Assessment of levetiracetam and valproic acid as monotherapy for quality of life in partial epilepsy patients

Background: Quality of life (QOL) is important in patients of epilepsy as it is affected both by disease as well as therapy. QOL is the most overlooked component of antiepileptic treatment.Methods: An observational analytical study was conducted in the Department of Pharmacology in collaboration with Department of Neurology of Himalayan Institute of Medical Science, Dehradun over 12 months. 80 patients satisfying inclusion criteria were enrolled and divided into two groups based on physician discretion and followed up for 12 weeks. Patients were evaluated at 0 and 12 weeks for quality of life using QOLIE-10 self-administered questionnaire, they were also assessed for seizure control and drug related adverse effects.Results: 60 patients were enrolled and divided into two treatment groups as per physician discretion, levetiracetam (30) and valproic acid (30) groups. Study groups showed significant improvement in QOL (mean change in QOL17.95�527 for LEV and 11.56�540 for VPA). Levetiracetam (LEV) group showed significant improvement over valproic acid (VPA) group (p=0.05) at 12 weeks. Patients who achieved total seizure control at 6 weeks were 93.33% patients in levetiracetam and 90% in valproic acid group, reason being non adherence which was 6.67% and 10% respectively. Adverse event recorded with levetiracetam (03), most common being drowsiness and with valproic acid (08), with most common being anorexia.Conclusions: Levetiracetam therapy has led to better quality of life and has the same seizure control as valproic acid, and has shown to have lower incidence of adverse effect.

Cognitive Function and Neuropsychological Comorbidities in Children with Newly Diagnosed Idiopathic Epilepsy

BACKGROUND: In this study, we aimed to identify cognitive function and neuropsychological comorbidities in children with newly diagnosed idiopathic epilepsy. METHODS: We retrospectively reviewed the records of 97 antiepileptic drug-naïve children (9.7 ± 2.9 years; 54 males and 43 females) with newly diagnosed idiopathic epilepsy, all of whom underwent a neuropsychological battery. The battery consisted of the Korean Wechsler Intelligence Scale, Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale, ADHD Diagnostic System, Children's Depression Inventory, and State-Trait Anxiety Inventory for Children. We investigated association between scores of the neuropsychological battery and epilepsy classification, lateralization of interictal epileptiform discharges (IEDs) on electroencephalography (EEG), and variables related to seizures. RESULTS: Thirteen patients (14.3%) had ADHD symptoms. Three patients (4.1%) had depressive symptoms, and 9 (12.3%) had anxiety symptoms. Patients with idiopathic generalized epilepsy (IGE) had significantly lower full-scale intelligence and performance intelligence quotient scores than patients with idiopathic localization-related epilepsy (ILRE) (89.0 ± 17.6 vs. 96.3 ± 14.8; P = 0.030 and 88.9 ± 16.3 vs. 97.0 ± 16.4; P = 0.016, respectively). Patients with ILRE having unilateral IEDs had significantly higher full-scale intelligence quotient scores than patients with ILRE having bilateral IEDs and patients with IGE (99.9 ± 12.2 vs. 93.7 ± 16.1 vs. 89.0 ± 17.6; P = 0.039, respectively). CONCLUSION: Our results suggest that idiopathic epilepsy may be accompanied by various neuropsychological comorbidities even at initial diagnosis. Patients with IGE and ILRE having bilateral IEDs on EEG appear more likely to be at high risk of decreased cognitive function.

Effect of OXC and VPA on EEG,Hcy and ADMA in adult patients with partial epilepsy / 国际检验医学杂志

Objective To investigate the effect of oxcarbazepine(OXC) and sodium valproate(VPA) on electroencephalogram(EEG) and peripheral blood levels of homocysteine(Hcy) and asymmetric dimethylarginine(ADMA) in adult patients with partial epilepsy.Methods From May.2014 to May.2015,a total of 100 patients with partial epilepsy were enrolled and randomly divided into treatment group(treated with OXC) and control group(treated with VPA),with 50 cases in each group.After treatment,changes of EEG indices,Hcy,ADMA,cognitive function and adverse reaction were analyzed.Results Before treatment,there was no significant difference of EEG indices between the two groups(P>0.05).After treatment,the incidence rates of α wave decreasing more than 0.5 Hz,increasing of θ wave and increasing of δ wave were significantly different(P0.05).After treatment,serum Hcy and ADMA levels were both significantly increased(P0.05).After treatment,MMSE score of treatment group was higher than that of control group(P<0.05).In treatment group,there were 1 case of skin rash and 2 cases of gastrointestinal discomfort,which were self-improved.In control group,there were 3 cases of dizziness,5 cases of skin rash and 1 case of gastrointestinal discomfort,which were self-improved.Conclusion The effects of OXC and VAP on peripheral blood levels of Hcy and ADMA could be similar,and compared with VAP,OXC could significantly improve cognitive function in patients with epilepsy.

