Evaluation of Etiology and Prognostic Factors of the Developmental Outcome in Neonatal Seizures / 대한소아신경학회지

PURPOSE: The purpose of this study was to investigate the clinical features of neonatal seizures and to identify prognostic factors of neurodevelopmental outcome in term infants who experienced clinical seizures. METHODS: A retrospective analysis was performed on 153full term and preterm infants with seizures from January 2008 to December 2013. Binary logistic regression analysis was applied to assess risk factors associated with neurological adverse outcomes using variables that were found to be significant on univariate analysis. RESULTS: During the study period, 102 (66.7%) term and 51 (33.3%) preterminfants were enrolled. The main cause of neonatal seizures was hypoxic ischemic encephalopathy (24.5%) in term infants and intracranial hemorrhage (74.5%) in preterm infants. The most common type of seizure was focal clonic seizure. Generalized tonic seizure was more commonly observed in preterm than in term infants. 39 out of 56 term infants with at least 12 months of neurologic follow-up showed normal outcomes while only one preterm infant showed normal development.Prognostic factors related to adverse neurodevelopmental outcomes in term infants were perinatal history of fetal distress, etiology of hypoxic ischemic encephalopathy, severity of EEG(Electroencephalogram) abnormality, evidence of hypoxic ischemic encephalopathy on brain magnetic resonance imaging, and the need for multiple antiepileptic drugs for seizure control. CONCLUSION: Preterm infants showed poorer neurodevelopmental outcomes compared to term infants. The etiology of seizures, treatment response, neuroimaging and electroencephalographic findings were important in predicting the developmental outcome in term infants with seizures.

Klippel-Trenaunay-Weber syndrome with hemimegalencephaly; report of a pediatric case

Klippel-Trenaunay-Weber Syndrome [KTWS] is a rare neurocutaneous syndrome. Hemimegalencephaly [HME] and seizure episodes have been reported previously in a few cases with KTWS. We report here a 3 day-old girl with partial motor seizures, extensive port-wine staining and mild structural deformities in the feet, and a hemimegalencephaly. Occurrence of partial motor seizures in addition to bilateral lower extremities extensive port-wine staining is a unique feature seen in our case

Visual Seizure: A Reversible Complication of Non-Ketotic Hyperglycemia

A 65-year-old man with diabetes mellitus was presented with left visual aura, followed by a versive seizure, each lasting approximately 3 minutes. Neurological examination showed an intermittent left homonymous hemianopsia. Brain magnetic resonance imaging (MRI) showed right occipital lobe lesion, with cytotoxic edema. Blood glucose was 593 mg/dL and serum osmolarity was 309 mOsm/kg. The seizures were controlled by normalization of blood sugar and short-term anticonvulsant, and the lesions were resolved in a follow-up MRI. We report a case of visual seizures associated with non-ketotic hyperglycemia.

EEG Characteristics of Full-Term Neonatal Seizures Confirmed by Electrical Seizure / 대한간질학회지

PURPOSE: Neonatal seizure is the most significant parameter of neurological insult, however its pathophysiology and diagnostic consensus is still controversial. We performed this study to investigate the characteristics of electroencephalogram (EEG) in neonatal seizures, to validate the efficacy of radiological studies, and to estimate the occurrence of further subsequent epileptic seizures. METHODS: Seventeen patients with full-term neonatal seizure confirmed by electrical seizure were enrolled. Mean birth weight is 3.29 kg, and mean duration of follow-up is 22.7 months. Medical records and EEG were retrospectively reviewed. RESULTS: Subtle seizure is the most common seizure type: subtle seizure in 6 (35%), subtle seizure with focal clonic seizure in 2(12%). In 12 patients (71%), abnormal background activities were observed, and trace discontinua is the most common abnormal finding. Ictal EEGs were mostly localized into unilateral posterior quadrant in 11 (64%), however, the remained were localized into the frontal area. Brain USG did not reveal any abnormal finding in 9 patients (53%), whereas brain MRI didn't in 4 patients (25%). Brain MRI found abnormal findings in 5 out of 9 patients with negative brain USG result. Subsequent epileptic seizures followed in 7 patients (44%). Conclusion: Background activity is still useful as an indirect marker of neonatal seizure. Different generation or propagation mechanism can be suggested in that ictal EEGs were often localized into the frontal area in minor portion. Brain MRI is more sensitive than brain USG, especially in case of cerebral infarct or hypoxic-ischemic encephalopathy.

