History Of Febrile Convulsions Research Articles

Acute Seizure-Related Hospitalizations in Children with Newly Diagnosed Epilepsy

Hospitalizations due to breakthrough seizures were studied in children with newly diagnosed epilepsy to evaluate (1) risk factors associated with such admissions, in particular the withholding of medication and subtherapeutic dose of anticonvulsants, and (2) the impact of the unscheduled hospitalization on subsequent seizure outcome. We recruited patients aged less than 18 years with newly diagnosed epilepsy who presented to the pediatric department in Tuen Mun Hospital between January 2002 and December 2003. Patients with acute seizure-related hospitalization within 1 year after diagnosis were included as cases (n = 36); patients with no such hospitalization were included as controls (n = 86). Treatment effect was analyzed at the last follow-up visit before January 2005. Significant univariate association was observed between seizure-related hospitalization and age at seizure onset (OR = 0.91, 95% CI 0.84, 1), idiopathic epilepsy (OR = 0.35, 95% CI 0.15, 0.81), no antiepileptic drug (OR = 3.67, 95% CI 1.51, 8.18), and subtherapeutic doses of antiepileptic drug (OR = 9.9, 95% CI 2.2, 43.8). Independent risk factors of such hospitalizations were etiology of epilepsy, no antiepileptic drug, subtherapeutic dose of antiepileptic drug, and history of febrile convulsion. Sixty-four percent of the cohort was seizure-free. Acute seizure-related hospitalization was associated with less favorable outcome (OR = 3.79, 95% CI 1.48, 9.26).

Estudio descriptivo de la epilepsia infantil

To analyse the epidemiological characteristics and the relative distribution of the different types of epilepsy and epileptic syndromes in the childhood population.We reviewed the medical histories of 365 patients (192 males and 173 females) with epilepsy. Epidemiological and clinical data were collected, together with information from complementary examinations. The diagnostic criteria applied were those of the International League Against Epilepsy (ILAE).The mean age at diagnosis was 5.9 years and the mean follow-up time was 4.6 years. A personal and/or familial history of febrile convulsions was reported in 13.4% of cases and 23.5% had a history of epilepsy in the family. The aetiology was idiopathic in 166 cases (45.5%), cryptogenic in 106 (29%) and symptomatic in 93 (25.5%). Of the total number of patients, 52.9% reported having focal epilepsies, they were generalised in 43.6% and 3.5% had epilepsies with an undetermined localisation. In each age group the most common epileptic syndromes were: in infants, West's syndrome (34.1%) and symptomatic focal epilepsies (24.4%); in preschoolers, idiopathic focal (21.3%) or cryptogenic (17.7%) and myoclonic-astatic epilepsies (12.8%); in school-age children, idiopathic focal epilepsies (27.3%) and absences (24.5%); and in teenagers, cryptogenic (26.6%) and idiopathic focal epilepsies (23.4%).The initial distinction between epileptic syndromes is usually difficult to establish and developmental monitoring is essential for reaching a definitive diagnosis and a classification of their syndromes. Age appears to be a determining factor in the clinical expression of the different types of childhood epilepsy, and the relative distribution of the epileptic syndromes is different in each age group.

Relationship between bilateral temporal hypometabolism and EEG findings for mesial temporal lobe epilepsy: Analysis of 18F-FDG PET using SPM

To investigate the clinical significance of bilateral temporal hypometabolism (BTH) for patients with mesial temporal lobe epilepsy (MTLE) by using statistical parametric mapping (SPM). Interictal 18F-FDG PET scans were performed for 29 patients with surgically treated MTLE. Clinical data, interictal epileptiform discharges (IEDs), ictal scalp EEG and intracarotid amobarbital test (IAT) were analyzed. To assess an 18F-FDG PET image, an SPM analysis as well as visual interpretation were applied. In 9 of 29 patients, the 18F-FDG PET scan revealed BTH by the SPM analysis, while only 3 patients showed BTH by the visual assessment. When the patients were classified into the unilateral temporal hypometabolism (UTH) and BTH groups based on the SPM results, bitemporal IEDs occurred significantly more frequently in the BTH group than in the UTH group (66.7% versus 22.2%). Bilateral independent seizure onset seen on the scalp EEG and bitemporal epilepsy were present only in the BTH group. Lateralized ictal onset was present less frequently in the BTH group than in the UTH group (44.4% versus 83.3%). There was no statistically significant difference in age at onset, duration of epilepsy, generalized seizure, history of febrile convulsion and CNS infection, lateralization throughout the whole tracing, lateralization on the IAT test, and surgical outcome between the UTH and BTH groups. Bilaterality of the EEG findings correlated with BTH on 18F-FDG PET by the SPM method. Our results suggest that analysis of 18F-FDG PET by using SPM may have a role in predicting those patients with bitemporal excitability or bitemporal independent epileptogenicity, and these patients should be monitored carefully.

