Minor Motor Seizures Research Articles

A Giant Calcified Subdural Empyema, a Complication of Ventriculo Peritoneal Shunt: Surgical Management and Revue of Literature

Subdural empyema is not a usual complication of ventriculo peritoneal shunt and the discovery of his calcified form is much exceptional in young adults. We report the case of a female patient of 17 years old carrying a shunt since 16 years who was received for retro auricular suppuration facing the intra ventricular drain and whom cerebral CT-Scan shows a right hemispheric calcified empyema. A large craniotomy was realized in the same time than an external ventricular drain. Evolution was marked by minor right body motor troubles and seizures. Difficulties we have faced during the management are a reminder about morbidity due to the insertion of a ventriculo peritoneal shunt and the need of and long term follow up for the carriers.

EFFICACY OF RUFINAMIDE IN THE TREATMENT OF DRUG-RESISTANT FOCAL EPILEPSIES IN PAEDIATRIC PRACTICE

Among drug-resistant epilepsies, epileptic syndromes, characterized by combination of several types of seizures, are considered to be the most difficult in terms of treatment. Lennox–Gastaut syndrome is one of them. It manifests with polymorphic seizures (tonic axial, myatonic, atypical absence seizures, status epilepticus of minor motor seizures, myoclonic, generalized convulsive, and focal seizures). This is a heterogeneous disease, represented by a complex of clinical and electroencephalographic manifestations with various etiology. Current review is devoted to a novel antiepileptic drug rufinamide, which has a new mechanism of action. The drug has been registered in Russia in 2015. The authors also describe their own experience of rufinamide usage in the treatment of drug-resistant focal epilepsy as a part of multicomponent therapy for polymorphic seizures. One patient achieved clinical remission for 16 months; the second one had more than 50 % decrease in seizures frequency with a remission of drop-attacks.

Clinical features of psychogenic nonepileptic seizures: A study of 64 cases in southwest China

This article describes the clinical features of psychogenic nonepileptic seizures (PNES) in people in southwest China. Patients with a confirmed diagnosis of pure PNES by video/EEG monitoring were retrospectively reviewed. A total of 64 patients with PNES were included, 32 (50%) of whom were male. Twenty (31.3%) patients had previously been misdiagnosed and treated for epilepsy. Psychological trauma and head injuries were considered antecedent traumatic factors. A history of abuse was rare. The PNES cases were divided into three subtypes: psychogenic minor motor seizures, psychogenic major motor seizures, and unresponsive seizures. Age at onset was identified as a predictor of prognosis. The results of this study demonstrated a higher prevalence of PNES in males compared with previous studies. The semiology of PNES in China is similar to that in Western countries. Classification of semiology may be helpful in the differential diagnosis of PNES.

Experiences with Bivotril in treatment of epilepsy--particularly minor motor epilepsy--in mentally retarded children.

The effectiveness of Rivotril® (Clonazepam, Ro 5-4023) when used either as the sole anti-convulsant or in combination with other drugs in institutionalised mentally retarded children with epilepsy is reported. The material comprised 37 children—19 girls and 18 boys—aged 4 to 19 years. Minor motor seizures—especially akinetic-myoclonic attacks—were seen in 34 children either alone or in combination with other epileptic seizures. In 3 children the only seizure type was grand mal attacks. A history of infantile spasms preceding the actual symptoms was found in 9 children. In 3 children Valium® and in 22 children Mogadon® was the first drug of choice. These drugs were discontinued on account of pronounced drowsiness and in 2 cases also hypersalivation. Electroencephalographic registrations were performed in 31 children, a petit mal variant pattern being found in 20 cases and an equivocal pattern in 6 cases. Rivotril was instituted in gradually increasing doses. The final satisfactory dose varied between 0.03 and 0.33 mg/kg/day. In 4 children the akinetic seizures apparently diminished in frequency, the remaining attacks, however, being more violent. In these cases 0.25–0.50 g Diamox® provided partial relief. A drug interaction with phenytoin apparently occurred in 7 children (19 per cent) such that the serum concentration of phenytoin exceeded 20 μg/ml and symptoms of intoxication appeared. Side effects such as drowsiness were seen in 5 children, vertigo and ataxia in 1, hypersalivation in 1, and muscular hypotonia in 2 children. These side effects were transitory in all but 1 case with drowsiness and the 2 cases with hypotonia. In the first-mentioned one the drug was completely discontinued. Rivotril was judged to increase the anti-convulsive effect to complete or clearly improved seizure control, i.e. more than 50 per cent control, in 29 children (78 per cent). In comparison with other benzodiazepines Rivotril is the best anti-convulsant available for minor seizures. This fact is mainly based on the finding of minimal side effects. The anticonvulsive response was probably somewhat better than or did not significantly differ from that for Mogadon.

