Effects of a Broad-Spectrum Behavior Modification Treatment Program on Children with Refractory Epileptic Seizures

A group of 18 children with refractory epileptic seizures was divided into three groups--behavior modification treatment, attention control, and control groups--with the purpose of investigating the effects of a learning-based broad-spectrum treatment program superimposed on a regular medical treatment program. The design consisted of a 10-week baseline, 6-week intervention, and 10-week and 1-year follow-ups. A combination of number of seizures and seizure duration--termed "seizure index"--was used as a dependent measure. There was a significant reduction in seizure index only for those children receiving the behavior modification treatment, at both follow-ups. The results indicate that this behavioral treatment program may be of substantial help to children with epilepsy who are resistant to conventional drug therapy.     

Effects of a Contingent Relaxation Treatment Program on Adults with Refractory Epileptic Seizures

A group of eighteen adults with refractory epileptic seizures were given psychological treatment in a two-phase experimental group study. In phase one, the experimental phase, the patients were divided into three groups--contingent relaxation (CR), attention control (ATC) treatment, and a no-treatment (NT) control group--with the purpose of investigating the effects of a learning-based contingent relaxation program compared with the effects of professional attention alone when superimposed on a regular medical treatment program. The design of the experimental phase was comprised of a 10-week baseline, 6-week intervention, and 10-week follow-up. Results of this phase at the end of follow-up showed a significant reduction only for those patients receiving the CR treatment. In the nonexperimental phase, the two control groups also received the CR treatment for a 6-week period, and subsequent seizure frequency measures for all three groups were analyzed after 10-week and 30-week follow-up periods. Results of this phase showed a significant reduction in seizure frequency for all three groups after receiving the CR treatment. Effects of the CR treatment were maintained at a 30-week follow-up. The results indicate that the CR treatment program may be of substantial help to adults whose seizures are resistant to conventional drug therapy.     

Effects of a Behavioral Intervention on Epileptic Seizure Behavior and Paroxysmal Activity: A Systematic Replication of Three Cases of Children with Intractable Epilepsy

Three children with very frequent refractory epileptic seizures underwent a behavioral intervention consisting of symptom discrimination, countermeasures, contingent relaxation, and positive reinforcement for correct responses in a systematic replication series. The studies involved a 6-h nonintervention base rate, a 6-h treatment phase, and a 6-h nonintervention follow-up under laboratory conditions for each child. Neurophysiologic and behavioral measures of the effects of treatment were made using electroencephalogram (EEG)-video equipment. Effects of treatment were assessed by using a random sample of EEG-video sequences in base rate and follow-up. Results showed that no significant reduction of either seizure behavior or paroxysmal EEG activity was found subsequent to training in discrimination of early paroxysmal activity and/or sensations preceding seizures. Both seizure behavior and paroxysmal activity were significantly reduced in all three cases following intervention with an adapted countermeasure technique. No additional effects could be noted subsequent to the application of either contingent relaxation or positive reinforcement for correct responses. Paroxysmal EEG changes and seizure behavior were highly correlated. Reduction of the clinical manifestation or seizure response by behavioral manipulation was accompanied by a reduction of the total amount of paroxysmal activity as measured by the EEG.     

Follow-up one year after parent-child interaction training: effects on behavior of preschool children

A preventive mental health intervention previously reported found positive effects in a parent-child interaction training program on attention deficit and internalizing symptoms of low-income preschool children as rated by parents. Families were randomly assigned to a "minimal treatment" control group or a more extensive treatment experimental group. The present study reports follow-up results measured approximately 1 year after the end of the intervention. Parent ratings and child achievement test scores showed no difference between the two groups. Teachers blind to the condition of the intervention, however, rated experimental children as significantly superior to control children with respect to attention deficit and hyperactivity symptoms (preintervention ratings by teachers on the same variable were statistically controlled). Composite teacher ratings of child behavior also significantly favored the experimental group. Children's improvements in classroom behavior were significantly correlated with improvements parents had shown during the intervention in their behavior toward the children.     