FEBRILE SEIZURE: RECURRENCE AND RISK FACTORS

Background: Febrile Convulsion is the most common convulsive disorder in children, occurring in 2 to 4% of the pediatric population and recurring in 30- 50% of cases. Considering the varying recurrence rates reported, this study was conducted at the pediatric ward of the Shaheed Beheshti General Hospital, between 2000-2001 to determine the frequency of recurrence and related risk factors in children presenting with their first episode of febrile convulsion Materials & Methods: A two-year cohort study was performed on 50 children presenting with the first attack of febrile convulsion. Patient demographic data including age, sex, type and duration of seizure, family history of febrile seizure or epilepsy and the interval between fever onset and occurrence of seizure were recorded in questionnaires. Those patients, for whom prophylactic medication was not administered, were followed at three-month intervals for up to one year. Findings were statistically analyzed using Fisher's exact test. Results: Recurrence was observed in twelve children (24%) out of the fifty, being most common in patients aged than one year (54.4%). Recurrence rates among children with a positive family history of febrile convulsion, presence of complex febrile seizure and positive family history of epilepsy were 42.1%, 42.8% and 25% respectively. From among those children with a less than one interval between fever onset and occurrence of seizure, recurrence occurred in 43-7% of cases, while in those with a more than one hour interval, 14.7% experienced recurrence. Conclusion: Recurrence rates are increased by certain factors including age-below one year-, positive family history of febrile convulsion, and a less than one interval between time of fever onset and seizure occurrence. Keywords: Febrile Seizure, Recurrence, Risk Factors

Value of non-invasive testing when there are independent bitemporal seizures in the scalp EEG

We investigated the value of non-invasive data for predicting the outcome of intracranial EEG and anterior temporal lobectomy (ATL) (follow-up > 1 year) in patients who have bitemporal independent seizures in the scalp EEG. No previous report has dealt with this patient group. Independent variables were duration of epilepsy, febrile seizures, interictal and ictal scalp EEG, ictal behavior, MRI, [18F]-fluorodeoxyglucose–PET (PET) and Wada test and dependent variables were surgical outcome (seizure free or not) and localized on intracranial EEG (finding all symptomatic seizures from one temporal lobe). Non-parametric statistics were used. Of 24 patients, 20 patients had IEEG, of which 12 were localized and 8 were not. Sixteen patients had ATL and, of these, 13 (81%) became seizure free and the remaining three improved. Lateralized findings on MRI and PET, a history of febrile convulsions and shorter duration of epilepsy were all associated with a focal onset on intracranial EEG, while there was a non-significant trend with ictal behavior. The non-invasive data did not predict surgical outcome. We conclude that some of these patients can do well with surgery. In most cases, intracranial EEG is necessary for localization of seizure focus, but if PET and MRI show focal abnormalities and there is a history of febrile convulsions no further evaluation could be needed. These findings need confirmation.

Sleep-related hyperkinetic seizures: always a frontal onset?

Hyperkinetic seizures are considered a typical manifestation of nocturnal frontal lobe epilepsy (NFLE). Patients with temporal lobe epilepsy with mainly sleep-related seizures have been described; however they commonly lack hyperkinetic activity and seizure frequency is low. We retrospectively analysed our population of 442 consecutive patients surgically treated between January 1996 and January 2004. Among these there were 25 patients with sleep-related hyperkinetic epileptic seizures, with a frontal lobe onset in 18 cases and a temporal lobe onset in 7. Patients with sleep-related hyperkinetic seizures with temporal lobe origin had anamnestic and clinical features strikingly similar to those with a frontal onset, with agitated movements, high seizure frequency and no history of febrile convulsions. We confirm our previous findings that this kind of epileptic manifestation is not only peculiar to frontal lobe epilepsy.

