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Cappellari AM, Mariani S, Bruschi G. Febrile seizures and convulsions with mild gastroenteritis: age-dependent acute symptomatic seizures. Front Pediatr 2023; 11:1151770. [PMID: 37534200 PMCID: PMC10390780 DOI: 10.3389/fped.2023.1151770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Background Febrile seizures (FS) and benign convulsions in children with mild gastroenteritis (CwG) are acute symptomatic seizures, transiently occurring in infants and young children, probably related to the immaturity of the brain. Our paper aims to review the literature data on patients with FS and CwG. Methods A review of series of patients with FS and CwG was performed by literature search on PubMed January 1960 to October 2022. Several parameters were considered, including epidemiology, pathophysiology, clinical features, electroencephalographic findings and other diagnostic studies, and treatment. Results FS and CwG share an age-dependent course, but they show significant differences in the pathophysiology, clinical features, diagnostic studies, and treatment. Conclusion Acute symptomatic seizures include seizures that are caused by acute structural brain pathologies, such as stroke, as well as seizures that are provoked by a reversible factor, such as hyponatraemia, although the two groups should be not equated. Furthermore, FS and CwG should be set apart as "age-dependent acute symptomatic seizures", reinforcing the concept of their self-limited course over a certain period.
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Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Mariani
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
| | - Gaia Bruschi
- Department of Medical-Surgical and Transplant Pathophysiology, University of Milan, Milan, Italy
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2
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Mínguez JJ, Martinez F, Vargas A, Wessmann A, Lorenzo V. Benign juvenile focal epilepsy in a captive Iberian lynx (
Lynx pardinus
). VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Juan J Mínguez
- Neurology & Neurosurgery DepartmentHospital Veterinario GuadiamarSanlucar la MayorSevillaSpain
- Neurology & Neurosurgery DepartmentNeurologia VeterinariaGetafeMadridSpain
| | - Fernando Martinez
- Veterinary Medicine DepartmentCentro de Cría de Lince Ibérico El AcebucheAlmonteSpain
| | - Astrid Vargas
- Veterinary Medicine DepartmentCentro de Cría de Lince Ibérico El AcebucheAlmonteSpain
| | | | - Valentina Lorenzo
- Neurology & Neurosurgery DepartmentNeurologia VeterinariaGetafeMadridSpain
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Castellazzi L, Principi N, Agostoni C, Esposito S. Benign convulsions in children with mild gastroenteritis. Eur J Paediatr Neurol 2016; 20:690-5. [PMID: 27292317 DOI: 10.1016/j.ejpn.2016.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Benign convulsions with mild gastroenteritis (CwG) is a clinical condition characterized by convulsions occurring in otherwise healthy children, usually in the absence of fever and in the presence of mild acute gastroenteritis. Until now, CwG had not been fully recognized as an epileptic syndrome, and several aspects of this condition are not clearly defined, especially its pathogenesis. METHODS The main aim of this paper is to discuss after the review of the literature what is known about CwG to facilitate its recognition and treatment. RESULTS CwG is a benign condition that has several clinical and prognostic similarities with febrile seizures. The disease occurs in infants and in children who are 1 month to 3 years old, during the winter and early spring when rotavirus and norovirus are circulating. In most cases, seizures follow gastrointestinal symptoms. In a minority of patients, the seizures and gastrointestinal symptoms occur before or simultaneously with the development of diarrhoea. Even if convulsions are mostly described as generalized tonic-clonic, the ictal recordings have always demonstrated a focal origin. Electroencephalography, lumbar punctures, and radiological examinations are not useful because they are normal in these patients; and when alterations are present, they disappear in a relatively short time. Only prolonged seizures, which are usually not common, require antiepileptic treatments in the acute phase. CONCLUSION Knowledge of CwG characteristics is essential for paediatricians to avoid useless hospitalization, examinations and, above all, drug administration, as the drugs have potential side effects.
