Significance of seizure in cerebral venous sinus thrombosis

PurposeTo report the frequency and predictors of presenting seizures in cerebral venous sinus thrombosis (CVST) and their influence on seizure recurrence and outcome.MethodsThis retrospective study, between 1995 and 2011, included 90 consecutive patients with CVST diagnosed using magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Clinical parameters like frequency, type (presenting, early, and late), and duration of seizures, precipitating causes of CVST, and underlying prothrombotic conditions, were recorded. The location of infarction on MRI and the number of sinuses involved on MRV, were noted. The patients were prescribed anticoagulants, and those with seizures were prescribed antiepileptic drugs. The patients were followed up at 3, 6, and 12 months. The functional outcome at 6 months was categorized into death, poor, partial and complete recovery.ResultsA total of 42 patients with CVST presented with seizures (focal 11, focal with secondary generalized 19, and generalized tonic clonic 16), of whom 10 had status epilepticus. On univariate analysis, supratentorial lesion (P = 0.005), frontal (P = 0.02) or parietal lobe (P = 0.04) involvement and haemorrhagic lesion (P = 0.002) were associated with higher risk of presenting seizure. On multivariate analysis, only supratentorial parenchymal lesion on MRI (odds ratio [OR] = 4.67, 95% confidence interval [CI] 1.51–15.08, P = 0.005) was independently associated with higher risk of presenting seizure. Only 4 patients had early seizures and none had late seizures. At 6 months, 10 patients died and 73 patients had complete recovery. Seizures were not associated with death (P = 1.00) and 6-month functional outcome (P = 0.66).ConclusionAbout half the patients with CVST had presenting seizures which was independently related to supratentorial lesion. However, seizures were not related to death or 6-month outcome.     

Physical injuries in patients with epilepsy and their associated risk factors

ObjectivesTo determine the frequency, nature, and risk factors associated with physical injuries in patients with epilepsy.MethodsIn this retrospective cohort study, patients 18 years of age and older with active epilepsy for at least 1 year were included. A questionnaire (including age, gender, education, type of epilepsy, seizure frequency, having aura, drug compliance, polypharmacy, comorbidity, type and place of injury) was completed from patients and healthy individuals. Statistical analyses were performed using multiple logistic regression and Chi-square tests.Results264 patients with epilepsy and 289 healthy participants were studied. Among patients, 8.7% reported severe injuries and 44.3% had mild injuries. Most patients reported soft tissue injuries, followed by dental injury, burn, and head injury. Severe injuries were 2.9 times more frequent among patients having generalized tonic–clonic seizures (GTCS) compared to healthy control; this was not statistically significant (P = 0.07). No patient reported having severe injuries due to SPS, myoclonic or absence seizures. Mild injuries were 10.3 times more frequent among those with GTCS compared to healthy control (P = 0.001). The relative risk for having injury in patients compared to control group was 3.42 (95% confidence interval: 2.50–4.69). Injury was significantly related to having GTCSs, illiteracy, having fall with seizures, comorbidity and having uncontrolled seizures.ConclusionPhysical injuries are common in patients with epilepsy; however most of these injuries are mild. Severe injuries rarely occur in patients with seizures other than GTCS.     

Differences in iron deficiency anemia and mean platelet volume between children with simple and complex febrile seizures

ObjectiveThe relationship between iron deficiency anemia and febrile seizures (FSs) were examined in several studies before. The aim of our study is to find out the differences regarding iron deficiency anemia, demographic characteristics and mean platelet volume (MPV) which is an inflammatory marker between simple and complex febrile seizure groups.MethodsIn this study, the authors investigated the recordings of 493 children with a diagnosis of simple and complex febrile seizure, aged between 6 months and 6 years, followed between 2002 and 2010 retrospectively.ResultsMean age and male/female ratio were similar in two groups. There was no significant difference regarding with age, gender and family history of FS between two groups. We found significant difference statistically with respect to gestational age, consanguinity, family history of epilepsy and birth weight between two groups. The mean levels of Hb, Htc, MCV were lower and Plt and RDW levels were higher in children with CFS than SFS group, the differences were statistically significant (p: 0.001).A higher proportion of children with CFS (16.2%) had iron deficiency anemia compared to SFS group (12.1%). Mean platelet volume (MPV) of CFS (7.99 ± 0.96 fL) were significantly lower than that of SFS group (8.77 ± 0.75) (p < 0.001).ConclusionsThe results of this study suggests that iron deficiency anemia is more frequently seen among the patients with CFS than the patients with SFS. The lower levels of MPV as an inflammatory marker, supports the idea that CFS is a brain inflammatory disease and the consequence of this inflammatory mechanism is the development of the epilepsy. Further studies are necessary to highlight the relationship between iron metabolism, inflammation and seizures.     