Childhood Absence Epilepsy: Evolution and Prognostic Factors

To evaluate how diagnostic criteria influence remission rates for patients with childhood absence epilepsy (CAE) and to assess clinical and EEG parameters as predictors of outcome. One hundred nineteen patients were diagnosed with CAE, according to International League Against Epilepsy (ILAE) classification criteria. They were subsequently evaluated according to stricter diagnostic criteria. Sixty-two subjects fulfilled these criteria as group 2; 57 did not and constituted group 1. Diagnostic parameters that prevented patients of group 1 from entering group 2, and variables such as sex, familial history of generalized epilepsy, and personal history of febrile convulsions also were tested as prognostic factors for terminal remission. Compared with those in group 1, patients of group 2 had significantly higher rates of seizure control (95% vs. 77%), higher rates of terminal remission (82% vs. 51%), fewer generalized tonic-clonic seizures (8% vs. 30%), and shorter mean periods of treatment (2.2 vs. 3.8 years). Significantly fewer patients were receiving polytherapy in group 2 than in group 1 (11% vs. 47%), and fewer patients had seizure relapses at antiepileptic drug discontinuation (0 vs. 22%). Remission rates of patients with CAE are greatly influenced by the classification criteria used for selection. Stricter diagnostic criteria allow the definition of a homogeneous group of patients with excellent prognosis. Factors predicting unfavorable prognosis were generalized tonic-clonic seizures in the active stage of absences, myoclonic jerks, eyelid myoclonia or perioral myoclonia, and EEG features atypical for CAE.

Predicting seizure frequency after epilepsy surgery

Objective To identify clinical features related to seizure frequency after epilepsy surgery in patients with recurrent seizures. Background No studies have examined the differences between patients who have rare seizures and patients who experience frequent seizures after epilepsy surgery. Since seizure frequency correlates with morbidity and quality of life, it is desirable to know which preoperative clinical features predict postoperative seizure frequency. Methods Patients with recurrent seizures were placed in two categories: rare postoperative seizures (≤2 per year) and frequent postoperative seizures (≥12 per year) using seizure frequency in the second postoperative year. Variables included preoperative seizure frequency, age of first risk, age at first seizure, epilepsy duration, age at surgery, history of febrile convulsions, tonic-clonic seizures, status epilepticus, or family history, IQ, magnetic resonance imaging (MRI), and positron emission tomography (PET). Variables were analyzed using non-parametric tests to assess relationship to postoperative seizure frequency. Results Of 475 patients who had epilepsy surgery, 111 had rare or frequent seizures in the second postoperative year. After anterior temporal lobectomy (ATL), age of first risk ≤ 5 years and presence of mesial temporal sclerosis on MRI were associated with rare seizures (66% of patients), whereas lack of these risk factors was associated with frequent seizures (75% of patients) ( p < 0.03). For non-ATL operations, preoperative seizure frequency of ≥20 seizures per month was associated with frequent postoperative seizures ( p = 0.03). No other variables influenced outcome. Conclusions Some preoperative clinical features correlate with postoperative seizure frequency in patients with recurrent seizures after epilepsy surgery. This has implications for the surgical decision making process and early postoperative management.

Progression in temporal lobe epilepsy

To determine the relationship between hippocampal, amygdalar, and entorhinal cortex atrophy and duration of epilepsy, presence of secondary generalized seizures, and prolonged childhood febrile convulsions in patients with pharmacologically intractable temporal lobe epilepsy (TLE). Volumetric MRI of the hippocampus, amygdala, and entorhinal cortex were performed in 86 consecutive patients with TLE and 44 age- and sex-matched healthy control subjects. Linear regression analysis was used to explore the relation between the volumetric measurements and the clinical parameters. In simple regressions, duration of epilepsy but not age at seizure onset was related to hippocampal (r2 = 0.19, p < 0.001), entorhinal cortex (r2 = 0.11, p = 0.002), and amygdalar (r2 = 0.15, p < 0.001) atrophy ipsilateral to the seizure focus. Prediction of the regression function to time of onset of recurrent seizures (time = 0) resulted in a y intercept of < 0 for the hippocampus and the entorhinal cortex but was not different from 0 for the amygdala. Patients with a positive history of febrile convulsions had smaller hippocampal volumes ipsilateral to the seizure (p < 0.001). No relationship was found between febrile convulsions and entorhinal cortex and amygdalar volumes or between secondary generalization of seizures and any mesial temporal volume. Progressive volume loss in the mesial temporal lobe in relation to duration of epilepsy is not limited to the hippocampus but affects the entorhinal cortex and the amygdala.

