Epileptic seizures and syndromes

This article describes the main characteristics of the different types of seizures and their classifications. The main types of epilepsies are reviewed, including their main, clinical, and EEG features and an overview of their treatment.     

Epileptic seizures and electroencephalographic evolution in genetic leukodystrophies.

The purpose of this study is to explore and compare epileptic seizures and EEG evolution in the various types of genetic leukodystrophy (GL). The authors reviewed the medical records and analyzed 69 serial EEGs in 27 patients with GLs: 13 with late infantile metachromatic leukodystrophy, one with juvenile metachromatic leukodystrophy, one with globoid cell leukodystrophy, six with X-linked childhood adrenoleukodystrophy, one with neonatal adrenoleukodystrophy, four with classic Pelizaeus-Merzbacher disease (PMD), and 1 with connatal Pelizaeus-Merzbacher disease. The diagnoses were made by biochemical and molecular studies. Two or more EEG studies with both awake and sleep traces were recorded during the varying clinical stages for each patient. At the beginning of the GLs, the EEGs were normal or showed mild slowing of background activity. Clinical seizures, mainly of focal origin, with progressive slowing and paroxysmal discharges on EEGs, usually appeared during the later stages of metachromatic leukodystrophy, X-linked childhood adrenoleukodystrophy, and classic Pelizaeus-Merzbacher disease. However, intractable seizures, mainly generalized in nature, and more severe slowing and abundant paroxysmal discharges on EEGs, with commensurate neurologic deterioration, were observed during the earlier course of globoid cell leukodystrophy, neonatal adrenoleukodystrophy, and connatal Pelizaeus-Merzbacher disease. These results indicate that GLs involve not only white matter, but gray matter as well. In all types of GL, there is good correlation between the severity of EEG changes, the severity of the diseases, and the clinical state of the patient.     

Epileptic seizures and vardenafil

INTRODUCTION: Epileptic seizures complicating treatment with selective inhibitors of phosphodiesterase type 5 are scarcely reported. CASE REPORT: A previously non-epileptic 78-year-old patient presented with a partial epileptic seizure following oral intake, for the second time, of 10mg of vardenafil (Levitra). The brain MRI failed to show any preexisting lesion. To our knowledge, only 2 cases of generalized tonic-clonic seizures induced by sildenafil (Viagra) use have been reported. In our patient, the seizure could be due to the epileptogenic potential of the drug or to its vascular complications. CONCLUSION: Further studies are needed to elucidate the association of phosphodiesterase inhibitors use and epileptic seizures.     

Epileptic seizures induced by sexual abuse. Pathogenic and pathoplastic factors

Previous sexual abuse is now thought to be a common cause of non-epileptic seizures (pseudoseizures). However, since sexual abuse is common, a previous history of sexual abuse may also occur in people with actual epilepsy. We present six patients in all of whom sexual abuse may, by acting as a stressor in the already predisposed, have precipitated epilepsy and in some of whom the abuse may have affected the actual experiences of the epilepsy itself: all but one of the patients had partial seizures.     

Epileptic seizures in acute stroke

We evaluated prospectively the incidence of early seizures in 1000 consecutive patients with stroke and transient ischemic attacks to determine whether seizure occurrence correlates with stroke type, pathogenesis, or outcome. Seizures occurred in 44 patients (4.4%; SE, 0.7%), including 10 (15.4%) of 65 (SE, 4.5%) with lobar or extensive hemorrhage, 6 (8.5%) of 71 (SE, 3.3%) with subarachnoid hemorrhage, 24 (6.5%) of 370 (SE, 1.3%) with cortical infarction, and 4 (3.7%) of 109 (SE, 1.8%) with hemispheric transient ischemic attacks. Lacunar infarcts and deep hemorrhages were not associated with seizures. Arteriovenous malformation was a common cause of lobar hemorrhage with early seizures, but in cortical infarcts there was no association between seizure occurrence and pathogenesis. Seizures generally occurred within 48 hours of stroke onset, were usually single, partial, and readily controlled. Seizures were not associated with a higher mortality or worse functional outcome.     

Epileptic seizures and cerebrovascular disease

A series of 88 patients with completed stroke was selected in which heralding, early and late seizures were distinguished according to their onset. Relationships between CT scan and clinical EEG data are discussed with particular emphasis on possible mechanisms of seizures. Thus, small emboli or haemodynamic factors are stressed in the cases of heralding seizures, metabolic disturbances with cytotoxic effects in early seizures and chronic epileptic focus in late seizures.     

Epileptic seizures in thrombotic stroke

Summary Epileptic seizures due to thrombotic cerebral infarction were studied in 118 patients. The occurrence of seizures had a bimodal distribution with one peak period within 2 weeks and another peak period from 6 to 12 months after stroke. Four patients had seizures preceding stroke, while 23 patients without a history of previous stroke had silent infarct on the CT scan. Fifteen patients (13%) had status epilepticus. Simple partial seizures occurred in 56% of patients, complex partial seizures in 24% and generalized tonic-clonic seizures in 4%. Epilepsy developed in 35% of patients with early seizures and in 90% of patients with late seizures.     

Epileptic seizures in post-stroke patients

We were investigating the frequency of early (within 30 days) and late (within 12 months) poststroke epileptic seizures, in our group consisting of 483 patients with stroke (423 cases of ischaemic stroke and 60 cases of haemorrhagic stroke) and without prior diagnosis of epilepsy. In 28 (5.8%) cases early seizures were observed. The most common type of early seizures were generalised seizures, slightly less frequent were simple partial seizures. EEG usually showed focal slow waves or non-specific slowing of background activity. Among 195 one-year survivors late seizures occurred in 6 (3.1%). 5 of them had ischaemic stroke. 30 day and 12 months fatality in the group of patients with seizures was not significantly higher than in all stroke patients.     

