Epilepsias generalizadas idiopáticas / Idiopathic generalized epilepsies

Resumen Las epilepsias generalizadas idiopáticas (EGI) son un grupo de epilepsias generalizadas edad de pendientes, subgrupo de las Epilepsias genéticas generalizadas(EGG), con hallazgos electro-clínicos característicos y herencia poligénica. Las EGI inclu yen las cuatro epilepsias generalizadas clásicas más comunes de las EGG: la epilepsia de ausencias de la infancia (EAI), epilepsia de ausencias juveniles (EAJ), epilepsia mioclónica juvenil (EMJ) y la epilepsia con crisis tónico clónicas generalizadas. Clínicamente caracterizadas por la presencia de una o una com binación de crisis de ausencias, mioclonías, tónica-clónicas omioclónica-tónica-clónicas con patrón elec troencefalográfico de punta onda lenta de 2.5 a 6cps y activación con la hiperventilación y fotoestimula ción, Sobresalen de las EGG por compartir atributos particulares como el buen pronóstico con control frecuente de las crisis, la no evolución a encefalopa tías epilépticas, frecuente superposición clínica entre las tres primeras, pudiendo evolucionar entre ellas; la probabilidad y edad de remisión varía en cada una.Más del 80% se controlan adecuadamente con medicamentos anticrisis de amplio espectro como el ácido valproico y pueden empeorar con bloqueadores de sodio o gabaérgicos. Si bien los pacientes son previamente sanos con neurodesarrollo normal, frecuentemente se asocian con trastornos del ánimo, déficit de atención e hiperactividad (TDAH) y problemas del aprendizaje pero no presentan déficit cognitivo. El reconocimiento de este grupo de EGI es importan te para el uso adecuado del recurso, evitando estudios innecesarios, adecuada orientación del pronóstico y un tratamiento óptimo.

Abstract Idiopathic generalized epilepsies (IGE) is a group of epilepsies age-dependent, a subgroup of EGG genetic generalized epilepsies, with electro-clinical features and polygenic inheritance. Four syndromes comprising the IGEs: childhood absence epilepsy (CAD), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and generalized tonic-clonic seizures epilepsy. Clinically characterized by the presence of one or a combination of absence seizures, myoclonus, tonic-clonic, or myoclonic-tonic-clonic with common electroencephalographic pat terns of 2.5-5.5 Hz generalized spike-wave and activated by hyperventilation or photic stimulation. They generally have a good prognosis for seizure control, not evolve to an epileptic encephalopathy. Frequent clinical overlap between the first three, being able to evolve between them; the probability and age of remission varies in each one. About 80% responding to broad-spectrum anti-seizure drugs such as valproic acid, may worsen with sodium or GABAergic blockers. Development is typically normal; however, they are frequently associated with mood disorders, attention-deficit/hyperactivity disorder (ADHD), and learning dis abilities, but do not have cognitive deficits. The recognition of this group of EGI is important for the adequate use of the resources, avoiding unnecessary studies, adequate orientation of the prognosis and an optimal treatment.

Therapeutic Outcomes and Prognostic Factors in Childhood Absence Epilepsy

BACKGROUND AND PURPOSE: Childhood absence epilepsy (CAE) is one of the most common types of pediatric epilepsy. It is generally treated with ethosuximide (ESM), valproic acid (VPA), or lamotrigine (LTG), but the efficacy and adverse effects of these drugs remain controversial. This study compared initial therapy treatment outcomes, including VPA-LTG combination, and assessed clinical factors that may predict treatment response and prognosis. METHODS: Sixty-seven patients with typical CAE were retrospectively enrolled at the Korea University Medical Center. We reviewed patients' clinical characteristics, including age of seizure onset, seizure-free interval, duration of seizure-free period, freedom from treatment failure, breakthrough seizures frequency, and electroencephalogram (EEG) findings. RESULTS: The age at seizure onset was 7.9±2.7 years (mean±SD), and follow-up duration was 4.4±3.7 years. Initially, 22 children were treated with ESM (32.8%), 23 with VPA (34.3%), 14 with LTG (20.9%), and 8 with VPA-LTG combination (11.9%). After 48 months of therapy, the rate of freedom from treatment failure was significantly higher for the VPA-LTG combination therapy than in the three monotherapy groups (p=0.012). The treatment dose administrated in the VPA-LTG combination group was less than that in the VPA and LTG monotherapy groups. The shorter interval to loss of 3-Hz spike-and-wave complexes and the presence of occipital intermittent rhythmic delta activity on EEG were significant factors predicting good treatment response. CONCLUSIONS: This study showed that low-dose VPA-LTG combination therapy has a good efficacy and fewer side effects than other treatments, and it should thus be considered as a firstline therapy in absence epilepsy.