Severity of anxiety and depression are related to a higher perception of adverse effects of antiepileptic drugs

After reviewing the negative effects of antiepileptic drugs (AEDs) on general health and quality of life, the Commission on Outcome Measurement from the International League Against Epilepsy (ILAE) recommended incorporating reliable and valid tools in clinical essays in order to achieve a more accurate assessment of the subjective adverse effects rate and disease severity when using AEDs.PurposeThe aim of this study was to correlate the severity of adverse effects of AEDs, with the presence of anxiety and depression in patients with epilepsy.MethodsThe Spanish version of the Liverpool Adverse Events Profile (LAEP) and the Hospital Anxiety and Depression Scale (HADS) were applied on 130 consecutive outpatients with epilepsy from the epilepsy clinic at the Mexico's National Institute of Neurology and Neurosurgery. A correlation analysis was carried out to determine if the presence of depression and anxiety was related to the adverse effects of AEDs. The relation between LAEP scores with other epidemiological variables was also assessed.ResultsOur study found a positive correlation between the LAEP and the HADS scores (p = <0.01).The most common adverse effects were drowsiness (81.5% [n = 106]), difficulty in concentrating (76% [n = 99]), and nervousness and/or agitation (75% [n = 97]). Female gender, a history of febrile seizures, persistent seizures and polytherapy were associated with a higher toxicity on LAEP. In our study, age at epilepsy onset, duration of epilepsy, type of epilepsy and patients’ age were not related to higher LAEP scores.ConclusionAdverse effects to AEDs can be related with the presence of psychiatric disorders such as anxiety and depression in patients with epilepsy.     

Association between iron status and febrile seizures in children

ObjectivesThe aim of this study was to determine the association between iron status and febrile seizures in children aged 6 months to 5 years.MethodsThis prospective case–control study enrolled 300 children who presented with febrile seizures (case group) and 200 children who presented with a febrile illness without seizures (control group) from March 2007 to January 2009. Hemoglobin, mean corpuscular volume and serum ferritin concentration were compared in the two groups in relation to age, sex and use of iron supplementation.ResultsPatients with febrile seizures were more frequently iron deficient as defined by a serum ferritin level below 20 ng/dl (56.6% vs. 24.8%, P = 0.0001). Mean hemoglobin concentration was 10.8 g/dl in the control group and 11.7 g/dl in the case group (P < 0.05). The difference between groups in mean corpuscular volume was not statistically significant (75.5 fl vs. 74.4 fl, P < 0.130).ConclusionLow serum ferritin concentration and low iron status may be risk factors for the development of febrile seizures.     

Fever as a seizure precipitant factor in Panayiotopoulos syndrome: a clinical and genetic study

PurposeTo examine fever as a precipitating factor for focal seizures in patients with Panayiotopoulos syndrome (PS) and evaluate the role of SCN1A in PS patients with seizures triggered by fever.MethodsFrom January 2000 to June 2008, we identified patients referred for seizures who fulfilled the criteria of PS. Patients were divided into two groups, according to the presence (group A) or the absence (group B) of seizures triggered by fever. Electroclinical features of the two groups were compared. In addition, an analysis of SCN1A in patients of group A was performed.ResultsThirty patients fulfilled the inclusion criteria. Eleven patients (36%) had at least one focal autonomic seizure triggered by fever (group A). In group A, 7/11 patients (63.5%) had the first focal autonomic seizure during a febrile illness. Two of these 7 patients were misdiagnosed at the onset of PS. The median age at the onset of PS was slightly lower in group A than in group B (p = .050). Moreover, patients in group A more frequently had a positive familial history of febrile seizures (FS) (p = .047). No mutations of SCN1A were found in any of the 10 patients screened.ConclusionFever is a common trigger for focal autonomic seizures in PS. Knowing that an autonomic manifestation during fever can be an epileptic seizure could facilitate diagnosis and prevent unnecessary investigations and erroneous treatments. Moreover, our data show that SCN1A gene does not contribute significantly to susceptibility to autonomic seizures during fever in patients with PS.     

