Clinical and electroencephalographic features of complex partial seizures in infants

The clinical and electroencephalographic (EEG) features were evaluated in a consecutive series of 50 infants with complex partial seizures. The age of onset of seizures showed a peak at age of 2 months. Significant development delay was seen in 60% of the infants. In 92% an underlying aetiological factor could be identified. Birth asphyxia was the commonest aetiological factor (30%). The seizure patterns were most frequently described as behavioural arrest, upward deviation of eyes, tonic posturing of the limbs, apnoea and cyanosis. Interictal EEG showed bilateral temporal lobe foci in 22%, unilateral foci in 78% and multiple foci in 46% of the cases. The response of the seizures to anticonvulsant drugs is discussed.     

癫痫伴肌阵挛-失张力发作的临床及脑电图特征分析

目的探讨癫痫伴肌阵挛-失张力发作(epilepsy with myoclonic-atonic seizures,EMAS)的临床及视频脑电图特点,以提高对该病的认识。方法对2017年12月-2018年12月吉林大学白求恩第一医院小儿神经科收治的6例EMAS患儿临床及脑电特征进行回顾性分析。结果 6例EMAS患儿中,男5例,女1例;发病前智力运动发育正常,影像学正常。发病年龄2岁2个月～6岁,确诊时间2个月～1年6个月。6例患儿至少有肌阵挛、肌阵挛-失张力、失张力发作、不典型失神发作中两种发作形式。其中4例在上述发作前或后出现强直-阵挛发作,1例在病程晚期有强直发作。6例患儿中5例背景活动正常; 1例背景活动偏慢。6例患儿的脑电图在清醒期及睡眠期均出现广泛性2～4 Hz棘慢波、多棘慢波不规则或节律性发放,睡眠期放电有时类似高度失律,均无局灶性发作。所有患儿影像学检查均正常。6例患儿均给予正规抗癫痫药物治疗,其中2例治疗反应良好,4例治疗无效后给予甲基强的松龙治疗,其中3例有效缓解,1例虽然没有发作仍有大量放电。结论 EMAS好发于学龄前期儿童,癫痫发作类型主要包括肌阵挛、失张力或肌阵挛-失张力发作,但不典型失神等,脑电图主要为广泛性棘慢波、多棘慢波发放,治疗以抗癫痫药物和激素治疗为主,预后相对较好。     

Symptoms in focal sensory seizures. Clinical and electroencephalographic features.

PURPOSE: Aura is a brief subjective symptom that may represent the initial manifestation of a partial epileptic seizure with objective signs or constitute the entire epileptic attack (focal sensory seizure (FSS)). We studied the electro-clinical features of FSSs recorded in 28 patients. METHODS: Using long-term surface video-EEG recordings, we examined 28 patients (from a consecutive series of 64) with stereotyped FSSs and complex partial seizures (CPS) preceded in at least one instance by identical subjective manifestations (overall 255 FSSs and 39 CPS were recorded). FSSs were subdivided according to the type of sensation into somatosensory, visual or oculosensory, viscerosensory, experiential, cephalic and diffuse warm sensations. The EEG discharges accompanying FSSs were examined by two of the authors either blinded as to the type and timing of the seizure, or unblinded, i.e. after receiving complete clinical information including timing of the patient's warning. RESULTS: The ictal pattern accompanying FSSs was identified blind in 13 patients and unblind in 8 patients. In seven patients, the ictal discharge remained undetected. In the cases with recognizable ictal abnormalities, two main patterns could be distinguished, static and dynamic. FSSs whose ictal discharge could be recognized by blind EEG examination more frequently consisted of somatosensory and visual or oculosensory manifestations, and the discharge generally involved the centro-parieto-occipital regions. The ictal discharge of viscerosensory and experiential FSSs more easily remained undetected; when identified, it generally involved the fronto-temporal regions. CONCLUSIONS: FSSs are often accompanied by ictal abnormalities recognizable on surface EEG. A thorough knowledge of their EEG accompaniments may be a useful diagnostic aid in patients with partial epilepsy.     