The sleep-wakefulness cycle of Wistar rats with spontaneous absence-like epilepsy / O ciclo vigília-sono de ratos Wistar portadores de epilepsia espontânea tipo ausência

Possible interactions between the sleep-wakefulness cycle and a new kind of spontaneous epilepsy, expressed as absence-like seizures and spike-wave bursts in FMUSP rats, are evaluated. The electro-oscillograms of some cortical and subcortical regions of the brain were recorded, as well as head, rostrum/vibrissae and eye movements. Recordings were performed uninterruptedly during 24 hours. The seizures were mostly concentrated in the wakefulness state but they could occur in any other phase, including paradoxical sleep. After the seizure, the rats usually returned to the same phase that was interrupted, although they often returned to wakefulness. There was an intense fragmentation of the sleep-wakefulness cycle. The incidence of each cycle phase was significantly reduced, except S III of synchronized sleep and paradoxical sleep, thus maintaining the overall duration and architecture of the sleep -wakefulness cycle. The fragmentation of the cycle seems to be due to an impairment of the very processes that generate sleep and wakefulness. Electrophysiological and behavioral profiles of the FMUSP rats recommend accurate and comprehensive study of the animal model owing to its resemblance to seizures in humans and also to discrepancies with existing genetic or experimental epilepsy models.

A razão principal desta investigação foi estudar a arquitetura do ciclo vigília-sono numa cepa de ratos Wistar (FMUSP-rats) portadores de epilepsia espontânea tipo ausência. Foram utilizados 10 ratos Wistar adultos, que receberam eletrodos em regiões corticais e subcorticais, nos músculos trapézios e nos epicantos oculares, pelos quais registramos os eletroscilogramas continuamente por 24 horas, dos quais foram analisados os registros eletroscilográficos e demais parâmetros da arquitetura do ciclo vigília-sono. As crises ocorriam preferencialmente durante o período escuro, coincidindo com a maior prevalência de estados de vigília. O ciclo vigília-sono sofreu intensa fragmentação nos ratos epilépticos, e a duração média de algumas fases do sono foi mais prolongada nos ratos epilépticos do que nos sadios. As manifestações eletrofisiológicas das crises assumiram várias formas, predominando, porém, os complexos espícula-onda (de 7 a 9,5 Hz) o que se assemelha muito à faixa de oscilação das ondas teta. As características eletrofisiológicas e comportamentais da epilepsia que estudamos recomendam o estudo acurado e abrangente desse modelo de síndrome epiléptica, por sua semelhança com as crises encontradas em humanos, mas também por algumas discrepâncias em relação a modelos de epilepsia genética ou experimental já existentes.

Lamotrigine for absence seizures in children and adolescents：a systematic review / 药学实践杂志

Objective To assess the efficacy and safety of lamotrigine for absence seizures in children and adolescents . Methods Databases of PubMed ,the Cochrane Library ,EMbase ,CENTRAL ,VIP ,WanFang ,CBM and CNKI were electron-ically searched till August ,2014 for clinical trials on lamotrigine for absence seizures in children and adolescents .All literature were screened by two reviewers independently according to the inclusion and exclusion criteria .The data was extracted ,and the methodological quality was assessed .Then ,meta-analysis was performed using RevMan 5 .2 .Results Seven trials were in-cluded involving a total of 721 patients .The results of methodological qualities were two studies rated as A-class ,three studies rated as B-class and two studies rated as C-class .Meta-analysis results showed that the efficacy of lamotrigine monotherapy for absence seizure in children and adolescents was better than placebo ,but efficacy of lamotrigine was lower than valproic acid and ethosuximide .The adverse reaction rates of lamotrigine were with no significant difference compared with valproic acid and et-hosuximide .Conclusion Lamotrigine monotherapy was effective for absence seizures in children and adolescents and was well tolerated .Lamotrigine was a good choice for patients that are intolerable to valproic acid or ethosuximide .