Proton magnetic resonance spectroscopy in epilepsy: key findings / Espectroscopia de prótons por ressonância magnética em epilepsia: principais achados / Espectroscopia de protones por resonancia magnética en epilepsia: principales hallazgos

Magnetic resonance spectroscopy (MRS) is a non-invasive technique useful both in research and neuroclini- cal evaluation. It relies on the same physical principles of magnetic resonance imaging providing information on chemical compounds in vivo. MRS uses the magnetic properties of several nuclei such as 13C, 31P and 19F, although the 1H is the most common due to its abundance and magnetic resonance signal sensitivity. Particularly in the last two decades, MRS has helped to better understand epilepsy and characterize its metabolic changes. In this review article, we aimed to point out the main contributions of MRS for epilepsy, focusing on proton magnetic resonance spectroscopy (1H-MRS).

A espectroscopia por ressonância magnética (ERM) é uma técnica não invasiva útil tanto em pesquisa quanto em avaliação neuroclínica. Baseia-se nos mesmos princípios físicos da ressonância magnética (RM) convencional, fornecendo informações sobre compostos químicos in vivo. A ERM usa as propriedades magnéticas de vários núcleos, como 13C, 31P e 19F, embora o 1H seja o mais utilizado devido a sua abundância e à sensibilidade do sinal de ressonância magnética. Especialmente nas duas últimas déca- das, a ERM tem ajudado a compreender melhor a epilepsia e a caracterizar suas alterações metabólicas. Nesse artigo de revisão, buscamos apontar as principais contribuições da ERM para a epilepsia, com foco em espectroscopia de prótons por ressonância magnética (1H-ERM).

La espectroscopia por resonancia magnética (ERM) es una técnica no invasiva utilizada en la investigación y en la evaluación neurológica clínica. Se basa en los mismos principios físicos de la resonancia magnética (RM) convencional, proporcionando informa- ción sobre compuestos químicos in vivo. Para este fin, la ERM utiliza las propiedades magnéticas de diversos núcleos tales como 13C, 19F y 31P. Sin embargo, el 1H es el más utilizado debido a su abundancia y la mayor sensibilidad de la señal de resonancia magnética. Especialmente en las últimas dos décadas, el uso de la ERM ha ayudado a comprender mejor la epilepsia y caracterizar sus cambios metabólicos. En este artículo de revisión tratamos de señalar las principales aportaciones de la ERM para la epilepsia, centrándonos en la espectroscopia de protones por resonancia magnética.

Partial epilepsy: A pictorial review of 3 TESLA magnetic resonance imaging features

Epilepsy is a disease with serious consequences for patients and society. In many cases seizures are sufficiently disabling to justify surgical evaluation. In this context, Magnetic Resonance Imaging (MRI) is one of the most valuable tools for the preoperative localization of epileptogenic foci. Because these lesions show a large variety of presentations (including subtle imaging characteristics), their analysis requires careful and systematic interpretation of MRI data. Several studies have shown that 3 Tesla (T) MRI provides a better image quality than 1.5 T MRI regarding the detection and characterization of structural lesions, indicating that high-field-strength imaging should be considered for patients with intractable epilepsy who might benefit from surgery. Likewise, advanced MRI postprocessing and quantitative analysis techniques such as thickness and volume measurements of cortical gray matter have emerged and in the near future, these techniques will routinely enable more precise evaluations of such patients. Finally, the familiarity with radiologic findings of the potential epileptogenic substrates in association with combined use of higher field strengths (3 T, 7 T, and greater) and new quantitative analytical post-processing techniques will lead to improvements regarding the clinical imaging of these patients. We present a pictorial review of the major pathologies related to partial epilepsy, highlighting the key findings of 3 T MRI.