Impact of epilepsy characteristics and behavioral problems on school placement in children

Children with epilepsy are known to be prone to educational underachievement as a result of learning and behavioral problems. This cross-sectional study evaluated the effects of the characteristics of epilepsy and behavioral problems on school placement. One hundred eighty-five children aged between 3 and 16 years with nonoccasional epileptic seizures were included; 82 were mainstreamed in regular schools and 103 were in specialized medical and educational institutions for children with epilepsy. Gender distribution and age were comparable for the two groups. Logistic regression analysis indicated a statistically significant effect for age at onset, generalized nonidiopathic epileptic syndromes, number of antiepileptic drugs and behavioral problems, as dominant factors explaining the type of school placement. No significant effect was found for the state of seizure control. By use of a parent-rated behavior questionnaire, children in special institutions were shown to have significantly more problems in the hyperactivity/attention deficit and sociability domains. Later age at onset of epilepsy was related to more depression/anxiety.     

Acute encephalitis with refractory, repetitive partial seizures

BACKGROUND: Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is a new epileptic syndrome described by Sakuma in Japan in 2001. The clinical manifestations, neuroimaging findings and outcome of AERRPS in Taiwan have not been reported. METHODS: From 2000 to 2006, we collected cases that fulfilled the diagnostic criteria of AERRPS and analyzed the clinical course, virology, medication, electroencephalographic findings, neuroimaging characters and prognosis retrospectively. RESULTS: Fourteen children aged from 1 year and 2 months to 15 years and 6 months were enrolled. They presented with prodromic symptoms including fever (n=13, 92.9%), upper respiratory tract infection symptoms (n=12, 85.7%) and gastrointestinal tract discomfort (n=6, 42.9%). Seizures occurred 3-14 days after antecedent symptoms with patterns of generalized tonic-clonic seizures, focal seizures or myoclonic seizures. The seizures were refractory to combinations of antiepileptic drugs (AEDs). Prolonged fever (n=14, 100.0%), hypersensitivity to AEDs (n=11, 78.6%) and liver function impairment (n=8, 57.1%) were noted during the period of hospitalization. The follow-up EEG findings were similar to those of initial findings including epileptiform discharges and/or generalized background slow waves. Initial brain MRI scans were normal but later showed focal or multifocal abnormal signal intensity followed by generalized brain atrophy in more than 50% of cases. The general prognosis was poor with variable psychomotor retardation and persistence of refractory epileptic seizures. CONCLUSIONS: The similarities of the clinical features support AERRPS as a new epileptic syndrome. More study is needed to specify the etiology of the syndrome as the first step for more effective treatment.     

Primary generalized epilepsy during infancy and early childhood

The present study delineates a benign generalized epileptic disorder during infancy and early childhood similar to the well-defined syndrome of primary generalized epilepsy in adolescence. The inclusion criteria for the study required infants under the age of 4 years mainly presenting with generalized nonfebrile seizures, requiring corroboration with generalized epileptic discharges on electroencephalograms (EEGs); an unremarkable pregnancy, labor, and perinatal course; a favorable response to antiepilepsy drugs, preferably monotherapy; and a normal cognitive outcome. The clinical features of seizures, EEG correlates, response to medications, developmental outcome, and family history were analyzed. Twenty-five infants fulfilled the inclusion criteria, presenting at ages 4 to 36 months (mean 17 months) with recurrent generalized clonic seizures, which were commonly short-lived, lasting up to 5 minutes; two infants also had status epilepticus. Fourteen infants (56%) had accompanying febrile seizures, which preceded the nonfebrile seizures in 10 of them. A positive family history of seizures was found in 8 (32%) patients. Analysis of the EEG showed generalized epileptiform discharges in the form of 3 to 4 Hz spike-wave and normal background activity in 21 patients (84%), with a photosensitive response induced in 3 children. A larger group of 18 infants promptly responded to therapy, mainly valproic acid, which was terminated after 2 years, along with EEG normalization and no recurrence of seizures. A smaller group of 7 patients require prolonged therapy that keeps them seizure free; the EEG remains paroxysmal, and the seizures could recur when treatment is discontinued. All patients are presently seizure free within a follow-up period of 1.5 to 14 years. Their cognition is normal, but 12 patients have short attention and concentration spans, impulsiveness, and learning difficulties. As such, the data presented here delineate an idiopathic generalized epileptic disorder during infancy with a benign course, a rapid response to therapy, and preservation of cognitive skills that may be added to the current classification of the epileptic syndromes.     

