities, usually severe. (6) Etiology is variable and largely nonspecific, including prenatal, perinatal, and postnatal cerebral pathologies. (7) Prognoses for seizures and psychomotor development are poor. Seizures are very intractable and may cause psychomotor deterioration. CONCLUSION SE-MISF may be classified into symptomatic generalized epilepsy, namely a diffuse encephalopathy with mutual transition between other age-dependent epileptic encephalopathies. This characteristic entity may be acknowledged as a new epileptic syndrome.
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Affiliation(s)
- Yasuko Yamatogi
- Faculty of Health and Welfare Science, Okayama Prefectural University, 111 Kuboki, Soja-shi, Okayama Prefecture 719-1197, Japan.
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Eisermann MM, Ville D, Soufflet C, Plouin P, Chiron C, Dulac O, Kaminska A. Cryptogenic Late-onset Epileptic Spasms: An Overlooked Syndrome of Early Childhood? Epilepsia 2006; 47:1035-42. [PMID: 16822250 DOI: 10.1111/j.1528-1167.2006.00518.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Few reports detailing late-onset epileptic spasms have been published. To determine whether this condition merely represents a late variant of classic West syndrome or exhibits specific features distinct from the latter and related to a later stage of brain maturation, we analyzed the whole population with this specific seizure type, excluding symptomatic cases to avoid the effect of brain lesion. METHODS We reviewed the files of the 56 children evaluated for epileptic spasms in clusters having begun at age 12 months or later and analyzed clinical and video-EEG data of the 22 patients (4-17 years; mean, 8.5 years) without obvious cause. RESULTS Interictal EEG did not show classic hypsarrhythmia. A temporal or temporofrontal slow wave and/or spike focus could be identified in all cases. Twelve children showed spasms with a tonic component. Ictal EEG revealed generalized high-voltage slow wave followed by diffuse voltage attenuation with superimposed fast activity. All children also exhibited other types of recorded seizures consisting of bursts of spike-waves with temporofrontal predominance, reminiscent of "atypical absences." In contrast with the occurrence of tonic components within a cluster of spasms, no tonic seizure stricto sensu was recorded or reported by the caregivers. In 10 children, treatment (two vigabatrin, seven hydrocortisone, one adrenocorticotropic hormone) achieved complete cessation of seizures and disappearance of focal EEG anomalies, but spasms persisted in 12 children. CONCLUSIONS The cryptogenic group in our series without recognized cause and temporal or temporofrontal EEG anomalies seems to represent a type of epileptic encephalopathy intermediary between West and Lennox-Gastaut syndromes, in terms of seizure types and interictal EEG, and could correspond to dysfunction of the maturation process of the temporal lobe, possibly due to an undisclosed lesion.
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Affiliation(s)
- Monika M Eisermann
- Department of Clinical Neurophysiology, Saint Vincent de Paul Hospital, Paris, France.
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Kobayashi K, Oka M, Inoue T, Ogino T, Yoshinaga H, Ohtsuka Y. Characteristics of Slow Waves on EEG Associated with Epileptic Spasms. Epilepsia 2005; 46:1098-105. [PMID: 16026562 DOI: 10.1111/j.1528-1167.2005.63004.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The high-voltage slow waves (HVSs) on EEG associated with epileptic spasms were investigated to clarify their characteristics and their relation to the pathophysiology of spasms in West syndrome and related disorders. METHODS In 14 patients, digitally recorded EEG segments showing the ictal HVSs were extracted and their traces were overlaid by using an average reference. The ictal HVSs were also averaged to build maps for investigation of the pattern of potential distribution over the scalp. RESULTS In a total of 685 recorded spasms, 346 (50.5%) with minimal artifacts were selected to demonstrate that the ictal HVSs had a largely consistent waveform and distribution in each patient. The ictal HVSs were symmetrical in 10 patients and asymmetrical in the other four, and were relatively negative over the posterior region and positive over the frontal or temporal regions in 11 patients. Two symptomatic patients showed a marked deviation of the distribution of HVSs to the pathologically more involved hemisphere. An infant with Aicardi syndrome had two different types of spasms, each type showing a consistent pattern of HVSs with a lateralized distribution. CONCLUSIONS The patterns of distribution of the ictal HVS may be related to the abnormal activation of the brain in the generation of spasms.
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Affiliation(s)
- Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, and Okayama University Hospital, 5-1 Shikatacho 2-chome, Okayama 700-8558, Japan.
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Oguni H, Funatsuka M, Sasaki K, Nakajima T, Yoshii K, Nishimura T, Osawa M. Effect of ACTH Therapy for Epileptic Spasms without Hypsarrhythmia. Epilepsia 2005; 46:709-15. [PMID: 15857437 DOI: 10.1111/j.1528-1167.2005.37504.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We analyzed the short- and long-term effects of adrenocorticotropic hormone (ACTH) therapy for patients with epileptic spasms (ESs) who did not meet the criteria of West syndrome (WS). METHODS The subjects were 30 patients, including 13 boys and 17 girls, who had received ACTH therapy between 1970 and 2003. We excluded patients with WS, but included those with a history of WS who no longer showed hypsarrhythmia at the period of ACTH therapy. The age at onset of ESs and at ACTH therapy ranged from 2 to 82 months with a median of 18 months, and from 11 to 86 months with a median of 29 months, respectively. RESULTS Excellent and poor responses were obtained in 19 (63%) and 11 (37%) patients, respectively, as a short-term effect. Although the patients could be subclassified into five subgroups according to the previous reports, no difference was seen in short- term response to ACTH. Among 17 of the 19 patients with excellent short-term outcomes and a follow-up of >1 year after the ACTH therapy, eight patients have continued to be seizure free (29%; excellent long-term effect), whereas the remaining nine patients had a recurrence of seizures (complex partial seizures, four; generalized tonic seizures, three; ESs, two) at 9 months to 198 months (median, 49 months) after ACTH therapy. In addition, nine of the 17 patients demonstrated a localized frontal EEG focus after the ACTH therapy, although most of these had previously shown diffuse epileptic EEG abnormality. CONCLUSIONS ACTH therapy is worth trying for patients with resistant ESs, even without features of WS. However, the long-term effect is uncertain because recurrences of various types of seizures, including focal, were frequently observed.
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Affiliation(s)
- Hirokazu Oguni
- Department of Pediatrics, Tokyo Women's Medical University, Shinjuku-ku, Japan.
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