Sleep instability and cognitive status in drug-resistant epilepsies

ObjectiveThe aims of this study were to evaluate the sleep habits of children with drug resistant epilepsy and to correlate sleep abnormalities with epilepsy and level of intelligence.Subjects and methodsTwenty five subjects with drug resistant epilepsy (14 males, age range 2–16.4 years) were recruited for this study. A control group was formed by 23 normal children. Two instruments to assess sleep habits were administered to the patients with epilepsy: a questionnaire on sleep habits (to preschool children) and a questionnaire on sleep behavior (for children aged more than seven years old); a cognitive test (Wechsler Intelligence Scale for Children-WISC) was also performed. Patients underwent a complete polysomnographic study and sleep parameters, including CAP, were analyzed and correlated according to cognitive-behavioral measures in children with epilepsy.ResultsChildren with drug-resistant epilepsy and severe mental retardation showed sleep abnormalities such as low sleep efficiency, high percentage of wakefulness after sleep onset, reduced slow wave sleep, and reduced REM sleep. Sleep microstructure evaluated by means of CAP analysis showed a decrease in A1 index during N3 in patients with more severe cognitive impairment. Children with epilepsy and cognitive impairment (n = 10) had higher Sleep Behavior Questionnaire for Children (SBQC) total scores (65.60 ± 18.56) compared to children with epilepsy and normal IQ (50.00 ± 10.40), p < 0.05.ConclusionsChildren with drug-resistant epilepsy have a greater incidence of sleep problems regarding qualitative aspects, macrostructure, and CAP. The decrease of CAP rate and of A1, mainly during slow wave sleep (associated to REM sleep reduction), might represent a sleep microstructural pattern of intellectual disability.     

Age of onset in idiopathic (genetic) generalized epilepsies: clinical and EEG findings in various age groups

PurposeThe prevalence and differences of idiopathic (genetic) generalized epilepsies (IGEs) with atypical age of onset compared to classical IGEs is a matter of debate. We tried to determine the clinical and EEG characteristics of IGEs in various age groups.MethodsAll patients with a clinical diagnosis of IGE were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 through 2011. We subdivided the patients into four different age groups: 4 years of age and under, 5–11 years, 12–17 years, and finally, 18 years and above, at the time of their epilepsy onset. Syndromic diagnosis, sex ratio, seizure types and EEG findings were compared. Statistical analyses were performed using Pearson Chi square test.Results2190 patients with epilepsy were registered. 442 patients (20.2%) were diagnosed as having IGEs. Age of seizure onset was 12.4 ± 6.9 years. The peak age of onset had a bimodal appearance. Sixty-seven patients (15.2%) were four years and under at the time of the onset of their disease, 112 persons (25.3%) were 5–11 years, 197 people (44.6%) were 12–17 years of age, and 66 patients (14.9%) had 18 years and above at the onset of their epilepsy. The sex ratio was significantly different between patients in group one compared to groups three and four. All expected seizure types (i.e., generalized tonic–clonic, absence or myoclonic seizures) and all expected EEG abnormalities were observed among all age groups, despite some differences in their prevalence.ConclusionAlthough IGE syndromes are often age dependent and most of them appear within the first two decades of life, adult-onset IGE is not rare. Presentation of IGEs could be different in various age groups, but these differences do not offer pathognomonic or characteristic features at any age.     

