Partial Seizures In Children Research Articles

Etiological classification of seizures in pediatric age group (6-12years) – MRI study

Background: A seizure is an occurrence of signs or symptoms due to abnormal excessive orsynchronous neuronal activity in the brain. The present study aims to study the etiological factorsand clinical profile for new-onset seizures in children aged 6-12 years and to determine thefrequency of Magnetic resonance imaging (MRI) abnormalities in the pediatrics age group with new-onset unprovoked seizure and those with inadequately investigated longstanding epilepsy andclassify the etiology based on the MRI findings. Methods: A prospective study involving a total of 50patients was recruited aged between 6 to 12 years. All of them underwent neuro-imaging with MRI.Uncooperative patients were imaged following sedation and monitoring by the anesthetist. Allchildren aged 6-12 years who presented with new-onset seizures were included. All MR images wereobtained at a 3-mm section thickness except magnetization-prepared rapid gradient-echo images,which are obtained at a 1.8-mm section thickness. Results: Of the 50 patients 28 presented withgeneralized tonic-clonic seizures, 12 with simple partial seizures, 10 with complex partial seizures.Generalized seizures were a more common presentation than partial seizures in children 6-12 yearsof age. Conclusion: With the positivity of the MRI in the new-onset seizure in children between 6-12 years in our study gives an important aspect of the essential factor of imaging in pediatric new-onset seizures.

Clinico-Radiological Presentation of Angiocentric Neuroepithelial Tumor Associated with Pharmacoresistant Epilepsy: A Case Report

The World Health Organization (WHO) Classification of Central Nervous System describes several types of glioneuronal tumors, which are known to induce refractory partial seizures in children and adults [1]. The most frequent ones are Dysembryoplastic Neuroepithelial Tumors (DNETs) [2], gangliogliomas and oligodendrogliomas, but other types of complex glioneuronal lesions can be observed and are described as Low-Grade Epilepsy Associated Neuroepithelial Tumors (LEAT).

English

English

Study of partial seizures in children with respect to EEG and CT Scan

Introduction: Incidence of Seizure disorders is more in children compared to adults. Partial seizures are fairly common form of seizures in children. Methods: This study was carried to determine the etiology of partial seizures in children with the help of EEG and CT scan. In this study total of 80 children with partial seizures defined as per ILAE, belonging to 1- 12years of age group were studied retrospectively. Data was collected in the form of history, EEG report and CT scan brain report over a period of 2 years, from the hospital records. Results: EEG was abnormal in 92.5% and CT scan was abnormal in 85% of children with partial seizures. The most common type of partial seizure was complex partial seizure (58.75%). The most common CT scan abnormality was (75%) ring enhancing lesion. Conclusion: EEG and CT scan plays an important role in establishing etiology of partial seizures and thus serves as a tool for appropriate management.

Eslicarbazepine acetate as add-on therapy for partial seizures in children: an integrated evaluation

Eslicarbazepine acetate as add-on therapy for partial seizures in children: an integrated evaluation

A placebo-controlled trial of eslicarbazepine acetate add-on therapy for partial seizures in children

A placebo-controlled trial of eslicarbazepine acetate add-on therapy for partial seizures in children

Valproic acid use in pediatric partial epilepsy after initial medication failure

We retrospectively identified 46 children and adolescents with partial epilepsy, who failed prior treatment with phenytoin, carbamazepine, phenobarbital and/or primidone. All patients were subsequently treated with valproate (VPA). Outcome measurements were stratified into seizure type, simple partial seizures (SPS), complex partial seizures (CPS) or secondarily generalized seizures (SGS), or lesions detected by magnetic resonance images (MRI). The majority of the patients had a > 75% reduction of seizure frequency. Complete seizure freedom was achieved in 7 (15%) patients. “Worthwhile” seizure reduction, defined as > 75% decrease (but < 100%) in seizure activity, was found in 30 (65%) patients. VPA was efficacious in SPS (2/2), CPS (9/12) and SGS (26/32) patients. Patients with MRI lesions of vascular insult (6/6), mesial temporal lobe sclerosis (8/10), or malformation of cortical development (6/7) had a higher response percentage than those patients with normal MRI findings (11/15) and tumors (5/7). Although the numbers of patients used in this study were too small for statistical significance, our results suggest that VPA is a useful medication for previous medication failures in childhood partial seizures across seizure types as well as MRI lesions. There is some suggestion that a higher percentage of patients with MRI lesions may respond favorably to VPA than patients with non-lesional partial seizures and tumors. (J Pediatr Neurol 2004; 2(4): 199-203).