Crisis parciales como presentación atípica de aneurisma gigante / Partial seizures as atypical presentation giant aneurysm

Los aneurismas gigantes suelen manifestarse en forma de hemorragia subaracnoidea o cefalea. La presentación clínica de un aneurisma gigante intracraneal como epilepsia parcial es inusual, como lo indican los pocos casos recogidos en la literatura. Se presenta el caso de un aneurisma gigante intracraneal de arteria carótida interna derecha, que debuta con crisis focales del lóbulo temporal, manteniéndose sin otra manifestación a lo largo de años a pesar de las llamativas dimensiones.

Giant intracranial aneurysms are usually manifested as subarachnoid hemorrhage or headache. The clinical debut of a giant intracranial aneurysm as partial epilepsy is unusual and indicates the few cases reported in the literature. For giant aneurysm of an intracranial internal carotid artery occurs. Debuts with focal seizures of the temporal lobe, remaining without further demonstration over the years despite the striking dimensions.

The genetic research progress in benign childhood epilepsy with centro-temporal spikes / 国际儿科学杂志

Benign epilepsy with centro-temporal spikes (BECT)is the most common epilepsy syndrome in childhood.The seizures are manifested with facial jerking and twitching to guttural noises,salivating with inability to speak and twitched limbs.The episode is proved to be closely associated with sleep,especially the nonrapid eye movement period.Centrotemporal spikes are the hallmark of the syndrome of BECT.Although the pathogenesis of BECT is still unknown,it is generally acknowledged that hereditary features play a critical role in the occurrence of BECT.In this article we are going to summarize the progresses of BECT in the fields of clinical genetics,cytogenetics and molecular genetics.

Clinical Observation of Carbamazepine Combined with Topiramate in the Treatment of Partial Epilepsy / 中国药房

OBJECTIVE:To observe the efficacy and safety of carbamazepine combined with topiramate in the treatment of par-tial epilepsy. METHODS:130 patients with partial epilepsy were randomly divided into observation group and control group. Con-trol group was orally treaed with carbamazepine 100 mg,3 times a day. Based on the treatment of control group,observation group was orally treaed with topiramate initial dose of 25 mg,once a day,and then increased 25 mg every week,the maximum dose was no more than 200 mg,once a day. After 6 months,the efficacy was evaluated,frequency of epileptic seizures,EEG epileptiform discharges wave and incidence of adverse reactions were observed. RESULTS:The total effective rate in observation group was sig-nificantly higher than control group(P0.05). CONCLUSIONS:Carbamazepine combined with topiramate has better efficacy than carbamazepine alone in the treatment of partial epilepsy,with similar safety.

EEG Source Imaging in Partial Epilepsy in Comparison with Presurgical Evaluation and Magnetoencephalography

BACKGROUND AND PURPOSE: The aim of this study was to determine the usefulness of three-dimensional (3D) scalp EEG source imaging (ESI) in partial epilepsy in comparison with the results of presurgical evaluation, magnetoencephalography (MEG), and electrocorticography (ECoG). METHODS: The epilepsy syndrome of 27 partial epilepsy patients was determined by presurgical evaluations. EEG recordings were made using 70 scalp electrodes, and the 3D coordinates of the electrodes were digitized. ESI images of individual and averaged spikes were analyzed by Curry software with a boundary element method. MEG and ECoG were performed in 23 and 9 patients, respectively. RESULTS: ESI and MEG source imaging (MSI) results were well concordant with the results of presurgical evaluations (in 96.3% and 100% cases for ESI and MSI, respectively) at the lobar level. However, there were no spikes in the MEG recordings of three patients. The ESI results were well concordant with MSI results in 90.0% of cases. Compared to ECoG, the ESI results tended to be localized deeper than the cortex, whereas the MSI results were generally localized on the cortical surface. ESI was well concordant with ECoG in 8 of 9 (88.9%) cases, and MSI was also well concordant with ECoG in 4 of 5 (80.0%) cases. The EEG single dipoles in one patient with mesial temporal lobe epilepsy were tightly clustered with the averaged dipole when a 3 Hz high-pass filter was used. CONCLUSIONS: The ESI results were well concordant with the results of the presurgical evaluation, MSI, and ECoG. The ESI analysis was found to be useful for localizing the seizure focus and is recommended for the presurgical evaluation of intractable epilepsy patients.

