Efficacy and Safety of Methylphenidate in Children with Epilepsy and Attention Deficit Hyperactivity Disorder / 대한간질학회지

PURPOSE: Twenty percent or more of children with epilepsy may have attention deficit hyperactivity disorder (ADHD). The treatment of ADHD with epilepsy has been an important clinical issue. The aim of this study is to investigate the efficacy and safety of methylphenidate in children with epilepsy and ADHD. METHODS: The subjects were 38 children with ADHD accompanied by epilepsy diagnosed at Department of Pediatrics and Epilepsy Center, Sanggye Paik Hospital. They were examined with IQ testing and Conners scales at baseline before using methylphenidate, and follow-up study was repeated 1 year after methylphenidate. Efficacy was determined by Conners scales and IQ score results. Safety was determined by measuring changes in seizure frequency, and electroencephalographic findings. RESULTS: According to their parents and teachers' reports, methylphenidate improved ADHD symptoms in 24 children (63.2%). Three of them (7.9%) showed significant improvement in IQ scores and 7 children (18.4%) revealed significant improvement in cognitive function with rising IQ scores between 10 and 15 points. There were no worsening in seizure frequency, and electroencephalographic findings after methylphenidate. CONCLUSION: Methylphenidate is effective and safe treatment in children with epilepsy and ADHD, showing significant benefit on children's behavior and academic improvement in many cases.

The Cases of Surgical Treatment of Intractable Childhood Epilepsy with Tuberous Sclerosis

Tuberous sclerosis(TS) is a disorder of aberrant neuronal differentiation and proliferation manifesting as multiple central nervous system(CNS) hamartomas. Seizures in patients with TS are often intractable to anticonvulsant therapy. Although TS shows various lesions including multiple tubers, many patients with well localized epileptic focus to some tubers may have a benefit from epileptic surgery. We experienced three cases who had clinical improvement after epileptic surgery in intractable epilepsy complicated by TS. We report three cases and the brief review of literatures.

Lipid Profiles in Patient with Ketogenic Diet for Intractable Childhood Epilepsy / 대한간질학회지

PURPOSE: Ketogenic diet has been frequently used in the treatment of intractable childhood epilepsy since proven strong antiepileptic effects. Because of prolonged maintenance of high fat diet, long-term side effects of hyperlipidemia and atherosclerosis has been concerned, but there are no sufficient data revealing lipid profile from ketogenic diet. This study is intended to investigate the changes of lipid profiles in patients with ketogenic diet. METHODS: Sixty-six children (0.8-14.7 yrs, mean age 4.6+/-3.6 yrs, 33 males and 33 females) with intractable epilepsy treated with the classic (4:1) ketogenic diet were studied at Inje University Sang-gye Paik Hospital, from January 1997 to July 2001. Follow-up period was more than 1year (range:1-2 yrs). Cholesterol, HDL-cholesterol and Triglyceride (TG) concentrations were measured at 1 day, 7 days, 6 months, 12 months, 18 months and 24 months, and LDL-cholesterol concentrations were measured. RESULTS: 1) Total cholesterol concentrations were significantly increased from 7 days to 24 months after ketogenic diet than that before ketogenic diet (p<0.05). 2) HDL-cholesterol concentrations were not significantly changed for 2 years. 3) LDL-cholesterol concentrations were significantly increased at 6 months (119.9 mg/dL, p<0.05), and 24 months (128.0 mg/dL, p<0.05). 4) TG concentrations were significantly increased at 7 days (164.9 mg/dL, p<0.05), 6 months (209.7 mg/dL, p<0.01), and 12 months (192.0 mg/dL, p<0.01), and were normalized at 18 months, 24 months. CONCLUSION: Most of lipid profiles were significantly changed during ketogenic diet. Long-term complication for cardio-vascular diseases should be further investigated.