Ictal nausea with vomiting as the major symptom of simple partial seizures: electroencephalographic and magnetoencephalographic analysis

Autonomic symptoms and signs rarely occur as isolated phenomena without impaired consciousness. Ictal nausea with vomiting is a rare clinical manifestation of seizures. Ictal vomiting is considered a localizing sign in patients with partial seizures of temporal origin. We encountered two patients with simple partial seizures that produced nausea with vomiting as the sole symptom, and we describe the interictal electroencephalographic and magnetoencephalographic findings. The episodes were paroxysmal and stereotypical in nature, and patients showed symptomatic response to a trial of antiepilepsy medication. In both patients, the diagnosis was simple partial seizures with autonomic symptomatology. Although interictal electroencephalography did not reveal focal spikes and focal slowing, estimated magnetoencephalographic dipoles were clustered in the parietal lobe. Interictal magnetoencephalographic foci may serve only as subsidiary evidence for the parietal origin of the episodes. However, our findings provide evidence of additional involvement of the parietal lobe in ictal vomiting.     

Complex partial seizures. Clinical features and differential diagnosis.

Complex partial seizures are the most common seizure type in patients with partial epilepsy. Most complex partial seizures emanate from the temporal lobe; however, the seizures also may be extratemporal in origin. The clinical phenomenology may distinguish complex partial seizures from nonepileptic paroxysmal disorders and other seizure types. Physiologic and psychological disorders need to be considered in the differential diagnosis of seizure activity. Long-term EEG monitoring may be necessary for select patients to confirm the diagnosis of epilepsy and to classify appropriately seizure type. Carbamazepine and phenytoin are the antiepileptic drugs of choice in the management of complex partial seizures. Polypharmacy and use of cognitively impairing antiepileptic drugs may reduce patient compliance and further impair the quality of life of the patient with epilepsy. Finally, epilepsy surgery is an important alternative for the patient with intractable partial seizures.     

Absence seizures in children: clinical and electroencephalographic features

The clinical and electroencephalographic (EEG) features of absence seizures in children were evaluated using EEG frequency modulation radiotelemetry and videotape monitoring. The only seizures evaluated were those with a spike-and-wave or multiple spike-and-wave duration lasting at least 3 seconds. A total of 926 absence seizures (426 typical, 500 atypical) were reviewed in 54 patients. Abnormal interictal EEGs, multiple seizure types, mental retardation, or developmental delay were more likely in patients with atypical absence seizures than in patients with typical absence seizures. Both types of absence seizures usually had a clear onset and cessation. Atypical absence seizures lasted significantly longer than did typical absence seizures. Automatisms occurred more frequently in typical absence seizures than in atypical ones, while decreases in postural tone or tonic activity occurred more frequently in atypical absence seizures. Receptive and expressive speech were retained in some patients during both types of seizures. This study demonstrates that typical and atypical absence seizures are not discrete entities but rather form a continuum. No single clinical feature can adequately distinguish the two seizure types.     

Self-abatement of simple partial epileptic seizures

Two patients with simple partial epileptic seizures were able to abate their attacks by vigorous somatosensory stimulation of the body part initially involved by the seizure. In both patients, the seizure symptoms progressed in a marching fashion which suggests a gradual spread of the epileptic discharge from its initial locus to adjacent areas.     

老年脑卒中患者癫痫发作的临床特点、脑电图表现及其危险因素分析

目的探讨老年人群脑卒中后癫痫(PSE)发作的临床特点、脑电图表现及其危险因素,为癫痫的早期预防提供依据。方法选取儋州市人民医院收治的脑卒中患者1485例,最终纳入患者992例,分析患者的临床特点及脑电图表现。根据脑卒中后癫痫发作情况,将其分为癫痫发作组87例和无癫痫发作组905例。应用单因素及多因素Logistic回归分析PSE的危险因素。结果 PSE的发生率为8.77%,其中早发型癫痫占55.17%,迟发型癫痫占44.83%。PSE发作的脑电图呈弥散性异常占26.44%,局限性异常占48.28%。单因素及多因素Logistic回归分析显示,高同型半胱氨酸血症、病灶部位、病灶范围、电解质紊乱、日常生活能力及NIHSS评分≥25分是PSE发作的独立危险因素,其OR(95%CI)值分别为2.063(1.146~3.125)、6.285(5.168~9.047)、4.725(3.684~6.835)、3.029(2.016~4.532)、2.538(1.568~3.562)和3.163(2.085~4.726)。结论老年人群脑卒中后癫痫发作的发生率较高,影响癫痫发作的危险因素较多,对存在危险因素的患者应高度警惕其癫痫的发生。     