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Affiliation(s)
- Luca Castellazzi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Pediatric Medium Intensity Care Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Beghi E, Giussani G, Grosso S, Iudice A, Neve AL, Pisani F, Specchio LM, Verrotti A, Capovilla G, Michelucci R, Zaccara G. Withdrawal of antiepileptic drugs: Guidelines of the Italian League Against Epilepsy. Epilepsia 2013; 54 Suppl 7:2-12. [DOI: 10.1111/epi.12305] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ettore Beghi
- Department of Neuroscience; IRCCS-Institute of Pharmacological Research “Mario Negri”; Milan Italy
| | - Giorgia Giussani
- Department of Neuroscience; IRCCS-Institute of Pharmacological Research “Mario Negri”; Milan Italy
| | - Salvatore Grosso
- Department of Pediatrics, Neurology-Immunology and Endocrinology Unit; University of Siena; Siena Italy
| | - Alfonso Iudice
- Department of Experimental and Clinical Medicine; Section of Neurology; University of Pisa; Pisa Italy
| | - Angela La Neve
- Clinic of Nervous System Diseases; University of Bari; Bari Italy
| | - Francesco Pisani
- Department of Nurosciences; University of Messina; Messina Italy
| | - Luigi M. Specchio
- Clinic of Nervous System Diseases; A.O.U. OORR; University of Foggia; Foggia Italy
| | | | - Giuseppe Capovilla
- Unit of Neurology; IRCCS-Institute of Neurological Sciences of Bologna; Bellaria Hospital; Bologna Italy
| | - Roberto Michelucci
- IRCCS-Institute of Neurological Sciences of Bologna; Bellaria Hospital; Bologna Italy
| | - Gaetano Zaccara
- Unit of Neurology; “San Giovanni di Dio” Hospital; Florence Health District, Florence Italy
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5
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Crisis convulsivas asociadas a gastroenteritis: estudio de incidencia y análisis clínico. An Pediatr (Barc) 2013; 79:162-6. [DOI: 10.1016/j.anpedi.2013.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/04/2013] [Indexed: 11/22/2022] Open
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Abstract
The clinical manifestations of seizures change in a predictable fashion with advancing age. For focal seizures these changes can be summarized into domains similar to those used in developmental models. These include fine motor, communication, and gross motor manifestations. Instead of socialization the fourth domain for seizure semiology concerns synchronization. Focal seizures in the very young tend to be simpler with fewer fine motor manifestations. Auras are uncommon, even in young children with some linguistic skill and it is often difficult to discern alteration of consciousness. Infantile focal seizures can present with spasms or even diffuse tonic seizures. In terms of synchronization, orderly secondary generalization is rarely seen so that primary generalized clonic seizures are rarely recorded in infants. Amongst so-called "generalized" seizures spasms are most often seen in the first year of life. Absence seizures, myoclonic-astatic and generalized tonic-clonic seizures are all usually not seen until after age 2 years. A full description of the clinical details of seizures is probably the most important part of the epilepsy history. A detailed knowledge of seizure semiology can make the history more effective and also in the identification of the correct seizure classification.
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Affiliation(s)
- Douglas R Nordli
- Epilepsy Center, Children's Memorial Hospital, Chicago, IL, USA.
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Espeche A, Cersosimo R, Caraballo RH. Benign infantile seizures and paroxysmal dyskinesia: A well-defined familial syndrome. Seizure 2011; 20:686-91. [DOI: 10.1016/j.seizure.2011.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 11/29/2022] Open
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Capovilla G, Verrotti A. Infantile convulsions in association with mild gastroenteritis: an emerging clinical condition. Eur J Neurol 2011; 18:203-204. [PMID: 20629719 DOI: 10.1111/j.1468-1331.2010.03140.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Capovilla
- Department of Child Neuropsychiatry, "C. Poma" Hospital, Mantova
| | - A Verrotti
- Department of Pediatrics, University of Chieti, Chieti, Italy (e-mail: )
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Durá-Travé T, Yoldi-Petri ME, Gallinas-Victoriano F, Molins-Castiella T. Infantile convulsions with mild gastroenteritis: a retrospective study of 25 patients. Eur J Neurol 2011; 18:273-278. [PMID: 20618844 DOI: 10.1111/j.1468-1331.2010.03120.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to analyze the epidemiologic, clinical, and evolutional characteristics in patients who presented convulsions with mild gastroenteritis (CwG) to facilitate the diagnosis in daily clinical practice. METHODS Twenty-five medical records of patients diagnosed with CwG were reviewed, and the epidemiological and clinical features, results of complementary studies, and evolutional data were collected. RESULTS Age of onset ranged between 12 and 24 months in 76% of patients. Female/male ratio was 2.6 (18 women and seven men). Seizures were mostly brief (<5 min) and apparently generalized, and often repetitive occurring in cluster (2.2 seizures per episode). One patient with status epilepticus was recorded. The average interval between the onset of gastroenteritis and seizures was 3.8 days, even though seizure preceded diarrhea in three cases. Mean rectal temperature at the moment of seizure was 37.1°C. Rotavirus antigen was positive in stool in 17 episodes (55.8%). There were no abnormalities in serum biochemistry tests and cerebrospinal fluid studies. Four patients showed anomalies in the interictal electroencephalogram. The period of follow-up was 4.2 years. Five patients (20%) experienced recurrences when suffering a new gastroenteritis episode. One patient developed epilepsy during the follow-up period. CONCLUSIONS CwG would constitute a well-differentiated convulsive syndrome. Prognosis is excellent, but a relatively important percentage of patients relapse when suffering a new diarrhea episode.