Prognosis and therapy of sporadic seizures (author's transl)]

Eighty-five patients were admitted to the hospital under the preliminary diagnosis of epileptic seizures. None of them had more than five seizures before admission. Sixty-five of these 85 patients had a neurological and electroencephalographic follow-up examination 5 to 7 years later. Another 8 had been readmitted before. From these 8 the diagnosis of cerebral tumor was made in 3 patients. In almost half of the remaining 70 cases the etiology of seizures remained uncertain. The leading known etiologic factors were chronic alcoholism, head injury and perinatal brain damage. Before admission seizures recurred once or twice a year in most patients. After discharge from the hospital 25 patients were without further seizures, 15 of the seizure-free group never received anti-epileptic treatment. The remaining 10 were without medication for a period of time before the follow-up. All seizure-free patients were given the diagnosis of very rare grand mal seizures or seizures of uncertain origin. Only two of the untreated group (total of 17) had seizures after discharge. These findings show that recurrence of seizures was predictable, when patients were discharged. Predictors of recurrance were "treatment" or "no treatment" given initially. Antiepileptic medication should be given in cases of one seizure or more a year, when epileptic origin is certain. Very rare seizures and seizures of uncertain origin may stay without antiepileptic treatment. Sporadic seizures are benign in most cases - comparable to seizures of late onset. Both groups overlap.     

Trial of antiepilepsirine (AES) in children with epilepsy

Antieplepsirine (AES) is a new antiepileptic drug (AED) which was originally extracted from a Chinese folk remedy, and is now chemically characterized and synthesized. Its chemical structure is different from those of other available AEDs. Animal experiments involving AES demonstrated significant antiepileptic activity. Only a few clinical studies of AES with open trial have been resorted, none of which were on children. A 6.5 month, add-on, double-blind, placebo-controlled, randomized, cross-over study on AES (10 mg/kg per day) was conducted on epileptic children (aged 1-14 years) refractory to treatment with standard AEDs. The seizure frequency was recorded, and the blood levels of AES and other co-medicated AEDs (phenobarbital, phenytoin, carbamazepine and valproate) were determined. Although not planned, patients or parents were allowed to refuse to cross-over to the alternate therapy. The results were compared to the children who crossed-over as well as for the entire group during the first 3 months of randomized treatment. A total of 58 children entered, but only 34/58 children completed the cross-over study. The 24 children whose parents refused to let them be crossed-over continued the original study treatment (AES or placebo) for the entire 6 months. There was no statistically significant difference in seizure control when the entire group of 58 patients was compared to a parallel study group for the first 3 months of therapy (P = 0.178). There was a significant difference (P<0.01) in seizure control between AES and placebo treatment for the 34 patients who completed the entire cross-over study. No significant changes were seen in the blood level of other AEDs, and no serious acute side effects were observed. The results of the present study indicate the efficacy of AES for epileptic children with refractory seizures.     

Mental retardation subsequent to refractory partial seizures in infancy

Whether seizures are the direct cause of cognitive deterioration in epileptic children is undetermined. This retrospective study aimed to delineate a subgroup of pediatric patients with cognitive deterioration and refractory seizures in the absence of recognized causes for mental retardation. Of the 80 children identified as having mental retardation and refractory seizure disorder, seven (8.7%) had normal cognitive development until at least 1 year of age. Their metabolic status was normal. Five of them suffered repeated frequent partial seizures with onset in the first year of life and two had repeated episodes of status epilepticus. All seven had similar characteristics of early onset partial seizures, six of them had partial seizures secondarily generalized and one had complex partial seizures. The time of peak cognitive deterioration correlated with increases in seizure frequency during that period. Evaluation revealed a well-defined epileptic focus in the absence of neuroimaging abnormality except for hippocampal atrophy in the two children with complex partial seizures and a small vascular malformation in one child. Uncontrolled partial seizures in the first months of life may result in cognitive deterioration.     

