ABSTRACT
Atonic seizure shows characteristic features such as head drop because postural muscle tone is suddenly lost. Atonia of the seizure means no muscle tone and loss of electromyographic activities were reported. We report a left parietal lobe epilepsy patient with atonic seizure showing hypotonia on electromyography. A 27 year-old woman had intractable head drop seizures since 6 years old. Her brain MRI demonstrated cortical dysplasia in the left parietal lobe. During the video-EEG monitoring, she had 21 epileptic seizures which were atonic seizures. During her atonic seizures, simultaneous EMG recordings showed decreased muscle activities during the head drop attacks, instead of no muscle tone. This is the first case showing transient hypotonia during the atonic seizure, instead of atonia.
Subject(s)
Female , Humans , Brain , Electromyography , Epilepsy , Head , Malformations of Cortical Development , Muscle Hypotonia , Muscles , Parietal Lobe , Seizures , SyncopeABSTRACT
Atonic seizure shows characteristic features such as head drop because postural muscle tone is suddenly lost. Atonia of the seizure means no muscle tone and loss of electromyographic activities were reported. We report a left parietal lobe epilepsy patient with atonic seizure showing hypotonia on electromyography. A 27 year-old woman had intractable head drop seizures since 6 years old. Her brain MRI demonstrated cortical dysplasia in the left parietal lobe. During the video-EEG monitoring, she had 21 epileptic seizures which were atonic seizures. During her atonic seizures, simultaneous EMG recordings showed decreased muscle activities during the head drop attacks, instead of no muscle tone. This is the first case showing transient hypotonia during the atonic seizure, instead of atonia.
Subject(s)
Female , Humans , Brain , Electromyography , Epilepsy , Head , Malformations of Cortical Development , Muscle Hypotonia , Muscles , Parietal Lobe , Seizures , SyncopeABSTRACT
Atonic seizures exhibits loss of postural tone, resulting in head drops or falling. When this event is extremely brief, It has been known as a drop attack. Atonic seizure are firmly placed under the category of generalized seizures. However, a various phenomena satisfying the above description has been recognized in patients with partial seizures. A 13-year-old girl had brief episodes of drop attacks. She complained of weakness of both legs in the absence of consciousness loss. These episodes occurred at a frequency of 4 or 5 time per day for 1 year. Her developmental and physical examinations were normal. Also, the brain MRI was normal. However, her Interictal EEG showed the repetitive spike and wave complexes on C(z) electrode. She was controlled completedly by antiepileptic drungs. We report a patient who suffered from focal atonic seizures characterized by drop attack.
Subject(s)
Adolescent , Female , Humans , Brain , Consciousness , Electrodes , Electroencephalography , Head , Leg , Magnetic Resonance Imaging , Physical Examination , Seizures , SyncopeABSTRACT
PURPOSE: In the pediatric patients who have medically intractable epilepsy the callosotomy is useful to prevent the propagation of seizure from one hemisphere to the other. The indications of callosotomy are drop attack, life threatening primarily or secondarily generalized seizure, medically refractory mixed seizure types such as Lennox-Gastaut syndrome. In addition, the retarded children are not contraindicated. The anterior callosotomy is used to perform to control medically intractable epilepsy which is believed to have some advantages to total callosotomy. But, we propose that the anterior callosotomy does not seem to be superior to total callosotomy for the prevention of the propagation of seizure or complication. We describe a series of 21 patients with medically intractable epilepsy who underwent total callosotomy in one stage. METHODS: The diagnoses in these patients included Lennox-Gastaut syndrome, atonic seizure, infantile hemiplegia, and no obvious solitary seizure focus on chronic video/EEG monitoring to characterize seizures, electrographic activity, and postictal behaviors. Preoperatively 16 patients suffered from disabling drop attacks or intense head drop seizures which caused frequent physical injuries. Other types of seizures are 12 generalized tonic-clonic seizures, 7 complex partial seizures, 1 absence seizure, and 7 myoclonic seizures. Male:Female=14:7, Age: 2-22 years (Mean: 9.4 years). The follow-up period ranged from 0.8 to 3.8 years (median 2.4 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with outcome were assessed postoperatively. RESULTS: Drop attacks disappeared completely during the entire follow-up period in 13 patients and decreased to less than 10% of baseline in five. The corpus callosum of the one patient were not completely sectioned in Diffusion Tensor Image, tractography. Other types of seizures resolved completely in 14 patients and decreased in 7. 2 patients experienced a transient disconnection syndrome, but completely resolved within four weeks. Overall daily function improved and parents were satisfied with the surgical outcome in all patients except three who experienced recurrent of drop attacks after operation. There was no sign of significant and persistent neurological deficits in any case. CONCLUSION: Results of total callosotomy in patients with medically intractable epilepsy with diffuse epileptic foci were favorable in most cases. The procedure was particularly effective against drop attacks causing physical injuries and impaired quality of life in these patients.
Subject(s)
Child , Humans , Corpus Callosum , Diagnosis , Diffusion , Epilepsy , Epilepsy, Absence , Follow-Up Studies , Head , Hemiplegia , Parents , Quality of Life , Seizures , SyncopeABSTRACT
PURPOSE: This is a clinical study to evaluate the efficacy and adverse reactions of deflazacort as adjunctive therapy in childhood intractable atonic seizure including Lennox- Gastaut syndrome. METHODS: This is a clinical prospective, add-on, and open-label study performed for 6 months from Jun. 2000 to Dec. 2000 at the pediatric neurology clinic of Severance Hospital. Subjects were selected according to the following criteria, 1) Patients were diagosed as refractory atonic seizure disorder including Lennox-Gastaut syndrome during more than 6 months, 2) Patients had been on maximal doses of at least 2 anticonvulants including sodium valproate and clonazepam or clobazam. We observed seizure frequency of 4 weeks and 24 week medication period as well as adverse reactions every 4 weeks. Those data were analysed primarily for median seizure frequency reduction rate and other efficacy variables such as responder rate with frequency reduction more than 50% and seizure free rate. We also compared the clinical aspects between responder and non responder group. RESULTS: 48 patients were evaluated for efficacy and adverse reactions. Median seizure frequency reduction rate was 42.7%, responders were 22 patients(45.8%) and seizure free patients were 4(8.3%). In Lennox-Gastaut syndrome, median seizure frequency reduction rate was 48.9% and in atonic seizure only 39.3%. However, there were no statistically significant differences in efficacy. We compared clinical aspects between respoder and non responder groups, but couldn't find any difference. The number of patients manifesting adverse reactions was 20(41.6%) in an descending order of frequency, weight gain in 16 patients(33.3%), and irritability in 4 patients(8.3%). CONCLUSION: Deflazacort is believed to be an effective and safe anticonvulsant when used as adjunctive therapy for atonic seizure including Lennox-Gastaut syndrome. However, long term follow up is required to evaluate relapse rate and its adverse reactions.