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Affiliation(s)
- T Durá-Travé
- Pediatric Neurology Unit, Virgen del Camino Hospital, Pamplona, Spain
| | - M E Yoldi-Petri
- Pediatric Neurology Unit, Virgen del Camino Hospital, Pamplona, Spain
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10
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Verrotti A, Nanni G, Agostinelli S, Parisi P, Capovilla G, Beccaria F, Iannetti P, Spalice A, Coppola G, Franzoni E, Gentile V, Casellato S, Veggiotti P, Malgesini S, Crichiutti G, Balestri P, Grosso S, Zamponi N, Incorpora G, Savasta S, Costa P, Pruna D, Chiarelli F. Benign convulsions associated with mild gastroenteritis: a multicenter clinical study. Epilepsy Res 2010; 93:107-14. [PMID: 21146369 DOI: 10.1016/j.eplepsyres.2010.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 10/26/2010] [Accepted: 11/14/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the clinical characteristics and the outcome of benign convulsions associated with mild gastroenteritis (CwG) in Italian children. METHODS We studied clinical and EEG features of 128 children with CwG who were hospitalized between January 2004 and February 2008 and then followed for at least 12 months in 14 Italian centers. RESULTS Age at onset ranged from 6 to 60 months. The seizures were generalized in 73 cases (57%), only focal in 16 (12.5%), and secondarily generalized in 39 (30.5%). The duration of the seizures was under 5 min in 97 patients (75.8%), between 5 and 30 min in 26 (20.3%), and longer than 30 min in 5 (3.9%). Seventy-three participants (57%) had 2 or more seizures, which recurred within 24-48 h. In the acute phase, antiepileptic drugs were used in 72 patients (56.3%). Although interictal abnormalities were present in EEG of 28 children (21.9%), these reverted to normal. During the follow up period, only 6 patients (4.7%) suffered from recurrence of CwG, 7 (5.5%) suffered from simple febrile seizures, and 3 (2.3%) developed epilepsy. CONCLUSIONS Recognition of CwG in children allows pediatricians to avoid extensive evaluations and continuous antiepileptic therapy and to reassure parents regarding the lack of long-term complications.
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11
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Espeche A. Benign infantile seizures: A prospective study. Epilepsy Res 2010; 89:96-103. [DOI: 10.1016/j.eplepsyres.2009.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/29/2009] [Accepted: 10/29/2009] [Indexed: 11/17/2022]
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12
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Caraballo RH, Gañez L, Santos CDL, Espeche A, Cersósimo R, Fejerman N. Benign infantile seizures with mild gastroenteritis: study of 22 patients. Seizure 2009; 18:686-9. [PMID: 19828335 DOI: 10.1016/j.seizure.2009.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 08/30/2009] [Accepted: 09/18/2009] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyze the electroclinical features, aetiology and outcome in patients with normal neurological examination and psychomotor development who presented seizures during a mild gastroenteritis (MG). PATIENTS AND METHODS Evaluation of the clinical charts of 22 patients who were assessed in the Neurology Department, Hospital Nacional de Pediatría Prof. Dr. JP Garrahan between 1999 and 2007. RESULTS Twelve patients were boys and 10 were girls, the age of onset ranged from 5 to 26 months, and the median age was 10 months. Rotavirus antigen test in stool was positive in 9 of 18 studied patients. The seizures were brief, focal with secondary generalization in 15 patients (68.5%), apparently generalized in 5 (22.5%) and focal in two (9%). Seven of the patients (35%) had more than one seizure in 24h. The interictal EEG was normal in all patients. Neuroradiological studies were performed in 19 patients with a normal result. No patient was put on long-term treatment with antiepileptic drugs. Four patients had subsequent mild gastroenteritis and two of them presented convulsions during the disease. After between 12 and 67 months of follow-up, all patients had normal psychomotor development and neurological examination. CONCLUSIONS In this study we confirmed the association of benign infantile seizures (BIS) and MG with or without rotavirus. The identification of this entity allows avoiding unnecessary complementary studies and treatment with antiepileptic drugs.