Seizure prognosis of patients with low-grade tumors

PurposeSeizures frequently impact the quality of life of patients with low grade tumors. Management is often based on best clinical judgment. We examined factors that correlate with seizure outcome to optimize seizure management.MethodsPatients with supratentorial low-grade tumors evaluated at a single institution were retrospectively reviewed. Using multiple regression analysis the patient characteristics and treatments were correlated with seizure outcome using Engel's classification.ResultsOf the 73 patients with low grade tumors and median follow up of 3.8 years (range 1–20 years), 54 (74%) patients had a seizure ever and 46 (63%) had at least one seizure before tumor surgery. The only factor significantly associated with pre-surgical seizures was tumor histology. Of the 54 patients with seizures ever, 25 (46.3%) had a class I outcome at last follow up. There was no difference in seizure outcome between grade II gliomas (astrocytoma grade II, oligodendroglioma grade II, mixed oligo-astrocytoma grade II) and other pathologies (pilocytic astrocytoma, ependymomas, DNET, gangliocytoma and ganglioglioma). Once seizures were established seizure prognosis was similar between different pathologies. Chemotherapy (p = 0.03) and radiation therapy (p = 0.02) had a positive effect on seizure outcome. No other parameter including significant tumor growth during the follow up period predicted seizure outcome. Only three patients developed new-onset seizures after tumor surgery that were non-perioperative. Anticonvulsant medication was tapered in 14 patients with seizures and 10 had no further seizures. Five patients underwent additional epilepsy surgery with a class I outcome in four. Two patients received a vagal nerve stimulator with >50% seizure reduction.DiscussionSeizures at presentation are the most important factor associated with continued seizures after tumor surgery. Pathology does not influence seizure outcome. Use of long term prophylactic anticonvulsants is unwarranted. Chemotherapy and radiation therapy have a favorable impact on seizure outcome. Additional epilepsy surgery is effective.     

Invasive explorations in children younger than 3years

PurposeIn children with drug-resistant focal epilepsy who are candidates for surgery, invasive exploration is sometimes required. However, this is being controversially discussed for children younger than 3 years. The question of its necessity, feasibility and its risks is often raised, since it concerns primarily lesional epilepsy and a lesionectomy might be proposed right away. However, this attitude does not take into account the specificities of epilepsy at this age, including poor specificity of electroclinical semiology and the ongoing myelination challenging the interpretation of magnetic resonance imaging (MRI).MethodsWe retrospectively studied the records of children with drug-resistant epilepsy who were younger than 3 years of age at the time of their invasive exploration at our institution from 2000 to 2009. We reviewed the clinical, imaging and electrophysiological data, and included post-operative outcome for those who underwent surgery.Key findings26 Children met the inclusion criteria. All had drug-resistant epilepsy that started at an average of 5.2 months (range 0–20 months) with multiple daily seizures in all and developmental delay in 16. The average age at the time of exploration was 21.8 months (range 5–35). In 20 children, subdural electrodes in combination with two or three depth electrodes were implanted, and in six children aged over 2 years a stereo-electro-encephalography (SEEG) was performed. SEEG was considered technically difficult to achieve before the age of 2 years. The tolerance of invasive exploration was good with a 3% morbidity consisting of one subdural hematoma during exploration by subdural electrodes, evacuated without any particular sequelae. In 25 patients, the exploration permitted to propose a focal resection. The surgical intervention was in the frontal lobe in 12 cases, the parietal lobe in six, the occipital lobe in two patients, and the temporal lobe in one child who underwent an additional resection. Four children had a resection of two or three lobes. Five underwent a second surgery, following a second invasive exploration. Histologically, the resected tissue revealed focal cortical dysplasia in 21 cases (including three patients with tuberous sclerosis), two post-ischemic lesions, one dysembryoplastic neuroepithelial tumor, and one gangliglioma associated with dysplasia. The mean postoperative follow-up period was 51 months (range 4–110). For the children operated on twice, follow-up was counted from the second surgery on. Seventeen children (68%) had an outcome of Engel class 1. In five (20%), seizure frequency was significantly improved (Engel class 3). In two of three patients without improvement in seizure frequency (Engel class 4), a new SEEG is planned and the third is presently a candidate for hemispherotomy.SignificanceInvasive exploration is feasible, well tolerated and carries a low morbidity in children under 3 years of age. At this age, it is indicated for drug-resistant lesional epilepsy associated with developmental delay. It permits delineating the lesion, which is not possible with MRI. The choice of the technique is in part age-dependent. The discussion of its indication arises in the same way as in the older child.     