Prenatal diagnosis of cerebral lesions in Tuberous sclerosis complex (TSC). Case report and review of the literature

Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous disorder with multi-organ involvement. The diagnosis is suspected at fetal ultrasound on the discovery of multiple cardiac rhabdomyomas (CRs). They typically develop in utero and undergo spontaneous regression during the first years of live. With developing neuroradiological methods more light is shed on antenatal cerebral lesions like cortical tubers or giant cell astrocytomas. Unfortunately these do not regress, but instead are in principle progressive in size and number, correlated with epilepsy, mental retardation and behavioral problems. It is unknown whether fetal cerebral lesions, are always correlated with a poor neurological outcome or a progressive course of disease. This makes prenatal counseling extremely difficult. We report one case of de novo TSC with first detection of cortical tubers on fetal ultrasound, later developing multiple CRs. The pregnancy was continued and the child is developing well during 16 months of follow-up. Minor motor seizures from the 10th month onwards are successfully treated with Valproate. The published cases with antenatal diagnosis of TSC are revised, trying to get more insight into the postnatal course of prenatally diagnosed TSC. This is crucial, either when termination of pregnancy (TOP) is considered, but even more for proper postnatal care and follow-up.

Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures.

To develop an objective classification of psychogenic nonepileptic seizures (NES) based on cluster analysis of clinical seizure semiology. We studied the clinical seizure semiology in 27 patients with psychogenic NES documented by prolonged video-EEG monitoring. We analyzed the following clinical symptoms: clonic and hypermotor movements as well as trembling of the upper and/or lower extremities, pelvic thrusting, head movements, tonic posturing backward of the head, and falling. We used cluster analysis to identify symptoms occurring together in a systematic way and thus tried to achieve a clinical classification of psychogenic NES. We could identify three symptom clusters. Cluster 1 was characterized by clonic and hypermotor movements of the extremities, pelvic thrusting, head movements, and tonic posturing of the head, and therefore was named "psychogenic motor seizures." Cluster 2 comprised trembling of the upper and lower extremities and was termed "psychogenic minor motor or trembling seizures." Cluster 3 consisted of falling to the floor as the only symptom and was referred to as "psychogenic atonic seizures." Our study represents the first study to analyze the clinical semiology of psychogenic NES by cluster analysis, which should be useful for an objective classification of psychogenic NES. This classification should allow both a better characterization of psychogenic NES and an easier differential diagnosis against specific epileptic seizures.

Reduction of seizure frequency with clomipramine in patients with complex partial seizures

Two patients with complex partial seizures who had been refractory to various antiepileptics were treated with clomipramine. The frequency of the seizures was reduced to 0–30% of the original levels. It has been reported that imipramine is effective in absence and minor motor seizures, and its antiepileptic effect is thought to be related to the inhibition of the presynaptic re-uptake of serotonin and norepinephrine. The basic effect of clomipramine is the same as that of imipramine except that the inhibitory action of clomipramine on serotonin re-uptake is 5- to 10-times more potent than that of imipramine. It is implied that clomipramine may be of use in the treatment of partial epilepsies.

Convulsions as a Possible Manifestation of Vitamin D Deficiency Rickets in Infants One to Six Months of Age

During the 42 months of January 1985 through June 1988, five infants between the ages of one and six months had hypocalcemic convulsions associated with vitamin D deficiency rickets. Despite abundant sunlight, convulsions as a manifestation of vitamin D deficiency in young infants are not uncommon in Saudi Arabia and should be considered as a probable cause for hypocalcemic seizure in breast fed infants.

Secondary generalized epilepsy in childhood: EEG patterns and correlation with responsiveness to benzodiazepines or ACTH (preliminary note)

Secondary generalized epilepsy in childhood, characterized by absences or minor motor seizures, occurs in the forms of various syndromes, as defined by current classifications. EEG often shows continuous or subcontinuous paroxysmal activity associated with partly reversible psychomotor or mental regression. The paroxysmal activity can exhibit one of two distinct patterns: "organized" or "disorganized," although intermediate forms are common. The two patterns differ not only morphologically but also in the responsiveness to drug or hormone therapy, reactivity to stimuli, sleep changes and frequency of disordered slow rhythms. These features are illustrated by means of a survey of 10 cases.