Clinical Utility of Interictal High-Frequency Oscillations Recorded with Subdural Macroelectrodes in Partial Epilepsy

BACKGROUND AND PURPOSE: There is growing interest in high-frequency oscillations (HFO) as electrophysiological biomarkers of the epileptic brain. We evaluated the clinical utility of interictal HFO events, especially their occurrence rates, by comparing the spatial distribution with a clinically determined epileptogenic zone by using subdural macroelectrodes. METHODS: We obtained intracranial electroencephalogram data with a high temporal resolution (2000 Hz sampling rate, 0.05-500 Hz band-pass filter) from seven patients with medically refractory epilepsy. Three epochs of 5-minute, artifact-free data were selected randomly from the interictal period. HFO candidates were first detected by an automated algorithm and subsequently screened to discard false detections. Validated events were further categorized as fast ripple (FR) and ripple (R) according to their spectral profiles. The occurrence rate of HFOs was calculated for each electrode contact. An HFO events distribution map (EDM) was constructed for each patient to allow visualization of the spatial distribution of their HFO events. RESULTS: The subdural macroelectrodes were capable of detecting both R and FR events from the epileptic neocortex. The occurrence rate of HFO events, both FR and R, was significantly higher in the seizure onset zone (SOZ) than in other brain regions. Patient-specific HFO EDMs can facilitate the identification of the location of HFO-generating tissue, and comparison with findings from ictal recordings can provide additional useful information regarding the epileptogenic zone. CONCLUSIONS: The distribution of interictal HFOs was reasonably consistent with the SOZ. The detection of HFO events and construction of spatial distribution maps appears to be useful for the presurgical mapping of the epileptogenic zone.

Síndrome opercular o síndrome perisilviano / Operculum syndrome or perisylvian syndrome

El interés de los autores es llamar la atención sobre el síndrome opercular, y estimular con ello su identificación en la práctica neuropediátrica. Se realizó una búsqueda en PubMed desde febrero de 2005 hasta septiembre de 2010, y se comentaron los artículos que, a consideración de los autores, mostraban los diferentes aspectos del concepto, historia, características clínicas, causas, así como del diagnóstico, evolución y pronóstico. El síndrome opercular puede ser de causa congénita o adquirida; en los adultos es más frecuente por infarto cerebral opercular bilateral, no así en los niños, en los que se puede presentar por diferentes causas, desde trastornos de la migración neuroblástica, hasta en la epilepsia. En niños epilépticos se debe estar atento a su evolución, ya que tanto por el tipo de epilepsia o síndrome epiléptico, como por la medicación antiepiléptica usada, puede presentarse este síndrome, teniendo una gran significación su identificación rápida y tratamiento adecuado

The interest of authors is to attract attention on operculum syndrome and thus to stimulate its identification in the neuropediatric practice. A search in PubMed from February, 2005 to September, 2010 was made commenting on papers that according authors showed the different features of concept, history, clinical features, causes, as well as diagnosis, evolution and prognosis. The operculum syndrome may be congenital or acquired; ion adults is more frequent by bilateral operculum cerebral infarction, but not in children in whom it may be present by different causes, from neuroblast migration to epilepsy. In the case of epileptic children it is necessary to pay attention to its course since due to the type of epilepsy or epileptic syndrome or due to antiepileptic drug used, this syndrome may be present, considering very much its fast identification and appropriate treatment

Increased EEG Current-Source Density in the High Beta Frequency Band Induced by Levetiracetam Adjunctive Therapy in Refractory Partial Epilepsy

BACKGROUND AND PURPOSE: Levetiracetam (LEV) is an antiepileptic drug (AED) that has favorable effects on cognition. Although neuropsychological studies have demonstrated these favorable outcomes on cognition, there are few electrophysiologic data describing the functional changes exerted by LEV. The purpose of this study was to determine the effects of LEV adjunctive therapy on the current-source density (CSD) in the high beta frequency band (22-30 Hz) of EEG background activity in refractory partial epilepsy (RPE). METHODS: We conducted a 24-week, open-label, prospective study in 24 patients with RPE. Scalp electroencephalography and neuropsychological tests (NPTs) were conducted twice, once before the LEV trial and then again after 24 weeks of medication. RESULTS: The CSD in the 22-30 Hz band of EEG background activity increased in the bilateral anterior cingulate gyri, left parahippocampal gyrus, and a small area of the right anterior parahippocampal gyrus after the LEV trial. Neither seizure freedom nor the dosage increment of LEV elicited meaningful CSD changes. Verbal memory and executive function were improved after the 24-week LEV trial. CONCLUSIONS: To our knowledge, this is the first study to examine the changes in CSD induced by LEV adjunctive therapy in RPE patients. The CSD changes and NPT results suggest that LEV enhances the activities of the neuronal networks in the prefrontal cortex and left hippocampus.