Seizure frequency in children with epilepsy: Factors influencing accuracy and parental awareness

RationaleThe objective of this study was to ascertain the accuracy of clinical reports to determine the seizure frequency in children diagnosed with epilepsy.MethodsWe reviewed the clinical record of 78 children (January–May of 2006) admitted to the EEG–video monitoring with epilepsy diagnosis. Clinical reports of parents and the files of EEG–video monitoring were reviewed to determine parents’ awareness for seizures.ResultsDuring video–EEG monitoring, 1244 were recorded on 78 children. Seizures were confirmed in 1095 of which 472 were correctly reported (38%) by parents whereas 623 remained under-reported (50%). Parents’ report thus had a sensitivity of 43%, positive predictive value of 76% to identify seizures. Based on the EEG–video monitoring, seizures were reported accurately in 22 (28%) and under-reported in 38 (49%) children. In the under-reported group, none of the seizures were recognized in 10 (13%), only a portion identified in 28 children. The parents’ report describing seizure frequency has limited value for young children (p = 0.01) and children with absence seizures (p = 0.03). However, clinical reports were accurate for the children with developmental delay (p < 0.06) or not being on any anticonvulsant drug (AED) therapy (p = 0.02).ConclusionOur results indicate that a significant number of seizures remain under-reported by parents of children with epilepsy. The current study underscores that the seizure frequency should be interpreted with caution for young children and children with absence seizures. Video–EEG recording has a complimentary role to the clinical observation for the accurate assessment of seizure frequency in children.     

Preoperative IQ predicts seizure outcomes after anterior temporal lobectomy

PurposeIQ tests are frequently used in the preoperative neuropsychological assessment of candidates for anterior temporal lobectomy (ATL). We reviewed IQ test results and surgery outcomes to evaluate the roles of IQ tests in the preoperative work-up.MethodsA total of 205 adult patients who had undergone ATL and whose seizure outcomes were followed for 2 years after surgery were included. The short form WAIS-R was used to estimate intelligence. Multiple linear regression and logistic regression analyses were used to examine the variables for IQ and seizure outcomes.ResultsEducation, duration of epilepsy and gender were factors that accounted for 24.6% of the variance in the full-scale IQ (FSIQ) scores. The verbal IQ and performance IQ discrepancies at various magnitudes could not lateralize the seizure foci. Freedom of seizure was noted in 128 (62.4%) of the patients. Seizure outcomes, however, correlated with the preoperative FSIQ. After adjustment for variables that affect seizure outcomes, the FSIQ was an independent predictor of postoperative seizure outcomes (OR 1.04, 95% CI 1.01–1.06, p = 0.003). Of patients who had FSIQ lower than 70, 50% became free from seizures by 2 years after surgery.ConclusionsIn our study, IQ tests were unable to lateralize seizure foci but may serve as an independent predictor of postoperative seizure outcomes. Since a longer duration of epilepsy had deleterious effects on intelligence, earlier surgical intervention might better preserve neuropsychological function and, consequently, allow better seizure control after ATL. Nonetheless, patients with lower IQ scores could still benefit from ATL.     

Duchenne muscular dystrophy and epilepsy

Cognitive and behavioral difficulties occur in approximately a third of patients with Duchenne muscular dystrophy. The aim of our study was to assess the prevalence of epilepsy in a cohort of 222 DMD patients. Epileptic seizures were found in 14 of the 222 DMD patients (6.3%). The age of onset ranged from 3 months to 16 years (mean 7.8). Seizures were more often focal epilepsy (n = 6), generalized tonic–clonic seizures (n = 4) or absences (n = 4). They were present in 12 of the 149 boys with normal IQ (8.1%) and in two of the 73 with mental retardation (2.7%). In two cases the parents did not report any past or present history of seizures but only ‘staring episodes’ interpreted as a sign of ‘poor attention’. In both patients EEG showed the typical pattern observed in childhood absence epilepsy. Our results suggest that the prevalence of epilepsy in our study (6.3%) is higher than in the general pediatric population (0.5–1%). The risk of epilepsy does not appear to increase in patients with mental retardation.     