A Case of Suspected Autosomal Dominant Nocturnal Frontal Lobe Epilepsy

Autosomal dominant nocturnal frontal lobe epilepsy(ADNFLE) is a recently identified partial epilepsy. This disorder is characterized by a variable age of onset(mostly in childhood), autosomal dominant inheritance, clusters of brief frontal nocturnal seizures, negative findings on neuroimaging, and fairly good prognosis. Carbamazepine is known to be the most useful drug in this type of epilepsy. We experienced a case of 5-year-old boy who had unusual arousal and irritability every night for 3 years and had sharp & wave discharges from frontal lobe region in long-term video-EEG monitoring, who was suspected as an autosomal dominant nocturnal frontal lobe epilepsy. We report a case with a brief review of literatures.

Clinical and Electrophysiologic Characteristics of Malformation of Cortical Development with Childhood Epilepsy / 대한간질학회지

PURPOSE: To evaluate the clinical and electrophysiological characteristics of malformation of cortical development (MCD) with epilepsy. METHOD: We studied clinical and electroencephalographic (EEG) features of 54 childhood epilepsy patients with MCD diagnosed by magnetic resonance imaging (MRI) and pathologic examinations. RESULTS: 1) Bilateral diffuse MCD's were in 5 patients, bilateral focal MCD's were in 8, unilateral diffuse MCD's in 7, and unilateral focal MCD's were noted in 34 patients. 2) Partial seizures were manifested in 35 patients, and 4 of them evolve to infantile spasm (IS), isolated IS was noted in 15 cases, and generalized seizures were noticed in 2 cases 3) Asymmetric EEG backgraound slowing was noted in 30 patients, and 29 patients (96.7%) had MCD's in abnormal side of brain. 4) Polymorphic slowing was noted in 36 patients, and 28 cases (77.8%) had MCD's in those area. 5) Sensitivity of partial epileptiform discharges (ED's) for MCD was 79.6%, but specificity was 68.5%. 6) Localized paroxysmal fast activity was noted in 16 cases (29.6%), and specificity for MCD was 90.7%. 7) Spindle shaped fast activity was noted in 8 patients (14.8%), and its specificity was 100%. 8) Thirty-one cases (57.4%) were intractable to antiepileptic drugs (AED's). Seventeen cases of them were treated by ketogenic diet, and 12 patients (66.7%) were completely controlled. Among 12 cases of surgical resection, 11 patients (91.7%) became seizure free for 6 months to 2 years. 9) In pathologically confirmed cases, EEG sensitivity for MCD lesion was 100%, but sensitivity of MRI was 69.2%. CONCLUSION: EEG is most sensitive diagnostic tool for MCD in childhood epilepsy. and many of intractable epilepsy could be controlled by ketogenic diet and surgery.

Clinical Characteristics of Occipital Lobe Epilepsy in Children / 대한간질학회지

PURPOSE: To evaluate the differential clinical & electroencephalographic characteristics between benign childhood epilepsy with occipital paroxysm (BCEOP) and symptomatic occipital lobe epilepsy (SOLE). METHODS: Nine patients of BCEOP and seven patients of SOLE diagnosed at the department of pediatrics and epilepsy center in Inje University Sang-gye Paik Hospital from March 1992 to June 1998, were studied for the determination of differential characteristics between the two groups. Clinical features, EEG characteristics, MRI findings, associated conditions, and prognosis were investigated and compared between these groups. RESULT: 1) Male : female ratio was 1 : 2 in BCEOP and 1 : 2.5 in SOLE. 2) Seizure onset age was older in SOLE as compared with BCEOP. 3) There was no significant difference in seizure types between two groups. 4) Visual aura could be elicited in 5 patients (55.6%) in BCEOP, and 3 patients (42.9%) in SOLE. 5) Ictus emeticus was only noted in 4 patients (44.4%) of BCEOP. 6) Migraine was associated only in 3 patients of BCEOP. 7) Background EEG abnormality was more frequently associated in SOLE than BCEOP. 8) Seizure control was inefficient only in 3 patients (42.9%) of SOLE, and all patients with BCEOP were successfully treated with antiepileptic drugs. CONCLUSION: SOLE showed higher seizure onset age, less frequent association of ictus emeticus and migraine, more frequent background EEG abnormalities and more medical intractability to antiepileptic drugs than BCEOP.