Progressive dysembryoplastic neuroepithelial tumour

Dysembryoplastic neuroepithelial tumour (DNET) is a benign tumour characterised by cortical location and presentation with drug resistant partial seizures in children. Recently the potential for malignant transformation has been reported, however progression without malignant transformation remains rare. We report a case of clinical and radiologic progression of a DNET in a girl 10years after initial biopsy.

Role of EEG and CT scan in partial seizures in children

Seizures disorders are the most prevalent serious neurological disease. Partial seizures are the most common form of seizures in children. This study was carried to determine the etiology and intracranial lesions in children with partial seizures with prospective study through the period of 5 years. One hundred and seventy two children with partial seizures (>2 attacks) were included in the study. All children had contrast CT scan of head and EEG. About 70% of children had their first episode of seizure before 6 years of age. The most common type of seizures was complex partial and the most common lesion on CT scan head was ring enhancing lesion (56.07%). For diagnosis of partial seizures detail history and CT scan head are essential. Key words: Partial seizures, neurocyticercosis, tuberculoma, CT scan.

Quality of life after surgery for intractable partial epilepsy in children: A cohort study with controls

Investigate if quality of life (QOL) normalizes on long-term follow-up after surgery for partial epilepsy in children. This is a cohort study with controls in which a consecutive cohort of nineteen 2-14-year-old children who underwent focal resections for intractable partial seizures between 1996 and 2006, were matched with 19 non-surgery intractable partial epilepsy patients, and with 19 healthy subjects. The two epilepsy groups were matched for age, sex, socio-economic status (SES), cognitive level, seizure type, and seizure frequency. The healthy group was matched with the two epilepsy groups for age, sex, SES, and cognitive level. QOL was assessed using the QOLCE (Quality of Life in Childhood Epilepsy Questionnaire). In the surgery group (follow-up 3.84+/-2.26 years), 78.9% had Engel class-I versus 21.1% in non-surgery (p=0.01) (follow-up 3.44+/-2.95 years). Surgery patients were similar to healthy subjects in the social, emotional, cognitive, behavioral, and overall QOL (p>0.05) but had lower scores in the total QOL, physical, and health domains (p<0.05). Surgery patients scored better than non-surgery in the behavioral domain and the HASES (Hague Side Effects Scale) score (p<0.05). Non-surgery patients scored worse than healthy in total QOL, physical, behavioral, health, and overall QOL (p<0.05). IQ, HASS (Hague Seizure Severity Scale), and HASES scores were positively associated with total QOL score (p<0.05). Subgroup analysis on seizure-free surgery patients showed that they did not differ from healthy subjects in any of QOL domains (p>0.05, power>0.8). Our data indicate that epilepsy surgery for partial seizures in children is associated with better QOL as compared to children with intractable epilepsy who are not operated on, and suggest that in those who achieve seizure freedom normal QOL may at least potentially be possible.

Acute oxcarbazepine overdose in an autistic boy

Oxcarbazepine (OXC), a 10-keto analogue of carbamazepine, is an antiepileptic drug licensed for the treatment of partial seizures in children and adults, as monotherapy or adjunctive therapy [1]. In humans, OXC is rapidly metabolized in liver to 10-monohydroxy-carbazepine (MHD), its active metabolite. MHD blocks voltage-sensitive sodium channels, stabilizing hyperexcited neuronal membranes, thereby inhibiting repetitive firing and decreasing the propagation of synaptic impulses [2]. Recently, successful use of OXC in the management of disruptive behaviours in autistic patients has also been reported [3].

A DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR IN THE AREA OF THE CAUDATE NUCLEUS IN A 57-YEAR-OLD WOMAN

Dysembryoplastic neuroepithelial tumors (DNTs) are clinicopathologically unique tumors. They are usually located within the supratentorial cortex, most often in the temporal lobe. These lesions are frequently associated with intractable complex partial seizures in children and young adults. DNTs may also arise outside of the cerebral cortex. We report a case of a 57-year-old woman who had a DNT in the caudate nucleus. During a 7-year follow-up period, the tumor did not recur. The literature on DNTs with atypical "ectopic" localizations is summarized. A patient presented with a 1-year history of headaches, nausea and vomiting, and progressive visual disturbances. Gross subtotal removal of the lesion was accomplished without further treatment. Unlike diffuse gliomas, such as oligodendrogliomas and central neurocytomas, DNTs are benign lesions with a favorable prognosis after surgical resection. Therefore, recognition of DNTs at atypical ectopic locations is essential for predicting the clinical course and for making the right therapeutic decisions.