拉考沙胺在儿童难治性癫痫添加治疗的临床效果观察

目的观察考拉沙胺(Lacosamide,LCM)对儿童难治性癫痫添加治疗中的临床疗效。方法收集2019年3月-2019年7月河南省人民医院儿科收治并使用LCM添加治疗的难治性癫痫患儿41例,男21例,女20例,年龄4.6~15.5岁,平均(7.21±3.06)岁。首发年龄0.1~11.0岁,平均(2.82±2.43)岁;病程在0.6~10.0年,平均(4.49±2.34)年。通过自身空白对照研究,口服LCM 6个月,并进行随访,对比观察使用LCM前后的疗效。结果通过空白自身对照,添加LCM药物后,随访时间3、6个月患儿癫痫发作频率显著减少,差异具有统计学意义(P<0.05),且LCM能有效改善患儿精神状态,但对局灶性难治性癫痫发作与全面性难治性癫痫发作改善作用的差异无统计学意义(P>0.05)。结论LCM作为第三代新型抗癫痫药物,添加治疗儿童难治性癫痫能有效地改善癫痫发作频率,并对改善患儿的精神状态具有一定作用。     

Nonlesional frontal lobe epilepsy (FLE) of childhood: clinical presentation, response to treatment and comorbidity

RATIONALE: Few studies have looked at long-term epileptic and cognitive outcome of frontal lobe epilepsy (FLE) in children. Most are limited by inclusion of lesional and nonlesional patients. GOAL: To define the epileptic and functional outcome of children with nonlesional FLE. METHODS: We reviewed medical records and neuropsychological evaluations of patients with nonlesional FLE diagnosed between 1994 and 2004. We included children with either focal or regional frontal EEG and/or functional imaging abnormalities. We reviewed their charts for seizure and neuropsychological outcome. RESULTS: We included 21 children. Twelve (57.1%) presented with daily seizures. Seizures were nocturnal in 8 of 21, secondarily generalized in 6 of 21, adversive in 5 of 21, and focal motor in 6 of 21. Although, initial seizure control was poor in 14 of 21, long-term control was achieved in 10 of 21 after 14.6+/-22.3 months. Early development was normal in 12 of 21 but at later formal neuropsychological evaluation only 3 of 12 still had a normal profile. The majority of children had learning difficulties requiring special education prior to seizure onset (6 of 10). A clearly defined regression after seizure onset was observed in three children. The majority exhibited attention deficit and hyperactivity or impulsivity (14 of 21), behavioral problems (8 of 21), and cognitive impairments (10 of 21). Early seizure control was associated with a better cognitive outcome. CONCLUSION: Nonlesional FLE is associated with poor seizure and behavioral outcomes. Whether this is secondary to MRI-silent developmental lesions or to the progressive repercussion of seizures on frontal lobe functions remains uncertain. A prospective study with early neuropsychological assessment could help confirm the latter.     

Benign Focal Epileptiform Discharges in Children After Severe Head Trauma: Prognostic Value and Clinical Course