MRI-negative Temporal Lobe Epilepsy: Is there a Role for PET?

MRI-negative PET-positive Temporal Lobe Epilepsy: A Distinct Surgically Remediable Syndrome Carne RP, O'Brien TJ, Kilpatrick CJ, MacGregor LR, Hicks RJ, Murphy MA, Bowden SC, Kaye AH, Cook MJ Brain 2004;127:2276–2285 Most patients with nonlesional temporal lobe epilepsy (NLTLE) will have the findings of hippocampal sclerosis (HS) on a high-resolution MRI. However, a significant minority of patients with NLTLE and electroclinically well-lateralized temporal lobe seizures have no evidence of HS on MRI. Many of these patients have concordant hypometabolism on fluorodeoxyglucose-PET ([18F]FDG-PET). The pathophysiologic basis of this latter group remains uncertain. We aimed to determine whether NLTLE without HS on MRI represents a variant of or a different clinicopathologic syndrome from that of NLTLE with HS on MRI. The clinical, EEG, [18F]FDG-PET, histopathologic, and surgical outcomes of 30 consecutive NLTLE patients with well-lateralized EEG but without HS on MRI (HS–ve TLE) were compared with 30 consecutive age- and sex-matched NLTLE patients with well-lateralized EEG with HS on MRI (HS+ve TLE). Both the HS+ve TLE group and the HS–ve TLE patients had a high degree of [18F]FDG-PET concordant lateralization (26 of 30 HS–ve TLE vs. 27 of 27 HS+ve TLE). HS–ve TLE patients had more widespread hypometabolism on [18F]FDG-PET by blinded visual analysis [odds ratio (OR,+∞(2.51,–); P = 0.001]. The HS–ve TLE group less frequently had a history of febrile convulsions [OR,0.077 (0.002 to 0.512), P = 0.002], more commonly had a delta rhythm at ictal onset [OR,3.67 (0.97 to 20.47); P = 0.057], and less frequently had histopathologic evidence of HS [OR,0 (0 to 0.85); P = 0.031]. No significant difference in surgical outcome despite half of those without HS having a hippocampal-sparing procedure. Based on the findings outlined, HS–ve PET-positive TLE may be a surgically remediable syndrome distinct from HS+ve TLE, with a pathophysiologic basis that primarily involves lateral temporal neocortical rather than mesial temporal structures.

Free Communications: Psychiatric Problems

Free Communications: Psychiatric Problems

An Interesting Case Of Epilepsy

A CASE OF EPILEPSY MS. M. R. is a 20 years old, single, five grade educated referred with aggression, irritability, escaping from home and suicidal though. The Wechsler intelligence score was 80. She was a case of Bipolar Mood Disorder. The patient was a known case of epilepsy with pattern of tonic-clonic seizures which started from about 13th years old. The onset was concomitant with onset of menstruations. The seizure attacks repeated only during 2 to 3 days before menstruation and occurred 7 to 8 times in each period. The attack disappeared about 12 hours before each menstruation. There was not any other attach between the menstruations. The interval of the menstruations was 20 days and it was fixed with alternation. There was a positive history of febrile convulsion in 3 years old. Then the episodes of staring and lip smacking appeared that last for about 30 seconds. She took Phenobarbital from 3 years old to 13 years old. Then it was changed to carbamazepine, which was stopped after drug eruption. Topamax and sodium valporate started. There was not any positive finding in neurological examination and Para-clinic laboratory findings. These medications never changed the frequency and pattern of the seizure. Consent form for publication was taken.

MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome.