Prognosis and Predictive Factors of Partial Seizures in Children

Our objective was to determine factors that influence the prognosis of cryptogenic partial seizures in children. In total, 233 patients were included in a hospital-based observational survey. Clinical characteristics of patients were reviewed and analyzed. Patients were characterized as having poor control of their seizures, or as having a > or = 50% decrease in their number of seizures. Student t test or Pearson's chi-square test were used to determine the differences between the groups with regard to clinical data. Multiple logistic regression analysis was used to investigate the independent effect of each risk factor. Complete seizure control was achieved in 71.7% of patients; improved seizure control was achieved in 13.3%; and poor seizure control was observed in 15.0%. Patients who had poor control of their seizures had a significantly younger age of onset (P = 0.03). In addition, chi-square analysis revealed that these patients had a higher seizure frequency (P < 0.001), and that seizure control was dependent on seizure type (P < 0.001). Multiple logistic regression analysis revealed that an initial seizure frequency of >3 per month (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.37-6.88), age of onset (OR, 1.14; 95% CI, 1.0-1.31), and seizure type (OR, 0.48; 95% CI, 0.22-1.01) were predictors of poor seizure control.

Response to Koutroumanidis

To the Editors: We appreciate the comments from Dr. Koutroumanidis about our article on autonomic symptoms (AS's) during partial seizures in children. Dr. Koutroumanidis raises some important questions, and we will try to address them briefly below. Regarding the predominant (most important) ictal manifestations seen in our population of children – Typical psychomotor or motor seizures were predominant. Autonomic symptoms occurred frequently, but were not the predominant feature of these seizures. Regarding the timing (early or late in the seizure sequence) of AS's – Most of the AS's appeared later in the seizures. Some of them were typically postictal (or occurred at the end of the ictal episode) – e.g., nose-wiping, vomiting, coughing, hiccupping. Other signs occurred within the ictal period, but late in the session – e.g., genital automatisms, flushing, pallor, hypersalivation. Only a few AS's appeared at an early stage – e.g., epigastric aura and apnea. In short, the occurrence of AS's in these children followed the typical adult pattern of late-appearing AS's, as cited by Dr. Koutroumanidis. Regarding the duration of seizures with and without AS's – The duration of the AS's was usually short and constituted a minor part of the seizure. We did not see any seizures with autonomic status epilepticus, and none of the seizures were characterized exclusively by AS's. Rather, the AS period appeared as part of the whole psychomotor or motor seizure attack. We did not measure the exact length of seizures (an enormous undertaking for 514 attacks), and therefore cannot compare statistically the length of seizures with and without AS's. Regarding signs typical of Panayiotopoulos syndrome (PS) – Loss of muscle tone or awareness, a typical sign of PS, was noted in our semiological seizure classification of “atonic seizure.” Only 4 of 514 seizures (<1%) contained atonic components, so loss of muscle tone was clearly not a characteristic symptom of this patient group. We believe that the differences of our seizure with AS's, as compared to the longer autonomic seizures of PS, result from our special patient population. In our study, all the children had focal, well-localized, therapy-resistant epilepsy – a group very much different from the idiopathic childhood epilepsy population.