Intrathecal immunoglobulin production and minor motor seizures.

Five infants with idiopathic infantile minor motor seizures had an elevated immunoglobulin G (IgG) index ((cerebrospinal fluid IgG/serum IgG):(cerebrospinal fluid albumin/serum albumin)). The infants had prolonged prodromal symptoms, and bad prognosis. It is suggested that immunological mechanisms may contribute to the pathophysiology in certain cases of infantile spasms.

Antecedents of seizure disorders in early childhood.

One or more nonfebrile seizures occurred between the ages of 1 month and 7 years in eight per 1000 white and in nine per 1000 black children enrolled in a large prospective study. We examined hundreds of prenatal and perinatal factors as predictors of childhood seizure disorders. Congenital malformations of the fetus (cerebral and noncerebral), family history of certain neurologic disorders, and neonatal seizures were the major predictors identified. Forty percent of children with postneonatal seizures and 68% of children with minor motor seizures had one or more of these risk factors compared with 21% of the seizure-free population. More than half of the children with minor motor seizures and a third of the infants with neonatal seizures had congenital malformations. Based on the prenatal and perinatal factors examined, prediction of postneonatal seizures carried a high rate of false-positive identification, indicating that our knowledge of the etiology of childhood seizure disorders is still very limited.

Rett syndrome. A commonly overlooked progressive encephalopathy in girls.

We report 15 cases of Rett syndrome, a slowly progressive disorder that occurs only in girls and is characterized by early deterioration of higher brain function with dementia and autistic behavior, loss of purposeful use of the hands, and deceleration of head growth. Epilepsy, with minor motor seizures being the predominant type, has its onset between 2 and 4 years of age in the majority of cases. Additional features include an extrapyramidal disorder with dystonia and choreoathetosis, and lactic acidemia. A precise biochemical marker of this disorder has not been identified.

Combined myoclonic-astatic and "benign" focal epilepsy of childhood ("atypical benign partial epilepsy of childhood"). A separate syndrome?

The authors have followed six children with atypical epilepsies but a favorable evolution, consisting in minor motor seizures of the myoclonic-astatic type (with diffuse slow spike-waves on the electroencephalogram) together with clinical and EEG features seen in benign focal epilepsy of childhood (BFEC), an association recently reported by Aicardi and Chevrie (1982). The maintenance of a normal neurological function despite severe epilepsy, the absence of tonic seizures and the marked activation of the spike discharges during sleep were described by these authors as important characteristics suggesting a good prognosis. The purpose of this study was to see if these children indeed represent a particular subgroup of idiopathic epilepsy and to draw attention to a special clinical and EEG combination indicating a possibly favorable ultimate outcome, in children usually diagnosed as suffering from Lennox-Gastaut syndrome. The six cases closely resembled the group described by Aicardi and Chevrie (1982), although the clinical and EEG features of BFEC were not as striking as in their cases. Also transient mental deterioration occurred during the active seizure periods. The therapeutic benefit of the various drugs tried was difficult to assess, but the behavior was often perturbed by medication. Although it is not possible to decide at the present time if these cases represent a particular epileptic syndrome, the special combination of clinical and EEG features seems characteristic enough to justify prospective studies of similar cases in the future.

Neuropsychological abilities of children with epilepsy.

One hundred eighteen epileptic children, aged 6-15 years, underwent detailed neuropsychological testing including the Wechsler Intelligence Scale for Children-Revised and the age-appropriate Halstead-Reitan battery. Eight had classical absence seizures only, eight had classic absence seizures and generalized tonic-clonic seizures, 30 had generalized tonic-clonic seizures only, 31 had partial seizures only, 20 had partial seizures and generalized seizures, 15 had atypical absence seizures, and five had minor motor seizures. A control group of 100 children without seizures, matched to the general population for intelligence and matched to the seizure cases for age, underwent identical testing. The Wechsler full-scale intelligence quotient (FSIQ) of cases was significantly (p = 0.01) lower than that of controls and was related to seizure type. Children with minor motor or atypical absence seizures had the lowest average FSIQ (70 and 74, respectively). All seizure types were associated with below-control intelligence except classic absence only. Intelligence was also correlated with degree of seizure control. A highly significant inverse correlation between years with seizures and intelligence was found (p less than 0.0001). A rating of neuropsychological impairment, derived from all measures of brain function, was assigned to each child. Epileptic children had significantly more impairment than controls (p less than 0.0001). Children with seizures had been placed in special education or had repeated a grade in school almost twice as frequently as controls (p less than 0.001). Even though often placed in a class of younger children, their academic achievement was behind grade placement more often than in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Age at onset of seizures in young children.