Efficacy of topiramate for intractable childhood generalized epilepsy with epileptic spasms: with special reference to electroencephalographic changes

PurposeEpileptic spasms (ES) beyond infancy are a highly refractory type of seizures that require the development of an effective treatment. We therefore studied the efficacy and safety of topiramate (TPM), which is a drug that is indicated to be effective for intractable childhood epilepsy, for ES.MethodsOut of 58 children with ES, we enrolled 33 patients treated with TPM at ≤12 years of age. The administration of TPM was limited to cases of epilepsies that were resistant to any other potent treatment. We retrospectively investigated the efficacy of TPM for seizures and changes in electroencephalogram (EEG) findings.ResultsThe median age at the start of TPM treatment was 5 years, 8 months. All patients had ES and 28 also had tonic seizures. As for the efficacy of TPM for all seizures, five patients became seizure-free and two had a ≥50% reduction in seizures. Seizure aggravation was observed in six patients. Of 29 patients whose EEG findings were compared before and during TPM treatment, nine showed EEG improvement with reduced epileptic discharges. Adverse effects were observed in 13 patients and included somnolence, anorexia, and irritability. In general, TPM was well tolerated.ConclusionsTPM can be effective at suppressing very intractable ES in a proportion of patients who do not respond to any other treatment. The efficacy of TPM may be predictable based on EEG changes observed early in the course of treatment. TPM is promising for the treatment of extremely intractable childhood epilepsy and it has largely tolerable adverse effects.     

Seizures during intracarotid methohexital and amobarbital testing

BackgroundMethohexital and amobarbital have been used as agents for Wada testing in the presurgical evaluation of patients with epilepsy. Previous experience with methohexital as an anesthetic indicates that methohexital may decrease seizure threshold and may trigger seizures.MethodsA retrospective chart review of 760 intracarotid amobarbital and methohexital tests was performed to determine the frequency of seizures associated with preoperative intracarotid barbiturate testing for language and memory lateralization.ResultsSixteen patients (2.1%) who had seizures were found. In 3 patients, seizures occurred prior to barbiturate injection, and in 13, following barbiturate injection. After injection of amobarbital, 4 of 538 patients (0.7%) had a seizure. Nine of 222 patients had a seizure after methohexital injection (4.1%) (P = 0.001).ConclusionPatients with a previous history of epilepsy may be at higher risk for seizures after methohexital injection as compared with amobarbital injection.     

Comparison between febrile and afebrile seizures associated with mild rotavirus gastroenteritis

PurposeWe aimed on identifying the differences of febrile and afebrile seizures associated with mild rotavirus gastroenteritis (RVGE) in the pediatric population.MethodMedical charts of pediatric patients who had been admitted between July 1999 and June 2011 due to RVGE were retrospectively reviewed. Subjects were ultimately divided into three groups; ‘no seizure’ (NS: patients without seizure), ‘febrile seizure’ (FS: patients with fever during seizure), ‘afebrile seizure’ (AFS: patients without fever during seizure). Comparisons between groups were carried out on demographic and clinical characteristics, laboratory test results, electroencephalogram findings, brain magnetic resonance imaging findings, antiepileptic treatment, and prognosis.ResultsAmong the 755 subjects who had been admitted due to mild rotavirus enteritis, 696 (90.3%) did not have any seizures, 17 (2.2%) had febrile seizures, 42 (5.5%) had afebrile seizures. The duration of gastrointestinal symptoms before the onset of seizures were significantly shorter in the FS group compared to the AFS group (1.3 ± 0.8 vs. 2.8 ± 1.0 days; p < 0.0001). A single seizure attack was significantly higher in the AFS group (3.0 ± 1.6 vs. 1.7 ± 1.0 episodes; p = 0.0003), and the frequency of seizures that were of focal type with or without secondary generalization were significantly higher in the AFS group (33.3% vs. 6.0%; p = 0.0139). All patients among the FS and AFS group had not received further antiepileptic treatment after discharge, and none developed epilepsy during follow up period.ConclusionDespite some differences in seizure characteristics, both febrile and afebrile seizures associated with mild RVGE were mostly benign with a favorable prognosis.     