Clinical and electroencephalographic characteristics of a cohort of patients with epilepsy and absence seizures / Características clínicas e eletrencefalográficas de uma coorte de pacientes com epilepsia com crises de ausência

BACKGROUND: Epileptic syndromes with absence seizures (AS) possess unique clinical and electroencephalographic (EEG) characteristics. In typical or atypical AS, ictal phenomenology may include various characteristics. Vídeo-EEG monitoring enables findings to be correlated with ictal phenomenology. OBJECTIVE: To evaluate the different AS in a cohort of patients with drug-resistant epilepsy (DRE) based on the International League against Epilepsy (ILAE)'s 2006 classification, to correlate with ictal phenomenology recorded and to apply the Panayiotopoulos criteria. METHOD: This study included patients with criteria of AS followed up at the Epilepsy Clinic. A dual, cross-sectional cohort study was carried out between 2005 and 2008. Patients receiving care in the Epilepsy Program of the HUCFF-UFRJ, who had been investigated by video-EEG and who presented clinical and EEG criteria for absence seizures, typical or atypical, according to the criteria defined by the ILAE, were included in the study, independent of age onset, the review of clinical history, age onset, family history, epilepsy onset and evolution, seizures phenomenology, antiepileptic drugs response and neuroimaging studies were used to classify the patients among the different epileptic syndrome associated to absence seizures. RESULTS: Typical absences were more frequent (71.4 percent) than atypical absences. Cases of juvenile absence epilepsy were the most frequent (19 percent) in this series, followed by childhood absence epilepsy (14.4 percent) and juvenile myoclonic epilepsy (4.8 percent). In 14 patients (66.67 percent), diagnosis was modified from focal epilepsy to primary generalized epilepsy. Clinical and EEG diagnosis of absence epilepsy resulted in a dramatic improvement in the control of seizures following modification of diagnosis and indication of an appropriate antiepileptic drug. CONCLUSION: Our results show that typical AS are more frequent than atypical. AS was ...

Síndromes epilépticas com crises de ausência (CA) possuem características clínicas e eletroencefalográficas (EEG) únicas. Nas crises de ausência típica ou atípica, a fenomenologia ictal pode incluir características que podem levar ao erro diagnóstico e à indicação de drogas antiepilépticas que pioraram o quadro. Quando esses pacientes são referidos a um Programa de Epilepsias para investigação, a monitorização por vídeo-EEG permite correlacionar os achados eletrográficos com a fenomenologia ictal. OBJETIVO: Identificar em uma coorte de pacientes com epilepsia fármaco-resistente (EFR), pacientes com CA segundo critérios propostos pela Liga Internacional contra a Epilepsia (ILAE) de 2006, correlacionar a fenomenologia ictal ao EEG e aplicar os de critérios Panayiotopoulos neste grupo. MÉTODO: Estudo de corte transversal incluiu doentes encaminhados ao Programa de Epilepsia do HUCFF-UFRJ entre 2005 e 2008, investigados por vídeo-EEG e que apresentavam os critérios clínicos e EEG para CA típicas ou atípica; a revisão da história clínica, idade início, história familiar de epilepsia, evolução, a fenomenologia ictal, resposta a drogas antiepilépticas e estudos de neuroimagem foram utilizados para classificar os pacientes entre as diferentes síndromes epilépticas associadas a CA. RESULTADOS: As CA típicas foram mais freqüentes (71,4 por cento) do que as atípicas. Casos de epilepsia ausência juvenil ocorreram em 19 por cento desta série, seguido por epilepsia ausência infantil (14,4 por cento) e epilepsia mioclônica juvenil (4,8 por cento). Em 14 pacientes (66,67 por cento), o diagnóstico de epilepsia focal epilepsia foi modificado para epilepsia generalizada primária. A mudança do diagnóstico de epilepsia focal para epilepsia com CA, seguido da troca para DAE adequadas, resultou em melhoria no controle de crises. CONCLUSÃO: Nossos resultados mostram que as CA típicas são mais freqüentes do que as atípicas. Em 10 pacientes, a aplicação dos critérios ...

Enfoque electroclínico de las epilepsias generalizadas idiopáticas con ausencias: [revisión] / Electrolytic approach of idiopathic generalized epilepsies with absences: [review]

La primera descripción de las crisis de ausencias data de 1705. Sin embargo, aún persiste el desconocimiento y la confusión en relación con algunos aspectos conceptuales, de clasificación, terminológicos, diagnósticos, pronósticos y de tratamiento de las diferentes formas de epilepsias con ausencias. El objetivo fundamental de esta publicación es tomar en consideración las denominadas epilepsias generalizadas idiopáticas con ausencias, en los aspectos clínicos y electroencefalográficos. Se realizó una revisión y actualización del tema.

The first description of absence seizures dates back to 1705. However, the lack of knowledge and confusion still persist as regards some aspects of concept, classification, terminology, diagnosis, prognosis and treatment of the different forms of epilepsies with absences. The fundamental purpose of this publication was to take into consideration the so-called idiopathic generalized epilepsies with absences in the clinical and electroencephalographic aspects. The topic was reviewed and updated.