Autonomic Symptoms during Childhood Partial Epileptic Seizures

To the Editors: I read with great interest the paper by Fogarasi and colleagues (Fogarasi et al., 2006) about autonomic symptoms and signs (AS/S) during partial epileptic seizures in 100 children with symptomatic focal epilepsies evaluated with video-EEG telemetry. It provides valuable information on an area we know too little about, and bridges the gap between symptomatic focal epilepsies in adults and idiopathic focal epilepsies of childhood, such as Panayiotopoulos syndrome (PS) (Ferrie et al., 2006) and others. Comparison of the relevant data would help understand not only if and how autonomic ictal semiology in symptomatic focal epilepsies may evolve with age, but also the relationship between symptomatic and idiopathic epileptogenesis in children. Data on adults come mainly from series of surgical candidates (Kramer et al., 1988; Devinski et al., 1995; Schauble et al., 2002). Here, ictal AS/S (mainly gastrointestinal, such as vomiting and hypersalivation) are rare, usually indicate involvement of the non-dominant temporal lobe, and tend to occur late in the seizure sequence during the phase of unresponsiveness of the complex partial seizure. On the other end, in idiopathic focal epileptogenesis with prominent autonomic seizures (PS) ictal AS/S occur as a rule early – frequently from onset – and in clear consciousness, and either persist as the sole ictal manifestations (purely autonomic seizures), or give way to more conventional seizure semeiology such as eye deviation, hemiconvulsions or rarely visual symptoms late in seizure sequence. Here seizures are prolonged and autonomic symptoms are usually multiple per seizure, with ictal vomiting occurring in up to 75% of children (Ferrie et al., 2006). Fogarasi and his colleagues report that at least one autonomic symptom was noted in 60 children (most with temporal lobe epilepsy); each child had no to three AS (median one), and only epigastric aura and postictal coughing (postictal symptoms were also included) localised to the temporal lobe; no AS/S lateralised the ictal onset zone. Interestingly, only 5 of the 60 children (8.3%) with AS/S during their seizures had vomiting, no child had both epigastric aura and vomiting, and papillary changes, cyanosis or pallor were either exceptional or were not observed at all. This paper describes information of extreme practical-clinical and theoretical significance. One can appreciate that a picture of ictal AS/S across different ages, syndromes and aetiologies is gradually coming into focus, and rightly one would like to learn more on autonomic semeiology in this – admittedly specific from the nosological aspect (all with medically intractable focal epilepsies) – group of children. The authors might wish to expand as much as this might be possible a posteriori on relevant points that are not easily deductible from the original paper. First, on the relative power and the timing of the AS/S within the ictal semeiology of the individual seizures, it is not clear whether AS/S were the quantitatively most predominant or clinically most important ictal manifestations in any of the children or they merely coexisted with conventional motor or sensory phenomena. It may also be interesting to know if AS/S and in particular ictal vomiting occurred early in the seizure sequence as in children with idiopathic autonomic seizures or late during the phase of unresponsiveness as in adults. Second, on seizure duration it would be interesting to know if focal seizures with autonomic symptoms lasted longer than those without and what was a typical length, and also whether the authors record or obtain historical evidence of partial status epilepticus with predominantly autonomic ymptoms. Third, did they observe or obtain historical evidence of episodes of sudden loss of muscle tone and awareness during the seizures, a phenomenon that has been reported (Ferrie et al., 2006) and recorded (Oguni et al., 1999) in children with PS.

The new ILAE Report on Classification and Evidence‐Based Commentary on Panayiotopoulos Syndrome and Autonomic Status Epilepticus

The new ILAE Report on Classification and Evidence‐Based Commentary on Panayiotopoulos Syndrome and Autonomic Status Epilepticus

Clinical Development of Antiepileptic Drugs for Children

A clinical development plan specific to children is a necessary component of every development plan for a new antiepileptic drug (AED). In the last decade, considerable discussion has occurred in the medical and regulatory communities, resulting in specific pediatric drug development legislation. Ethical issues are a foremost consideration in the design and conduct of studies. The timing of clinical studies differs between adults and children. In general, studies in children will not be performed until efficacy and safety has been demonstrated in adults. Exceptions include development of AEDs for seizure types seen only in children. Formulation preparation and dosing selection are often more challenging in children. Clinical trials including pharmacokinetic studies will be conducted in patients. A relatively small number of children, given subdivision into age groups and seizure types, are available for study. Clinical trials must be designed with children in mind, adjusting the length of the trials and the choice of controls. Efficacy extrapolation from adults may be considered for partial seizures in children, but not in infants. Seizure counts remain an appropriate efficacy endpoint; however, ascertainment in infants and younger children may require EEG monitoring. Safety specific to growing and developing children must be evaluated and long-term effects monitored.

Localizing and Lateralizing Value of Behavioral Change in Childhood Partial Seizures

To describe clinical characteristics as well as localizing and lateralizing value of behavioral change (BC) at the onset of childhood seizures. Five hundred forty-one videotaped seizures of 109 consecutive patients < or = 12 years with partial epilepsy and postoperatively seizure-free outcome were analyzed. Behavioral change (the first clinical feature of a certain seizure with a sudden change in the child's behavior) was evaluated by two independent investigators. Thirty-three (30%) patients showed BC at least once during their seizures. Behavioral changes appeared in arrestive form in 19 and with affective activities in 18 children; four patients produced both kinds of BCs, separately. Arrest-type BC happened in 16 of 50 children with right- and 3 of 59 patients with left-sided seizure onset zone (p < 0.001). Affective-type BC was observed in 17 of 67 temporal lobe epilepsy patients while it happened in only 1 of 42 children with extratemporal lobe epilepsy (p = 0.001). Arrest-type BC lateralizes to the right hemisphere, while affective-type BC localizes to the temporal lobe in childhood partial seizures. Type of BCs can add important information to the presurgical evaluation of young children with refractory partial epilepsy.

Randomized trial supports use of levetiracetam adjunctive therapy to treat partial seizures in children

Randomized trial supports use of levetiracetam adjunctive therapy to treat partial seizures in children

Lamotrigine Adjunctive Therapy Among Children and Adolescents With Primary Generalized Tonic-Clonic Seizures

Lamotrigine Adjunctive Therapy Among Children and Adolescents With Primary Generalized Tonic-Clonic Seizures