Cognitive outcome after stereotactic amygdalohippocampectomy

PurposeWe sought to determine the neuropsychological outcome after stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy.MethodsThe article describes the cases of 31 patients who were evaluated using the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised prior to, and one year after, surgery.Key findingsPatients showed increases in their mean Full Scale, Verbal and Performance IQ scores of 4, 3 and 4 IQ points respectively (p < .05). 5 (17.2%), 4 (13.8%) and 4 (13.3%) patients improved in their Full-scale, Verbal and Performance IQ respectively. No significant changes were found in memory performance – with a mean increase of 1, 3 and 0 MQ points in Global, Verbal and Visual memory respectively (p < .05). Global memory improved in 3 (10.3%) patients, verbal memory in 1 (3.4%) and 1 patient (3.3%) showed deterioration in visual memory.SignificanceOur results provide evidence for unchanged memory in patients with MTLE after the procedure. No verbal memory deterioration was detected in any of our patients, while improvements were found in intellectual performance. The results suggest that stereotactic radiofrequency amygdalahippocampectomy could be superior to open surgery in terms of its neurocognitive outcomes. A larger randomised trial of these approaches is justified.     

Early-onset versus typical childhood absence epilepsy; clinical and electrographic characteristics

PurposeChildhood absence epilepsy (CAE) is characterized by absence attacks with stereotyped electrographic discharges. Epidemiologic data concerning early-onset CAE is scarce. We tried to specifically analyze the early-onset CAE and compare it with typical CAE.MethodsIn this retrospective study, all patients with a clinical diagnosis of CAE were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 to 2011. We considered the age of onset at four years or earlier as early-onset and above four years as typical CAE. Age, gender, age at seizure onset, seizure type(s), epilepsy risk factors, and EEG findings of all patients were registered routinely. Statistical analyses were performed using Chi square and Fisher's Exact tests.ResultsForty-six patients were diagnosed as having CAE. Sixteen patients (35%) had early-onset and 30 (65%) patients had typical CAE. Sex ratio (female to male) in early-onset was 7:9 and in typical CAE was 19:11 (P = 0.2). Generalized tonic-clonic and myoclonic seizures were reported in both early-onset and typical CAE. The differences were not statistically significant. Epilepsy risk factors were similarly reported in both conditions. The EEG findings were similar in both groups.ConclusionWe did not observe any significant differences between early-onset and typical childhood absence epilepsies with respect to the demographic, clinical and electroencephalographic characteristics.     

Maternal pre-eclampsia is associated with childhood epilepsy in South Carolina children insured by Medicaid

ObjectiveWe examined the association between maternal pre-eclampsia/eclampsia (PE) and childhood epilepsy.MethodsWe conducted a retrospective cohort study using linked maternal–child billing data for Medicaid births in South Carolina from 1996 through 2002, with follow-up billing data for children through December 2008. Women with PE (exposed) and children with epilepsy (outcome) were identified using ICD-9 codes. Non-singleton births, children with documented conditions known to cause abnormal brain development, and children who neither remained in Medicaid until age 6 nor were diagnosed with epilepsy were excluded.ResultsOf 95,450 mother–child pairs in the final cohort, 5460 mothers were diagnosed with PE (5.7%) and 1106 children had the outcome of epilepsy (1.2%). After controlling for potential confounders, PE was significantly associated with risk of epilepsy (OR = 1.46, 95% CI = 1.17–1.82). The increased risk of epilepsy was observed only among full-term infants, and for this subgroup, late PE (first diagnosed after 37 weeks of gestation) was significantly associated with epilepsy (OR = 1.61, 95% CI = 1.21–2.16). The association between PE and epilepsy was particularly strong for children with focal epilepsy.ConclusionPre-eclampsia is associated with childhood epilepsy. Additional research is needed to identify potential mechanisms for the association.