OPTIMIZATION OF PARTIAL EPILEPSY THERAPY WITH CARBAMAZEPINOM

To determine carbamazepine pharmacokinetic parameters, define seizure stop dose for partial seizure and monitor carbamazepine effect by EEG

Tratamento das epilepsias parciais / Partial epilepsies treatment

As epilepsias parciais constituem a forma mais comum de epilepsia nos indivíduos adultos. As drogas antiepilépticas (DAEs) permanecem como a principal forma de tratamento para os pacientes com epilepsia. Apesar da importância da medicação um número elevado de pacientes permanece sob um regime terapêutico inapropriado ou até mesmo sem qualquer medicação. Existem várias medicações disponíveis para o tratamento das epilepsias. A escolha de uma medicação específica ou a associação entre DAEs deve ser particularizada o máximo possível. Neste artigo revisamos alguns aspectos como classificação, início das crises, idade, sexo, comorbidades, custo e posologia das DAEs e história medicamentosa com a perspectiva de auxiliar nesta individualização do tratamento. Algumas características das principais DAEs disponíveis também são discutidas. Estes aspectos podem auxiliar na criação de um perfil ajudando assim na escolha do regime terapêutico mais apropriado para cada indivíduo. Aspectos práticos como o manuseio dos efeitos adversos, monoterapia e politerapia também são abordados.

Partial epilepsies are the most common form of epilepsy in adult individuals. Antiepileptic drugs (AEDs) continue as the main form of treatment for patients with epilepsy. Regardless of the importance of the medication a high number of patients are under inappropriate or not receiving AEDs. There are several medications available for the treatment of epilepsy. The choice of a particular medication or association among AEDs may be individualized as much as possible. In this article some aspects such as classification, onset of the seizures, age, sex, associated medical conditions, cost and posology of AEDs and medical drug history are reviewed. Details of the available AEDs are also discussed. These points may help to create a profile helping the decision for the appropriate AED. Some practical issues like adverse reaction management, monotherapy and politherapy are also discussed.

Diferencias neurocognitivas entre las epilepsias parciales frontales y temporales en la infancia / Neurocognitive differences between frontal and temporal partial seizures in childhood

Introducción. Establecer las diferencias neurocognitivas entre las epilepsias pediátricas parciales del lóbulo frontal y del temporal. Métodos. En una investigación clínica de tipo transversal, descriptiva y prolectiva, se analizaron pacientes pediátricos con epilepsia parcial entre los 6 y 12 años de edad, de ambos sexos, en el Departamento de Neurología del Hospital Infantil de México Federico Gómez. Posterior a dividir a los pacientes en epilepsias parciales del lóbulo frontal y temporal, se aplicaron pruebas neurocognitivas, evaluación del cociente intelectual (CI), atención, memoria de trabajo, funciones ejecutivas y ejecución visuoespacial. Además, se evaluaron con resultados de electroencefalograma, neuroimagen y examen físico. Resultados. Se evaluaron 37 pacientes de ambos sexos (22 hombres, 15 mujeres) con epilepsia parcial del lóbulo frontal (17) y del lóbulo temporal (20). Las principales diferencias cognitivas entre estos dos tipos de epilepsia fueron: CI (promedio 82 en las epilepsias frontales y 97 en las epilepsias temporales) con mayor impacto en la memoria de trabajo y la ejecución vi-suoespacial en pequeños con epilepsia frontal. Los pacientes con epilepsia del lóbulo temporal presentaron mayores problemas en la atención de ejecución y de los test de memoria. Conclusiones. Los pacientes con epilepsia parcial del lóbulo frontal tienen mayor impacto sobre las habilidades neurocognitivas. Se considera muy importante esta evaluación con el fin de iniciar un soporte temprano con abordajes terapéuticos en este grupo de epilepsias, intentando revertir el impacto de crisis sobre las capacidades sociales y académicas.