Sydenham's chorea and seizures. Clinical and electroencephalographic studies

The hospital records of 28 children (mean age, 9.4 years) with typical Sydenham's chorea were reviewed. Nineteen of 28 patients had antistreptolysin O titers of greater than or equal to 200 Todd units. Other causes of chorea were excluded by appropriate laboratory and clinical follow-up studies. At the onset of the movement disorder, 17 of 28 patients had abnormal EEGs consisting of irregular posterior slowing in 15, sharp epileptic spikes in 5, and high-voltage sharp waves in 2. Two patients with spikes predominantly in the temporal lobe regions developed complex partial seizures. On follow-up evaluation, the EEGs returned to normal within one to four weeks. Seizures did not recur after therapy with anticonvulsants. Seizures have been reported only rarely in association with Sydenham's chorea. Our observation suggests that seizures may occur during chorea but may often be masked by frequent choreic movements and thus not recognized. The EEG changes and seizures were transient in our patients studied so far.     

Distinguishing features of pseudocomplex partial seizures.

The authors identify common features in the clinical presentations of three patients whose pseudoseizures mimicked complex partial seizures. All three had suffered the recent traumatic loss of a significant love object, and all manifested unconscious feelings of guilt and the use of defense mechanisms of denial, dissociation, introjection, identification, and symbolization. The authors explore the diagnostic, treatment, and etiological implications of these findings.     

Clinical and electroencephalographic characteristics of children with febrile seizures plus

OBJECTIVES: Febrile seizures plus (FS+) are attracting attention for their corresponding genetic abnormalities, and are defined as febrile seizures (FS) continuing beyond 6 years of age (late FS) or those associated with afebrile seizures. We tried to elucidate their clinical and EEG characteristics as compared with those of children having only FS. SUBJECTS AND METHODS: We reviewed clinical records in a pediatric neurology clinic to identify 31 patients with FS+ (group FS+) and 51 with only FS (group FS). Their family history of seizures, clinical features and EEG findings were compared. RESULTS: A family history of seizures was noted in 14 patients (45.2%) of group FS+ and in 24 (47.1%) of group FS. In group FS+, 19 patients had late FS, 11 had afebrile seizures, and the remaining one had both types of seizures. Two patients had seizures induced by TV/video-game as well, and another suffered from absences. Epileptic EEG abnormalities, which included diffuse spike-waves and focal spikes, were noted in 13 patients (41.9%) of group FS+ and 12 (23.5%) of group FS. CONCLUSIONS: The clinical and EEG characteristics of the children having FS+ were diverse, without significant differences from those with FS except for the seizures types.     

Subacute sclerosing panencephalitis presenting as simple partial seizures

Subacute sclerosing panencephalitis is reported in a 16-year-old girl with a 2 1/2-year history of right-sided simple partial sensory and motor seizures. The seizures were verified with video-electroencephalographic monitoring, showing left frontal epileptic activity. After an initial response to antiepileptic medication, her seizures became intractable, and mild, right-hemisphere signs developed. Magnetic resonance imaging showed an extensive right-hemisphere infiltrative lesion, thought to be a neoplasm. Cortical brain biopsy raised the possibility of subacute sclerosing panencephalitis, and this was confirmed serologically. The case highlights the importance of considering subacute sclerosing panencephalitis in the differential diagnosis of intractable seizures and demonstrates that strikingly asymmetrical magnetic resonance imaging abnormalities are not inconsistent with this diagnosis.     