Summary: Purpose: To assess the occurrence and prognosis of benign focal epileptiform discharges (BFED) in EEG after severe head trauma (SHT) in children.
Methods: Between January 1987 and December 1994, 47 of 828 children with anamnestic SHT showed a single or dominant epileptic focus in EEG. Spike wave localization and morphology were either suggestive for BFED (group I, 21 children) or were suspected to be symptomatic (group II, 26 children). We analyzed the course of epilepsy and epileptic discharges in EEG, neuroradiologic findings, neurologic outcome, and school adjustment.
Results: After SHT, spike waves appeared immediately (within 72 h) or delayed (maximum 7 years) and disappeared between ages 3 and 14 years in 14 children of group I and between ages 8 and 23 years in 10 of group II. Children with persistent spike waves in group I were all younger than 14 years; in group II, seven were older than 15 years. Computed tomographic (CT) lesions, ipsilateral to the epileptic focus, were seen in 10 children of group I and 15 of group II. Early seizures occurred in nine children of group I and eight of group II and late-onset seizures in one of group I and nine of group II (p = 0.028). Epilepsy developed in three children of group I and 12 of group II and was drug refractory in six children of group II, all with persistent epileptic foci. Regular schools were attended by 14 (67%) children in group I and 12 (48%) of group II.
Conclusions: Benign focal epileptiform discharges in post-traumatic EEGs have the same favorable prognosis as in benign focal epilepsy and should be handled as recommended for classic benign focal epilepsy.     

Photoparoxysmal responses in non-epileptic children in long-term follow-up

OBJECTIVES: To evaluate the photoparoxysmal responses (PPR) in non-epileptic children and adolescents in long-term follow-up. MATERIALS AND METHODS: We studied 14 non-epileptic children who showed PPR without any other electroencephalographic (EEG) abnormalities. RESULTS: One subjects was lost after 1 year of follow-up. At the final follow-up, four of the 13 patients (approximately 30%) did not show any PPR or other epileptic discharges, while in other children PPR continued to be present. The age of the disappearance of PPR in these four patients ranged from 1.1 to 5.9 years from the first evaluation. No patients suffered from epileptic seizures during the whole period of follow-up. CONCLUSION: Our study confirms that PPR can be present in the EEG of non-epileptic children and adolescents and demonstrates that this EEG change is not related to the presence of seizures and must not be considered a marker for the developing of epilepsy.     

Risk factors predicting refractoriness in epileptic children with partial seizures

The aim of this retrospective study was to determine the risk factors associated with intractability to therapy in childhood epilepsy. Fifty children with intractable epilepsy as evidenced by at least 1 epileptic fit per month were included in the study group, whereas the control group consisted of children who did not experience any recurrent seizure for at least 1 year at the time of the study. A chi( 2) test was used to evaluate the relationship between the test variables for the 2 groups, and the estimated relative risk (odds ratio) for each variable was calculated. The risk factors were subsequently determined by logistic multiple regression analysis. Univariate analysis showed that mental retardation, neurological abnormality, neuroradiological abnormality, perinatal anoxia, neonatal convulsion, presence of status epilepticus, and symptomatic etiology were significant risk factors for the development of refractory epilepsy (P < .05). For multivariate logistic regression analysis, age at seizure onset, status epilepticus, mixed type of seizures, and history of frequent seizures (more than once a month) were all found to be significant and independent risk factors for refractory epilepsy, and the number of drugs used in the study group was significantly higher than that in the control group (P < .05). In line with these findings, it was concluded that children who present with epilepsy and have these risk factors should be referred to a center where epileptic surgery is carried out without delay.     

Longitudinal study of epileptiform EEG patterns in normal children

EEG were recorded in 3,726 children, from 6 to 13 years of age who were neurologically normal and had no history of epileptic seizures. The records were taken during wakefulness, at rest, and during hyperventilation. In 131 cases (3.54%) epileptiform patterns were found. They consisted of 3 count/sec spike and slow waves discharges (4 cases), multiple spike and slow wave complexes (37 cases), midtemporal spikes (50 cases), rolandic or parietal spikes (27 cases), occipital spikes (2 cases), and multifocal spikes (11 cases). Half of the subjects with EEG abnormalities had behavior problems and/or slight psychomotor ability disturbances. Follow-up studies over an 8 to 9 year period were performed. These demonstrated the spontaneous disappearance of the EEG abnormalities, usually within school age or, at the latest, during adolesence. Only seven individuals developed epileptic seizures of the primary generalized type which responded well to anticonvulsant drug treatment. From this study we can deduce that the epileptiform EEG patterns that often are found in children during school age have no clinical relationship to epilepsy in the great majority of cases. The relationship with epilepsy exists probably on a genetic level for the generalized discharges. The spike foci are non-epileptic in nature in all probability, especially if they emerge from a fairly normal background activity and their duration is very similar to that of the constituents of the background activity, as found in the majority of these subjects. On the contrary, it is probable that these alterations express difficulties in affective or motor adaptation during childhood.     