Introduction. Objective: The purpose of this clinical trial was to differentiate the neurocognitive performance between frontal and temporal seizures in pediatric epilepsy. This is an important issue related to measure the impact of the different type of seizures in the neurodevelopment of children with epilepsy. Methods. We analyzed patients with partial epilepsy between 6 and 12 years old, both genders, in the Neurology Department of the Hospital Infantil de Mexico. After classifying frontal and temporal epilepsies, neurocognitive, IQ, attention, working memory, executive functions and visuospatial performance tests were applied. Likewise, EEG, neuroimaging, social evaluation and physical examination were performed. Results. Thirty-seven patients both genders (22 males; 15 females) with frontal partial seizures (17) and temporal partial seizures (20) were evaluated. The main neurocognitive differences between these 2 types of epilepsy were IQ (mean 82 in frontal epilepsy and 97 in temporal epilepsy) a higher impact on working memory and visuospatial performance was observed in infants with frontal epilepsy. The patients with temporal epilepsy had more problems in executing attention and long memory tests. Conclusion. Frontal partial seizures had more impact on the neurocognitive abilities than temporal partial seizures in the studied patients. This observation should be taken into account for the early treatment of children with epilepsy.

Neurocutaneous Melanosis Presenting as Chronic Partial Epilepsy

BACKGROUND: Neurocutaneous melanosis (NCM) is a rare neurocutaneous syndrome characterized by the presence of multiple congenital melanocytic nevi (CMN) and the proliferation of melanocytes in the central nervous system, usually involving the leptomeninges. Chronic partial epilepsy as a sole manifestation is rare in NCM. CASE REPORT: A 32-year-old man suffering from chronic partial epilepsy presented with multiple CMN on his trunk and scalp. Brain MRI demonstrated a focal lesion in the right amygdala that was consistent with interictal epileptiform discharges in the right temporal region on electroencephalography (EEG). An anterior temporal lobectomy was performed, and the pathology investigation revealed numerous melanophages in the amygdala. The patient was seizure-free after surgery. CONCLUSIONS: We report a patient with NCM presenting as chronic partial epilepsy who was successfully treated by anterior temporal lobectomy.

Epilepsias parciales benignas de la infancia: Correlación entre factores de riesgo con la evolución clínica y hallazgos electroencefalográficos y su aplicación en el establecimiento de criterios terapéuticos / Benign partial epilepsy of infancy: The Correlation between risk factors, clinical evolution and electroencephalographic findings and the application it has over the therapeutic criteria

Definición: Las epilepsias parciales benignas de la infancia (EPBI) representan el síndrome epiléptico mas común en niños en edad preescolar y escolar, correspondiendo al 15-24% de las epilepsias, diagnosticadas entre los 3 y 13 años. Remiten espontáneamente al llegar a la adolescencia. Las epilepsias rolándicas constituyen las EPBI de mayor incidencia, su principal característica es ocasionar crisis parciales, con anartria, hemiconvulsiones faciales, en algunos casos con hemigeneralización secundaria. El electroencefalograma interictal evidencia espigas focales centrotemporales. En el 40% de los casos existe historia familiar de convulsiones febriles, epilepsias clínicas, o descargas epilépticas en el electroencefalograma. Además, el 7-10% evidencian antecedentes personales de convulsiones febriles en su primera infancia. Algunos autores sugieren no medicar estos pacientes, sin embargo no existe un consenso al respecto.Objetivos:•Determinar si los antecedentes convulsivos familiares o personales representan una influencia en la evolución de la enfermedad y si su presencia es un criterio para iniciar medicación antiepiléptica. Proponer criterios terapéuticos de medicación y de observación.Metodología: Estudio monocéntrico, longitudinal, tipo cohorte histórico, realizado con pacientes de consulta externa del hospital Pediátrico Dr. Roberto Gilbert Elizalde, durante 3 meses (noviembre/2003 Enero/2004). Criterios de inclusión: convulsiones no febriles de inicio entre 3 y 13 años con neurodesarrollo normal, estudios de imágenes normales, examen neurológico normal y trazado electroencefalográfico compatible con EPBI. Se clasificó a los pacientes en dos subgrupos: con y sin antecedentes convulsivos familiares o personales, y se comparó las diferencias clínicas -en cuanto al intervalo interictal- y electroencefalográficas.

