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1.
Aim. To study the efficacy of vagus nerve stimulation (VNS) therapy in a highly drug‐resistant childhood epilepsy patient group and to investigate the effect of age at implantation on efficacy. Methods. The efficacy of VNS treatment was analysed in a cohort of 70 patients with drug‐resistant epilepsy. Both children with focal (n=16) and generalized epilepsies (n=54) were included. Age at implantation varied between 19 months and 25 years. Results. Overall, responder rate was 54% with 5.7% children becoming seizure‐free. The only factor in our analysis that could predict good outcome was age at implantation. In the youngest group (<5 years), the responder rate was 77% and this group also included three of the four seizure‐free children. These three seizure‐free children were known to have tuberous sclerosis. There were no outcome differences between generalized and focal epilepsies. Conclusions. Our single centre study confirms previous studies on the efficacy of VNS in children. A larger study using multivariate analysis to disentangle the contribution of different factors (such as age at implantation, aetiology, and epilepsy duration) is necessary to confirm our preliminary finding that younger age at VNS implantation might result in a better outcome.  相似文献   

2.
Summary: A population-based survey of childhood epilepsy was made in 1975 on the total population of children aged >10 years living in Okayama Prefecture (n = 2,378 patients). Using the data obtained, we attempted to re-classify the various types of epilepsy according to the international classification (ILAE, 1989). Reclassification was possible in 1,872 (78.7%) of the 2,378 cases. The 1,872 cases consisted of 1,045 (55.8%) with localization-related epilepsies, 824 (44.0%) with generalized epilepsies, and 3 (0.2%) with epilepsies undetermined whether focal or generalized. Classification of the epilepsies in a population-based survey using the international classification involves difficulties, because both clinical and EEG findings are essential. However, if an appropriate area is selected, classification of epilepsies and epileptic syndromes in a population-based survey is possible by referring to all medical records stored at every hospital and practitioner's clinic that administers treatment to patients with epilepsy in the area.  相似文献   

3.
Refractory Childhood Epilepsy and Factors Related to Refractoriness   总被引:4,自引:0,他引:4  
Summary: To clarify the characteristics of refractory childhood epilepsy, we compared recent refractory cases and those of approximately 15 years ago, all of which were seen at the Okayama University Hospital. We also analyzed predictive factors related to refractoriness in the recent refractory cases. Among the recent refractory cases, the proportion of localization-related epilepsies increased, and the proportion of generalized epilepsies decreased compared to historical cases. In generalized epilepsies, the proportion of cases with Lennox-Gastaut syndrome decreased to less than half. In localization-related epilepsies, the proportion of cases with frontal lobe epilepsy increased. The proportion of cases with unknown causes decreased to less than half. Of the cases with known causes, postencephalitis/postencephalopathy and focal cortical malformation, including tuberous sclerosis, accounted for most of the cases. More of the recent refractory cases were treated with high-dose AED monotherapy, compared to more poly-therapy in the cases of 15 years earlier. The following factors were related to future refractoriness: less than 1 year of age at onset of seizures, the presence of underlying pathology, status epilepticus, changes in type of epilepsy during the clinical course, and neonatal seizures. Regarding EEG findings of cases that had localization-related epilepsies at the end of follow-up, focal spike-waves associated with diffuse spike-waves on the first EEGs indicated future refractoriness.  相似文献   

4.
The relative frequency of different types of epilepsy in accordance with the International Classification of Epilepsies is reported, concerning 1,508 consecutive outpatients with epilepsy, who at the time of investigation were at age 15 years and above. The investigation showed a marked preponderance for partial epilepsies as against generalized epilepsies; partial epilepsies with complex symptomatology were especially frequent, contributing by more than one third of all cases.  相似文献   

5.
Abstract: A neurologist conducted research efforts for more than 12 years as a step toward the establishment of monotherapy for epilepsy. Of 406 patients with epilepsy, seizures could be controlled for more than one year in 72% and for more than 3 years in 54%. Monotherapy was given to 57% of all the patients with a success rate of 54%. Factors that were found likely to interfere with a reduction in antiepileptic drug therapy to one drug modality included: symptomatic etiology, prolonged duration of illness, low age at onset and secondary generalized epilepsy with a large number of seizures in combination, for generalized epilepsies; symptomatic etiology, prolonged duration of illness, low age at onset, other than occipital lobe origin, complex partial seizure with secondary generalization, temporal lobe epilepsy with associated automatisms, elementary sensorimotor seizure and high frequency of seizures, for partial epilepsies. In addition to these factors relevant to the nature of epilepsies, other factors apparently unrelated to the disease process, e.g., liability of polypharmacy to produce side effects precluding dosage elevation, patient's rejection to reduce drug and the inability of a physician to treat the patient properly for want of information, were also recognized to exist.  相似文献   