A group contingency program to improve the behavior of elementary school students in a cafeteria

Studies of behavior modification interventions for disruptive behavior in schools have generally focused on classroom behavior with less research directed toward child behavior in other school settings (e.g., cafeterias). The present report documents the effect of a group contingency intervention with a random reward component, targeting disruptive cafeteria behavior. An uncontrolled study of the effect of the group contingency program across the school year suggested substantial behavior improvement after the program started. Two natural treatment discontinuations during the same school year provide further support for the intervention. Both sources of information suggest behavioral improvement in rule-following behavior when the program was actively implemented.     

Clinical Effects of Thyrotropin-Releasing Hormone for Severe Epilepsy in Childhood: A Comparative Study with ACTH Therapy

We investigated the effects and side effects of thyrotropin-releasing hormone (TRH) on severely epileptic children to evaluate the clinical usefulness of TRH in the treatment of epilepsy and compared them with the results of ACTH therapy. The subjects were 64 patients admitted consecutively between 1980 and 1986. Their seizures were frequent, more than one a day or more than one a week. The subjects were divided into two groups; 33 patients treated with ACTH and 31 treated with TRH. The mean follow-up periods in TRH and ACTH therapy were 8 months and 3.0 years, respectively. The daily dose of TRH-t 0.5-1 mg was administered intravenously (i.v.) or intramuscularly (i.m.) for 1-4 weeks. The follow-up periods were 3-12 months (mean 6 months). In the TRH group, complete control of seizures was achieved in 7 of 13 (53.7%) of those with infantile spasms, and marked improvement of EEGs were observed in 8 of 13 (61.5%) of them. In the ACTH group, seizure cessation was observed in 75% of infantile spasms. Of the patients who received ACTH, 66.7% had various side effects, including pneumonia, huge subcutaneous abscess, hypokalemia, cataracts, and brain shrinkage as shown on computed tomography (CT), whereas only 16.7% of the patients treated with TRH had transient reduction of urine volume without other laboratory and physical abnormalities. The results of the study indicated that some patients who received TRH had cessation of infantile spasms and improved EEG findings with no serious side effect. Because of the untoward side effects of ACTH therapy, TRH is considered a possible new treatment for children with infantile spasms.     

The effect of kindled seizures on the locomotory behavior of Long-Evans rats

The incidence of attention deficit hyperactivity disorder (ADHD) is higher in children with epilepsy than in the general childhood population. The origin of the symptoms of ADHD seen in children with epilepsy is unknown. This experiment used an animal model to investigate whether seizures could be a cause of the hyperactivity sometimes associated with epilepsy. Sixteen male Long-Evans rats were implanted with electrodes, and 8 of them were kindled until generalized stage 5 seizures were elicited. Eight subjects were handled, but not kindled. The behavior of the rats in the two groups was compared in an open field test. The time spent in four behaviors was measured: exploratory behavior, immobility, eating, and grooming. Rats were tested after 5 stage 5 seizures, after 10 stage 5 seizures, after 15 stage 5 seizures, after a 2-week rest period, and after 5 more stage 5 seizures. Data were analyzed using the Mann-Whitney rank sum test. Twenty-four hours after a seizure, the kindled rats displayed a greater level of exploratory behavior than did the controls. They were not found to differ on any other measure. After a 2-week rest period, the group difference in behavior disappeared. When kindling was reinitiated, the kindled rats again showed increased exploratory behavior. The findings suggest that the increased exploratory behavior found in the kindled rats resulted from recent seizure activity. It may be that the hyperactivity seen in some children with epilepsy also results from recent seizure activity.