Definition: Benign partial epilepsy of infancy represents the most common epileptic syndrome in preschool and school children. It accounts for 15-24% of epilepsies diagnosed between the ages of 3 and 13 years. Rolandic epilepsy is one of BMEI with a high incidence its main characteristic is that it causes partial seizures, anartia, hemiseizures. The electroencephalogram shows centrotemporal spikes. In the 40% of the cases exist family history of febrile seizures, clinical epilepsy or epileptic discharges in the electroencephalogram. Also, 7-10% have a clinical history of febrile seizures in infancy. Some authors suggest to not medicate this patients. Objectives: XDetermine the family and history of seizures that can influence the evolution of the illness and if its presence is a criteria to start antiepileptic medication. Propose therapeutic criteria to medicate and of observation. Method: Monocentric, longitudinal, cohort study with patients that consulted Pediatric hospital of Dr. Roberto Gilbert Elizalde during the period of three months. (November 2003 V January 2004) Criteria to be included in this study: seizures without fever that began between the ages of 3 and 13 years of age with a normal neurodevelopment, normal image study, neurological exam and electroencephalogram that shows BMEI. Patients were classified in two subgroups: with or without family or clinical history of seizures and clinical differences were compared using.Results: Of the 57 patients 52 people were our study group out of which 67% were men and 33% were woman. The average of age was 9.26 years old +/- 2.99. The 63% of the patients had seizures while they were sleeping. Only 48% of the cases showed discharges are the electroencephalographic reading. Important clinical or electroencephalographic differences did not exist between the two groups. (with or with out clinical or family history).

Predictive Factors for the Relapse of Seizure after Withdrawal from the Monotherapy of the Antiepileptic Drug in Cryptogenic Partial Epilepsy / 대한간질학회지

PURPOSE: There is no apparent consensus about the successful policy of antiepileptic drug (AED) withdrawal, nor about definite factors to make patients remain seizure-free. We attempted to find out the predictive factors for seizure relapse after withdrawal of AED in patients with cryptogenic partial epilepsy. METHODS: This is a case-controlled and hospital-based observational study. A total of 91 crytogenic partial epileptic patients in whom seizure had been successfully controlled by AED monotherapy for more than two years were subjected to drug withdrawal. Patients with history of febrile convulsion, status epilepticus, and abnormal intelligence were excluded. Subjects were divided into two groups; the first group consisted of patients with seizure free more than 2 years after withdrawal of AED and another group with seizure recurrence during tapering or after drug withdrawal. The group with successful withdrawal had 48 patients, and, in 43 patients, seizure was recurred. Clinical profiles were compared between the two groups. RESULTS: There was no significant difference in gender, family history, age at onset, number of seizure attacks before AED initiation, duration of illness before treatment, and seizure or epilepsy classifications between the two groups. However, an abnormal EEG finding was associated with seizure relapse (Chi-square test p<0.05). On the other hand, the number of seizure attacks and the interval between the AED initiation and the time when a seizure free period was achieved had a correlation with seizure relapse, but was not statistically significant. CONCLUSIONS: Abnormal EEG findings was the predictive factor for seizure relapse after withdrawal from AED monotherapy in cryptogenic partial epilepsy.

Simple Partial Status Epilepticus Localized by SPECT Subtraction in Chronic Cerebral Paragonimiasis / 대한간질학회지

A patient with chronic cerebral paragonimiasis began to have new motor seizures of the right face clonic contractions that occurred several hundred times a day resulting in the simple partial status epilepticus. The ictal EEG discharge started from the left frontal region and then spread to the left hemisphere. The ictal discharges were limited clearly to the left hemisphere. The brain MRI showed the multiple conglomerated round nodules with encephalomalacia in the left temporo-occipital lobes. Applying the ictal-interictal subtracted SPECT, we were able to localize the focal ictal hyperperfusion on the left precentral cortex adjacent to the lesions that correspond to the anatomical distribution of the left face motor area.

A Case of Atypical Benign Partial Childhood Epilepsy

We report a case of atypical benign partial childhood epilepsy in a 11 years old male child whose case has been followed up for 6 years. His first symptom was focal seizure of the left side of his face during a drowsy state, followed by focal seizures of left fingers and legs. At that time he had been on phenobarbital for a year without any response clinically and electroencephalographically, so he was transferred to our hospital. The EEG, which was taken at his first visit, showed continuous generalized spike-wave pattern with high amplitude through the whole record during waking, drowsy and sleeping states. The clinical and EEG findings showed no improvement for the first 2 years even though he was on combination therapy with some drugs such as carbamazepine, valproate and vigabatrin. However, he began to show some improvement after 3 years(at 8 years of age) and no seizure has been observed for the last 2 years. Also an EEG, taken 6 years after onset, showed marked improvement.