全面性癫癎伴热性惊厥附加症的临床和脑电图特征分析

目的探讨全面性癫伴热性惊厥附加症(GEFS )的临床和脑电图(EEG)特点。方法收集4个GEFS 的家系资料,通过详细的调查建立完善的家系谱,并对受累者的临床资料、EEG进行分析总结。结果4个家系共有60名成员,其中受累者20例,表现为FS者5例,FS 者7例,FS 与失神发作2例,FS 与肌阵挛发作1例,FS 与失神和肌阵挛发作1例,此例患者发作间期EEG呈现局灶性癫放电和全面性癫放电共存的现象,1例表现为FS 和部分性发作,其发作间歇期EEG呈现中央中颞棘波灶,个体诊断符合良性罗兰多区癫。另外,受累者有肯定的临床发作,但是由于不能收集到可靠的发作表现资料,无法进行发作分类者3例。受累者神经系统检查以及头颅CT或磁共振成像(MRI)检查均未见异常。结论GEFS 的正确诊断需要注重个体,立足于整个家系进行,其临床发作谱还包括部分性发作,脑电图也有局灶的癫样放电。良性罗兰多区癫也许是GEFS 的一个新表现型。     

Clinical and electroencephalographic features of patients with polymicrogyria.

Polymicrogyria is a malformation of cortical organization. The aim of this historic cohort study was to describe clinical and EEG features of patients with polymicrogyria. Patients underwent clinical and neurologic examination and a prolonged routine EEG to allow recording during sleep. Neuroimaging data were classified as: perisylvian polymicrogyria (subdivided into holosylvian, posterior parietal, and generalized), hemispheric polymicrogyria, and frontal polymicrogyria. Forty patients were studied: 16 with holosylvian polymicrogyria, 14 with posterior parietal polymicrogyria, 4 with generalized polymicrogyria, 3 with hemispheric polymicrogyria, and 3 with frontal polymicrogyria. Patients with polymicrogyria usually did not have epilepsy and their EEGs were mostly normal (55%); the severity of the clinical and EEG features correlated with the extent of the cortical lesion. In perisylvian polymicrogyria, epileptiform abnormalities predominated in fronto-temporal regions. Dour patients had focal electrical status (FES) in awakeness and electrical status epilepticus of sleep (ESES); these four patients had right hemispheric polymicrogyria and asymmetric bilateral perisylvian polymicrogyria, mostly on the right hemisphere. The authors conclude that the EEG is usually normal in patients with polymicrogyria, despite it being associated with FES and ESES in certain patients.     

Complex partial seizures. Correlation of clinical and metabolic features

We compared metabolic patterns on 18F-2-deoxyglucose positron emission tomography (PET) with closed circuit television and simultaneous electroencephalographic ictal recordings of complex partial seizures in 48 patients. Closed circuit television and electroencephalographic data and PET scans were scored by "blinded" raters. Of the 48 patients, 26 had unilateral temporal; three, frontal; ten, ipsilateral frontotemporal; one, frontoparietal; and five, temporoparietal hypometabolism; and three had widespread hypometabolism affecting frontal, temporal, and parietal lobes. patients with frontal hypometabolism alone had shorter ictal and postictal durations, but involvement of multiple regions was associated with prolonged seizures. Auras were more likely to be present in patients with temporal hypometabolism alone, but an initial motionless stare did not distinguish this group. However, other metabolic patterns did not predict specific ictal clinical features. Vocalizations (formed or unformed) were not more closely associated with frontal involvement. When hypometabolism is multilobar, it may be difficult to use PET to distinguish between complex partial seizures of frontal and temporal origin.     

Changes in cerebral hemodynamics during simple partial motor seizures

Changes in cerebral perfusion were studied during nine short-lasting simple partial motor seizures (SPS) in an 11-year-old girl. Blood flow velocity changes in both middle cerebral arteries (MCAs) were assessed by transcranial Doppler sonography during simultaneous EEG monitoring. Within 7.4 +/- 1.4 s after electroencephalographic seizure onset, flow velocity in the MCA ipsilateral to the electrical discharges started to increase and then gradually rose up to 70% above baseline values. Spread of the epileptic activity to the other hemisphere in the late stage of seizure was associated with a slight increase in blood flow velocity (<30%) in the contralateral MCA. After the end of the seizure, flow velocities returned to baseline within 47 +/- 7 s. Our findings indicate that focal epileptic seizures evoke asymmetric perfusion increases which are closely related to the onset and cessation of the electroencephalographic seizure activity.