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Affiliation(s)
- Roberto H Caraballo
- Neurology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P Garrahan , Combate de los Pozos 1881, Buenos Aires, Argentina.
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13
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Maruyama K, Okumura A, Sofue A, Ishihara N, Watanabe K. Ictal EEG in patients with convulsions with mild gastroenteritis. Brain Dev 2007; 29:43-6. [PMID: 16919410 DOI: 10.1016/j.braindev.2006.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 06/10/2006] [Accepted: 06/13/2006] [Indexed: 11/26/2022]
Abstract
The aim of this study is to reveal detailed clinical manifestations and an evolution of ictal EEG discharges of convulsions with mild gastroenteritis (CwG). We recorded ictal EEGs of six patients with CwG. Clinical manifestations included loss of responsiveness, motion arrest, cyanosis, lateral eye deviation, and hemifacial convulsion. Automatism was not observed in any patients. A generalized tonic-clonic convulsion was observed in five of six patients. Ictal EEGs demonstrated that all seizures were of focal onset that evolved into a secondarily generalized seizure. The region of the onset of ictal discharge was the occipital area in three patients, parietal in one, central in one, and frontal in one, respectively. The seizure of patients with CwG is likely to be a partial seizure with secondary generalization.
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MESH Headings
- Age Factors
- Brain/physiopathology
- Child, Preschool
- Disease Progression
- Electroencephalography
- Epilepsies, Partial/complications
- Epilepsies, Partial/diagnosis
- Epilepsies, Partial/physiopathology
- Epilepsy, Benign Neonatal/complications
- Epilepsy, Benign Neonatal/diagnosis
- Epilepsy, Benign Neonatal/physiopathology
- Epilepsy, Generalized/complications
- Epilepsy, Generalized/diagnosis
- Epilepsy, Generalized/physiopathology
- Female
- Gastroenteritis/complications
- Humans
- Infant
- Male
- Predictive Value of Tests
- Seizures/complications
- Seizures/diagnosis
- Seizures/physiopathology
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Affiliation(s)
- Koichi Maruyama
- Department of Pediatrics, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, Aichi 446-8602, Japan.
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Capovilla G, Beccaria F, Montagnini A. 'Benign focal epilepsy in infancy with vertex spikes and waves during sleep'. Delineation of the syndrome and recalling as 'benign infantile focal epilepsy with midline spikes and waves during sleep' (BIMSE). Brain Dev 2006; 28:85-91. [PMID: 15967619 DOI: 10.1016/j.braindev.2005.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 05/05/2005] [Accepted: 05/09/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE To better delineate the electroclinical features of infants who presented with focal seizures and typical midline sleep EEG abnormalities with a benign outcome. We discuss the significance of the typical EEG marker in non-epileptic patients. METHODS Patients were selected from a group of epileptic subjects with seizure onset less than 3 years we observed from 1st November 1990 and 31st December 2003. Inclusion criteria were the presence of typical sleep EEG marker and focal seizures with benign outcome. Cases with less than 18 month follow-up period were excluded from this study. RESULTS There were 19 patients (12 males, 7 females). Pre-, peri- and post-natal personal history was negative in all patients. Psychomotor development was normal, both before and after seizure onset. Neuroradiological investigations gave normal results. Seizure manifestations were typical, characterized by cyanosis, staring and rare lateralizing signs, of short duration. Age at onset was comprised between 4 and 30 months. The typical EEG marker, a spike followed by a bell-shaped slow-wave, localized in the midline regions, was present in all subjects only during sleep. All had a favorable outcome and the overwhelming majority of the patients were not treated. CONCLUSIONS Our patients have an homogeneous electroclinical picture to constitute a new epileptic syndrome not included in the ILAE classification. We propose to call it 'benign focal epilepsy in infancy with midline spikes and waves during sleep' (BIMSE).
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Affiliation(s)
- G Capovilla
- Department of Child Neuropsychiatry, Epilepsy Center, 'C. Poma' Hospital, Viale Albertoni 1, 46100 Mantova, Italy.