Most patients with non-lesional temporal lobe epilepsy (NLTLE) will have the findings of hippocampal sclerosis (HS) on a high resolution MRI. However, a significant minority of patients with NLTLE and electroclinically well-lateralized temporal lobe seizures have no evidence of HS on MRI. Many of these patients have concordant hypometabolism on fluorodeoxyglucose-PET ([18F]FDG-PET). The pathophysiological basis of this latter group remains uncertain. We aimed to determine whether NLTLE without HS on MRI represents a variant of or a different clinicopathological syndrome from that of NLTLE with HS on MRI. The clinical, EEG, [18F]FDG-PET, histopathological and surgical outcomes of 30 consecutive NLTLE patients with well-lateralized EEG but without HS on MRI (HS-ve TLE) were compared with 30 consecutive age- and sex-matched NLTLE patients with well-lateralized EEG with HS on MRI (HS+ve TLE). Both the HS+ve TLE group and the HS-ve TLE patients had a high degree of [18F]FDG-PET concordant lateralization (26 out of 30 HS-ve TLE versus 27 out of 27 HS+ve TLE). HS-ve TLE patients had more widespread hypometabolism on [18F]FDG-PET by blinded visual analysis [odds ratio (OR = + infinity (2.51, -), P = 0.001]. The HS-ve TLE group less frequently had a history of febrile convulsions [OR = 0.077 (0.002-0.512), P = 0.002], more commonly had a delta rhythm at ictal onset [OR = 3.67 (0.97-20.47), P = 0.057], and less frequently had histopathological evidence of HS [OR = 0 (0-0.85), P = 0.031]. There was no significant difference in surgical outcome despite half of those without HS having a hippocampal-sparing procedure. Based on the findings outlined, HS-ve PET-positive TLE may be a surgically remediable syndrome distinct from HS+ve TLE, with a pathophysiological basis that primarily involves lateral temporal neocortical rather than mesial temporal structures.

Psychiatric adverse events during levetiracetam therapy

The prevalence and psychopathologic features of psychiatric adverse events (PAE) in 517 patients taking levetiracetam (LEV) were investigated. Fifty-three (10.1%) patients developed PAE. A significant association was found with previous psychiatric history, history of febrile convulsions, and history of status epilepticus, whereas lamotrigine co-therapy had a protective effect. PAE were not related to the titration schedule of LEV, and certain patients seem to be biologically more vulnerable.

Dysplasia: a common finding in intractable pediatric temporal lobe epilepsy.

Risk factors for temporal lobe epilepsy (TLE) include history of CNS infection, family history of epilepsy, and history of febrile convulsions (FC). Pre-existing cortical dysplasia (CD) may also predispose to refractory TLE, independent of other risk factors for epilepsy. The authors reviewed the neuropathologic features of surgical tissue from temporal lobectomies of 33 pediatric patients with refractory TLE, with and without a history of epilepsy risk factors. CD was found in 64% (21/33) of all patients with refractory TLE, including 73% (11/15) patients with a history of FC, 66% (2/3) patients with CNS infections, and 83% (5/6) patients with a family history of epilepsy. Disrupted cortical lamination, dystrophic and maloriented neurons, and balloon cells characterized the CD found in the temporal neocortex. CD was seen in 21 of 33 surgical specimens from children with refractory TLE, including those with and without other epilepsy risk factors.

Benign childhood epilepsy with centrotemporal spikes: a study of 50 Chinese children

In order to collect local data for children with Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS), we conducted a retrospective study of 50 Chinese children (32 males and 18 females) with BECTS diagnosed in two regional hospitals in Hong Kong from 1995 to 1998. Their peak age of onset was 7 years (range 3–13 years) and a male predominance was observed. Seven patients (14%) had a past history of febrile convulsions and five cases (10%) had a family history of epilepsy. The presentation was protean, but most of them had infrequent, short, nocturnal generalised seizures. The EEG spike foci were most frequently found in mid-temporal regions, followed by centrotemporal regions. Fourteen percent of children did not require anti-epileptic drug treatment. For those who were treated, they were easily controlled on a low dose of carbamazepine (median dosage of 12.75 mg/kg per day) or sodium valproate (median dosage of 20 mg/kg per day). Our study suggested a generally good prognosis for BECTS. No risk factors of frequent seizure recurrence could be identified.