Epileptic seizures in supratentorial gliomas

Two hundred patients with supratentorial glioma; astrocytoma (pilocytic, fibrillary, gemistocytic) 82, mixed glioma (oligoastrocytoma) 46, oligodendroglioma 8, malignant (anaplastic) astrocytoma 33 and glioblastoma multiforme 31, surgically treated for the tumours and followed up for one to sixteen years, were retrospectively analysed for the incidence of pre and postoperative epileptic seizures. 122 patients (61%) had seizures preoperatively. 62 (50.8%) of them had at least one or more seizures during follow up. Seizures were persistent in 22 patients. Doubtful, or one or two minor seizures occurred in 19 cases. Six patients in this group had seizure only at the time of CT confirmed recurrence, after a seizure free interval of one to nine years. Amongst 78 patients who did not have seizures preoperatively, 24 (30.6%) developed seizures during the postoperative follow up period. Recurrent attacks were reported only by 5 patients while 15 patients had seizure(s) only at the time of recurrence of tumour. Two patients had a few seizures in the early postoperative period and none thereafter, while doubtful seizures were reported by two patients.     

Epileptic syndromes in infancy and childhood

PURPOSE OF REVIEW: The aim of this article is to review new epilepsy syndromes, acquire a new understanding of older ones and emphasize the impact of this concept on basic research regarding aetiology and treatment. RECENT FINDINGS: In addition to those included in the classification of the International League Against Epilepsy, new epilepsy syndromes comprise febrile seizures plus, benign familial neonatal-infantile seizures (BFNIS), benign infantile focal epilepsy with midline spikes and waves during sleep (BFIS), malignant migrating partial seizures in infancy, devastating epilepsy in school age children and late onset cryptogenic spasms. Genetics played a central role in identifying some new entities (BFNIS, BFIS with choreoathetosis), to delineate older syndromes (Dravet syndrome and myoclonic astatic epilepsy) and determine their mechanisms (infantile spasms, pyridoxine dependent seizures, neonatal encephalopathy with suppression bursts). SUMMARY: A significant number of children, mainly infants, do not fit in any of the described epilepsy syndromes. Still many patients with infantile epilepsy require the identification of cause or recognition of an epilepsy syndrome.     

Epileptic seizures in aspartylglucosaminuria: a common disorder

Aspartylglucosaminuria (AGU) is a lysosomal storage disorder with reduced life-span. An analysis of 121 Finnish patients showed that 22 to 78 adults (28%) and one of 43 children (2%) had epileptic seizures. Twelve patients had the onset of attacks after the age of 30 years. Eleven patients had generalized, nine partial and three unclassified seizures. The response to carbamazepine was good. The major interictal EEG abnormality was the attenuation of the amplitude found in 10/27 patients. The brain CT-scans showed diffuse atrophy in 8/11 patients.     

Epileptic and non-epileptic seizures in multiple sclerosis

Knowledge concerning the relationship between multiple sclerosis and epilepsy is reviewed. Epidemiological studies have established that epileptic seizures are more frequent in multiple sclerosis than predicted by chance. Partial epilepsies with focal seizures often with atypical symptoms and with or without secondary generalisation are the usual pattern. In the survey special emphasis is laid on the direct correlation between paroxysmal phenomena and plaques now demonstrable by modern imaging techniques. These images have shown that epileptic seizures can be caused by cortical and subcortical lesions and by their accompanying oedema. We extend the review to non-epileptic paroxysmal symptoms, such as tonic spasm, which may be confused with epileptic seizures. As fas as they are suported by data, recommendations for diagnosis and therapy are given. Open questions are identified and issues for further research are suggested. Received: 7 February 2000 / Received in revised form: 14 June 2000 / Accepted: 1 August 2000     

Epileptic seizures and cerebral atrophy in alcoholics

Summary Computed tomography was carried out in two groups of chronic alcoholics diagnosed according to the research diagnostic criteria, one with and the other without epileptic seizures. The sizes of the ventricles and the extracerebral spaces were compared with those of a control group, in order to examine the possible role of cerebral atrophy in precipitating epileptic fits in chronic alcoholics. Although a severe degree of atrophy was demonstrated in both groups, no difference was found between alcoholics with and without seizures. However, by correlating the sizes of different spaces, a more generalized atrophy was found in alcoholics with seizures. Thus, cerebral atrophy in a more generalized form may play a yet undefined role in precipitating epileptic attacks.

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Zusammenfassung Zwei Gruppen von chronischen Alkoholikern, eine Gruppe mit und eine Gruppe ohne epileptische Anfälle, wurden computertomographisch untersucht und im Hinblick auf die Größe der äußeren und inneren Liquorräume verglichen. Ausgangspunkt war die Frage, ob eine Hirnatrophie einen wesentlichen Faktor für die Auslösung von epileptischen Anfällen darstellt. Die Diagnose Alkoholismus wurde entsprechend den Research Diagnostic Criteria gestellt. Wir fanden eine sehr ausgeprägte Hirnatrophie in beiden Gruppen von Alkoholikern. In der Gruppe mit Anfällen bestand eine strengere Korrelation zwischen den verschiedenen Liquorräumen, d. h., ein Hinweis auf eine mehr generalisierte Hirnatrophie. Eine mitverursachende Rolle dieser Form der Atrophie für das Auftreten von epileptischen Anfällen ist wahrscheinlich.