6.
Monotherapy for Childhood Epilepsies with Zonisamide   总被引:1,自引:0,他引:1  
Abstract: Zonisamide was tried on 44 children, 18 girls and 26 boys, from 8 months to 15 years of age at the start of the trial. In 6 children the drug has been stopped because of side effects. The drug was introduced at a dose of 2–4 mg/kg/day and increased to 12 mg/kg/day unless a satisfactory response occurred at a lower dose. A 100% control of seizures was achieved in 5 of 5 cases of idiopathic generalized epilepsies, in 7 of 8 cases of symptomatic generalized epilepsies, in one of one case of idiopathic partial epilepsies, and in 17 of 24 cases of symptomatic partial epiSepsies. The main side effect was drowsiness, especially during the introduction.  相似文献   

7.
Partial Epilepsies in Infancy: A Study of 40 Cases   总被引:14,自引:14,他引:0  
Forty patients with partial epilepsy that began before they were aged 3 years were recorded at the Centre Saint-Paul between 1981 and 1986 with a follow-up ranging from 1 year 9 months to 20 years. We analyzed the following data: age at onset, clinical features of seizures at onset and during the follow-up period, ictal and interictal EEG features, etiologic circumstances, evolution of the epilepsy, and psychomotor development. The age of onset was mostly between 2 months and 2 years (more than two thirds of cases). Most had partial symptomatic epilepsy. In nine cases, epilepsy was preceded by febrile convulsions. Seizures at onset were of the following type (in order of decreasing occurrence): unilateral seizures, complex partial seizures, elementary partial seizures, and other seizures, often difficult to classify. A few patients with infantile spasms associated with focal or multifocal EEG abnormalities, differing from West's syndrome, were included in this study. We discuss the problem arising from the classification of infantile seizures and epilepsies.  相似文献   

8.
Some clinical and EEG aspects of benign juvenile myoclonic epilepsy   总被引:20,自引:17,他引:3  
J Asconapé  J K Penry 《Epilepsia》1984,25(1):108-114
Twelve patients with benign juvenile myoclonic epilepsy (BJME) representing 4% of our population of epileptics (n = 275) are presented. Only two patients (17%) had myoclonic jerks as the only seizure type. Seven (58%) had generalized tonic-clonic seizures (GTCS) and myoclonus. Three patients (25%) had absence seizures (AS), GTCS, and myoclonic jerks. Electroencephalographic evidence of photosensitivity was found in four (33%). Auditory precipitation of seizures was found in one patient. As is the case with other primary generalized epilepsies, the onset of BJME seems to be age specific. In our series the mean age of onset in years was 4.3 for AS, 14.75 for myoclonic jerks, and 16.4 for GTCS. It took an average of 8.5 years from the onset of BJME (range, 2-20 years) and 6.5 years from the onset of GTCS (range, 2 months-6 years) until the condition was properly recognized. Five patients experienced at least one episode of myoclonic status epilepticus. Generalized, paroxysmal, symmetric polyspike and slow wave discharges are the typical EEG finding. These complexes, however, showed considerable interpatient variability. Sleep deprivation proved to be the most valuable activating procedure. Valproic acid monotherapy effectively controlled myoclonic jerks as well as associated GTCS in most patients.  相似文献   

9.
It is reported the analysis of a retrospective and prospective study on a series of 101 patients suffering from partial epilepsy who have been examined at the Neuropediatric Clinics of Hospital General Base Cayetano Heredia during the period that lasted from January 1984 to July 1988. The observation time varied from 6 months to 4 years. The patients age varied from 6 months to 3 years old. There were found 19% of idiopathic epilepsy with 7.7% from benign epilepsies in childhood. The symptomatic epilepsies corresponded to sequels of problems short after birth, followed by tuberculosis granulomata and sequels of infections in the central nervous system.  相似文献   

10.
PURPOSE: To estimate the main incidence-related characteristics of epilepsy in an adult population in Estonia. Epidemiologic data about epilepsy from central and eastern Europe is controversial. METHODS: All existing databases and lists in the area were reviewed to identify all persons with newly diagnosed epilepsy aged > or =20 years during 3 years. Special attention was paid to extensive adoption of definitions and criteria proposed by Guidelines for epidemiologic studies. RESULTS: Crude and age-adjusted incidence rates were 35 per 100,000 person-years. The age-specific rates tended to increase with advancing age. Of the seizure types, partial seizures had highest rates, 27 per 100,000. The largest syndromic categories were localization-related epilepsies. Risk factors for epilepsy were identified in 55.5% cases. CONCLUSIONS: Incidence-related characteristics in the adult population of Tartu was comparable with those reported from the developed countries. The predominance of localization-related syndromes and partial seizures is the result of age distribution of the study.  相似文献   

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