Clinical features and surgical outcome of medial temporal lobe epilepsy with a history of complex febrile convulsions

Purpose: Temporal lobe epilepsy (TLE) is frequently associated with hippocampal sclerosis (HS) and complex febrile convulsions (CFC). The causal relationship between TLE, HS, and CFC is unclear. There is also contradictory data whether CFC-associated TLE is a distinct epilepsy syndrome and has different surgical outcome than other medial TLEs. Methods: We investigated 133 patients (aged 16–59 years) with HS-associated TLE. Thirty-six patients with CFC (CFC group) versus 97 patients without febrile convulsions (NFC group) were compared for clinical history, video-EEG recorded seizure semiology, and surgical outcome. Results: In the CFC group the right-sided HS (67% versus 32%) occurred more frequently than in the NFC group ( P<0.001). The two groups did not differ according to the clinical features, both groups share the typical symptoms and findings of the medial TLE. In the CFC group, seizure-freedom 2 years after surgery was 91%, while in the NFC group it was only 64% ( P=0.023). This difference was significant even after considering the other known predictive factors for medial TLE. Conclusions: Medial TLE with CFC is not a distinct epilepsy syndrome. The surgical outcome, however, is much more favorable in these patients in comparison with medial TLE patients who had no history of febrile convulsions.

Topiramate and psychiatric adverse events in patients with epilepsy.

The aim of this study was to determine the prevalence of psychiatric adverse events (PAEs) in patients with epilepsy treated with topiramate (TPM). Classification, relation to TPM dosing, and outcome were evaluated to identify a patient profile at risk of developing PAEs. We evaluated the data of the first consecutive and prospectively collected patients in therapy with TPM. Follow-up information was available for 431 patients. PAEs occurred in 103 (23.9%) patients; M/F ratio, 55:48; mean age (+/-SD), 36.5 +/- 11.2. In 46 (10.7%) patients, an affective disorder developed; in 16 (3.7%), a psychotic disorder; in 24 (5.6%), aggressive behavior with or without irritability; in 17 (3.9%), other behavior abnormalities such as agitated behavior, anger/hostility behavior, or anxiety. High starting dose and rapid titration schedule were relevant for the development of PAEs. Family psychiatric history and family history of epilepsy, personal history of febrile convulsions, psychiatric history, and presence of tonic-atonic seizures were found to be significant risk factors. Low seizure frequency before starting TPM and TPM/lamotrigine coadministration had a protective effect for PAEs. We found that PAEs associated with TPM were related to the titration schedule of the drug and that a unique patient profile is suggested by the clinical history.

Right hippocampal sclerosis is more common than left after febrile seizures

Temporal lobe epilepsy (TLE) is frequently associated with hippocampal sclerosis (HS) and a history of febrile convulsions (HFC). The authors investigated 292 patients with TLE due to HS. Left HS occurred more frequently (57%) than right HS (43%, p = 0.01). Forty-seven percent of the patients had HFC. In patients with right HS, HFC occurred in 59.6%, whereas in patients with left HS, HFC was present in 37.5%, showing a highly significant lateralization difference.

Risk factors for childhood epilepsy: a case-control study from Irbid, Jordan

Objective: The goal of this case-control study is to identify the significance of certain risk factors for epilepsy in a population of epileptic children in Northern Jordan. The risk factors examined are febrile convulsions, head trauma, central nervous system infections, abnormal perinatal history, family history and parental consanguinity. Methodology: We designed a case-control study for patients attending the outpatient neurology clinic of Princess Rahma Teaching Hospital in Irbid, Jordan during a 7-month period. Controls were selected, matched for age and sex, from a group of non-epileptic patients attending the general paediatrics outpatient clinic in the same hospital and during the same period. Data about the investigated risk factors were obtained by personal interview and review of the medical records and were analysed statistically for significance. Results: The total number of participants was 200 patients and controls each. History of febrile convulsions, head trauma, abnormal perinatal history and family history showed a statistically significant increase risk for developing epilepsy. Central nervous system infections and parental consanguinity did not add to the risk of developing epilepsy. Conclusion: Positive family history for epilepsy, head trauma, febrile convulsions and abnormal perinatal history were shown to have a statistically significant association with epilepsy in patients attending Princess Rahma Teaching Hospital in Northern Jordan. Although consanguinity is widely practised in Jordan, it appears that it does not increase the risk of epilepsy probably due to the small contribution of monogenic recessive epilepsies to the population with epilepsy.