Age at onset of seizures in young children and its relationship to factors such as prior neurological status and neurological outcome were examined. Of 52,360 children, 39,270 of whom were followed for the full 7 years, a total of 2,635 experienced one or more seizures between birth and 7 years of age. The incidence of nonfebrile convulsions was highest in the first year of life, especially in the first month. Children with neonatal seizures who later developed nonfebrile seizures did so early, two-thirds by 6 months and three-quarters by 1 year of age. Children with neurological or developmental abnormality assessed in the first year of life did not have their first seizure earlier than children without abnormality. Neurological abnormality in the first year of life before any seizure, and the presence of minor motor seizures, were associated with an increased rate of mental retardation and cerebral palsy at age 7, but early age at onset appeared to have little prognostic value regarding intellectual function, cerebral palsy, and epilepsy.

Myoclonic, atonic, and absence seizures following institution of carbamazepine therapy in children

Five children, aged 3 to 11 years, treated with carbamazepine for epilepsy, had an acute aberrant reaction characterized by the onset of myoclonic, atypical absence and/or atonic (minor motor) seizures within a few days. When the carbamazepine was discontinued, two of the children returned to their former state very quickly, two had the minor motor seizures resolve in 3 and 6 months, and one had the seizures persist. The child in whom the seizures persisted was later found to have ceroid lipofuscinosis. The other children are doing well on other anticonvulsants.

Four Cases with Minor Motor Seizures Following Bacterial Meningitis

Four Cases with Minor Motor Seizures Following Bacterial Meningitis

Valproate Sodium in Refractory Seizures

Sodium valproate (N-dipropylacetic acid) is a newly released anticonvulsant drug with a broad spectrum of activity. Twenty-seven children with uncontrolled seizures, predominantly akinetic and myoclonic, were treated with this drug. Encouraging results were noted in those with head-nodding spells, body drops, and myoclonic jerks ("minor motor" seizures). Side effects included occasional gastrointestinal disturbance. No important hepatotoxic complications were noted. Two persons displayed transient neurologic side effects. Of particular interest was the noticeable improvements in mental status noted in 17 of the 27 patients. Some variations in blood level of other anticonvulsant drugs were noted, emphasizing the importance of monitoring these drugs. Valproate sodium provides important improvement in our ability to manage minor motor seizures.

Nephrotic Syndrome Associated With Ethosuccimide

Ethosuccimide has been used since 1958 to treat convulsions. Three cases of lupus-like syndrome without renal involvement have been reported involving this drug.^1,2,3We describe a child in whom the nephrotic syndrome developed with hypocomplementemia, thrombocytopenia, and a positive Coombs' test in association with the administration of ethosuccimide and chlorazepate dipotassium. <i>Report of a Case</i>.—A six-year-old American-born Chinese girl was hospitalized after three days of periorbital edema, anorexia, vomiting, and general malaise. She had minor motor seizures for four years and at the time of admission was receiving ethosuccimide, 1,250 mg/day for 15 months and chlorazepate dipotassium, 15 mg/day for two weeks. Three weeks prior to admission diphenylhydantoin therapy, 150 mg/day, had been discontinued after one year. On admission vital signs were normal. She had proteinuria (4 +) (9.7 gm protein/24 hours), centrifuged urine showed six to seven WBCs, few RBCs and occasional granular casts per high powered field. Hemoglobin

The utility of clonazepam in epilepsy of various types. Observations with 22 childhood cases.

Clonazepam, a new anticonvulsant, appears to be useful for childhood minor motor seizures and for petit mal refractory to Ethosuximide and Trimethadione. It appears less effective in infantile spasms though may be beneficial when there is no response to steroids. It is variably effective in partial complex and focal epilepsy and may exacerbate tonic seizures. A transient disadvantage is the high incidence of side effects, especially lethargy and ataxia, though these may be transitory. Aggressivity and hyperkinesis may necessitate medication withdrawal. Some children who initially respond to therapy and then relapse may respond again to a higher dosage.