Abstract
Abstract *NaokoToyota, *KazuyoshiWatanabe, *TamikoNegoro, *AkihisaOkumura, *JunkoTakenaka, and *AyakoSofue *Department of Pediatrics, Nagoya University School of Medicine, Nagoya, Japan Purpose: Some patients clinically have complex partial seizures (CPSs) but their interictal EEGs demonstrate diffuse spike-and-wave discharges (D-SpW). They are often difficult to control with antiepileptic drugs (AEDs) usually considered to be the first choice for partial seizures. The aim of this study was to determine the effectiveness of drug therapy in such patients. Methods: Fourteen patients meeting the following criteria were selected for this study from among those who had been treated and followed-up for >2 years at Nagoya University Hospital: (a) The main seizure type was CPSs, defined as those characterized by a duration of ≥1 min, impaired consciousness, signs suggestive of partial seizures such as eye deviation, autonomic signs such as cyanosis, nausea, and/or emesis, and postictal sleep; (b) A short duration (<5 s) of D-SpW on interictal EEG. Patients who had absences were excluded. Results: Of the six male and eight female patients, none had any abnormal history around birth. Two had mild mental retardation, and one, moderate mental retardation and mild cerebral palsy. Eight patients had a history of febrile seizures. The age at onset of afebrile seizures ranged from 1 to 11 years. No patients exhibited abnormal findings in neuroimaging studies [computed tomography (CT) and/or magnetic resonance imaging (MRI)]. Nine patients had CPSs alone, one had simple partial seizures (SPSs) with CPSs, and four had secondarily generalized seizures (SGSs) with CPSs. Interictal EEG revealed D-SpW alone in nine patients, and D-SpW and focal spikes in five. We needed to change the drugs in nine patients because of a lack of a response to the initial therapy. The drug that was ineffective was carbamazepine (CBZ) in six patients, phenobarbital (PB) in three, phenytoin (PHT) in two, and clonazepam (CZP) in two. We controlled the seizures in 13 patients for >2 years with the abolition of D-SpW in eight. The effective drugs were valproate (VPA) in six patients, CZP in two, VPA+CZP in two, and PB, VPA+PB and PHT+PB in one each. The serum-level ranges of the effective drugs were 47.5–112.65 μg/ml for VPA, 9.2–19.0 ng/ml for CZP, 16.7–19.12 μg/ml for PB, and 13.3 μg/ml for PHT. Conclusions: In patients who exhibited CPSs and D-SpW on interictal EEG, the seizures were often refractory to antiepileptics, such as CBZ, that are usually indicated for CPSs, but were controlled with drugs, such as VPA, that are usually prescribed for generalized seizures. We should consider not only the type of seizures but also the types of paroxysmal abnormalities on interictal EEG for the treatment of epilepsy.
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