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Okumura A, Watanabe K, Negoro T, Hayakawa F, Kato T, Maruyama K, Kubota T, Suzuki M, Kurahashi H, Azuma Y. Long-term Follow-up of Patients with Benign Partial Epilepsy in Infancy. Epilepsia 2006; 47:181-5. [PMID: 16417547 DOI: 10.1111/j.1528-1167.2006.00385.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to investigate the long-term outcome of children with benign partial epilepsy in infancy (BPEI). METHODS A telephone-interview survey using a structured questionnaire was conducted with patients who were diagnosed as having possible BPEI at age 2 years and who were 8 years or older at the time of the survey. The data from 39 of 48 patients were available. The median age at the time of the survey was 11.3 years; 18 boys and 21 girls were included. RESULTS Three patients had a recurrence of unprovoked seizure beyond age 2 years. Four patients had cognitive problems (mild mental retardation in three and Asperger syndrome in one). An association of paroxysmal kinesigenic choreoathetosis was observed in three patients, and another three had experienced seizures associated with mild gastroenteritis. Major behavioral problems were not recognized in any patients. Four patients were excluded from having definite BPEI at age 5 years, and another two were excluded for having definite BPEI at the last follow-up. Eventually, 33 of 39 patients were categorized as having definite BPEI beyond 8 years of age. CONCLUSIONS A large majority of patients diagnosed as possibly having BPEI at age 2 years did not have a recurrence of unprovoked seizures and cognitive problems beyond 8 years of age.
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Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Ohta H, Ohtsuka Y, Tsuda T, Oka E. Prognosis after withdrawal of antiepileptic drugs in childhood-onset cryptogenic localization-related epilepsies. Brain Dev 2004; 26:19-25. [PMID: 14729410 DOI: 10.1016/s0387-7604(03)00089-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to clarify the risk factors of relapse following discontinuation of AEDs in patients with childhood-onset cryptogenic localization-related epilepsies. The subjects were 82 patients who fulfilled the following criteria: (1) age at first visit of less than 15 years, (2) follow-up period of more than 5 years, (3) suffering from cryptogenic localization-related epilepsies, and (4) the patient underwent AED withdrawal during the follow-up period. As a basic principle, we decided to start withdrawing AEDs when both of the following two conditions were met: (1) the patient had a seizure-free period of 3 years or more, and (2) there were no epileptic discharges on EEGs just prior to the start of withdrawal. Seizures recurred in eight of the 82 patients (9.8%). Univariate analysis revealed that the following factors were correlated with higher rates of seizure relapse: 6 years of age or higher at onset of epilepsy; 15 years of age or higher at the start of AED withdrawal; 5 years or more from the start of AED treatment to seizure control; five or more seizures before seizure control; and two or more AEDs administered before seizure control. Among these risk factors, 6 years of age or higher at onset and 5 years or more from the start of AED treatment to seizure control were determined by multivariate analysis to be independent risk factors for relapse. Thus, we conclude that the physician should be more careful in discontinuing AEDs in these higher-risk patients groups, and more generous in discontinuing AEDs in lower-risk groups.
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Affiliation(s)
- Hodaka Ohta
- Department of Child Neurology, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama, Japan.
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Watemberg N, Goldberg-Stern H, Ben-Zeev B, Berger I, Straussberg R, Kivity S, Kramer U, Brand N, Lerman-Sagie T. Clinical experience with open-label topiramate use in infants younger than 2 years of age. J Child Neurol 2003; 18:258-62. [PMID: 12760428 DOI: 10.1177/08830738030180040901] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To assess the efficacy, safety, and tolerability of topiramate in infants younger than 24 months of age, we conducted an open-label, multicenter chart review study of infants who received topiramate. Twenty-eight patients were evaluated. All had refractory epilepsy. The mean age of seizure onset was 3.8 months (range 0-10 months). Refractory infantile spasms were the most common epilepsy syndrome. Among infants without infantile spasms, complex partial seizures were the prominent seizure type in eight, followed by simple partial seizures in six. Topiramate was prescribed as add-on therapy in 25 cases and a s monotherapy in 3 cases. Seven of the eight infantile spasms cases improved on topiramate therapy, attaining topiramate monotherapy in three infants. Half of the infants with other seizure types responded to topiramate. The average treatment duration among topiramate responders was 11 months. Topiramate was prescribed after a mean of 3.3 antiepilepsy drugs had been used in these infants. In no case was topiramate the first prescribed antiepilepsy drug. Adverse effects occurred only in five patients, leading to topiramate discontinuation in two patients. Topiramate was efficacious and well tolerated in infants younger than 24 months of age with refractory epilepsy. Prospective data are needed to corroborate this observation.
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Affiliation(s)
- Nathan Watemberg
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.
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