Cranial computed tomography in partial motor seizures.

OBJECTIVE: To identify the pattern of intracranial structural lesions in developmentally normal children with partial motor seizures by computed tomography and to monitor the behavior of single ring enhancing lesion (SREL) after a period of time with or without treatment. METHODS: Consecutive developmentally normal children between one year and twelve years with partial motor seizures in a tertiary care referral Hospital. After clinical examination and appropriate investigation for tuberculosis and cysticercosis, CT scan was performed. In addition to anticonvulsants, children received antituberculous or anticysticercal therapy if indicated. Repeat CT was performed on children with SREL after 6 months. RESULTS: Computed tomography was abnormal in 102 (68%) children. Majority of the children (75) had SREL. The lesions were located in decreasing order of frequency in the parietal lobe (65), frontal lobe (7), occipital lobe (1), temporal lobe (1) and cerebellum (1). Repeat CT scan was performed on 50 of the 75 children with SREL. Among these, in 41 children who were only on antiepileptic therapy, the SREL had decreased in size in thirty-two whereas in the rest (9), there was no change in the size. CONCLUSION: Awareness of the existence of disappearing SREL lesions is essential to avoid unnecessary treatment with antituberculous or anticysticercal therapy and provides ample justification in treating with anticonvulsant drugs only.

Classification and the need to classify epilepsy.

Epilepsies are a diverse group of disorders with both shared and distinct features. Classification allows a coherent, systematic approach and serves as a 'universal language' between neurologists all over the world. There are two systems of classifications of epilepsies in use today. The International League Against Epilepsy (ILAE) Classification of Epileptic Seizures 1981 divides seizures into 3 morphologic types--generalised, partial and unclassifiable, with subtypes of each. This system has the advantage that seizures can be classified relatively easily and choice of antiepileptic is dictated by seizure type. However, the same patient may have more than one type of seizure either together or sequentially and many patients show a distinct evolution of their illness. This paved the way for another system of classification--the ILAE Classification of Epilepsies & Epileptic Syndromes 1989, which is meant to supplement the previous classification. An epileptic syndrome is defined as an epileptic disorder characterised by a cluster of signs and symptoms occurring together. According to this system, epilepsies are divided into 4 broad groups--localisation related and generalised, undetermined whether localised or generalised and special syndromes. Within the generalised and localised groups, there are further subdivisions into idiopathic, cryptogenic or symptomatic. This classification is complex and many syndromes are not adequately defined. At initial presentation, it may not be possible to identify the syndrome. Only a small proportion of patients fit into specific syndromes and a large proportion fall into non specific categories. For the present then, classification of epilepsy is still being refined. A brief description of major childhood epileptic syndromes according to age at onset is presented.

Análise quantitativa da atividade elétrica cerebral durante estimulaçäo cognitiva de pacientes epiléticos / Quantitative analysis of eletric cerebral activity submitted cognitive stimulations of epileptic patients

Neste trabalho, 30 indivíduos adultos (20 indivíduos epilépticos e 10 não epilépticos) foram submetidos a estimulações cognitivas durante a captação dos ritmos elétricos cerebrais. O grupo estudo foi constituído por 10 homens e 10 mulheres portadores de epilepsia temporal parcial, sem lesão orgânica subjacente demonstrável. O grupo controle constou de 5 homens e 5 mulheres sem história de doença neurológica prévia ou atual. Contudo, os indivíduos do grupo epiléptico e do grupo controle foram controles de si mesmos, uma vez que avaliamos os traçados do eletrencefalograma antes e durante a estimulação. As estimulações foram compostas por testes dicótico verbal, cálculos matemáticos, e audição de canto gregoriano. As amostras do traçado eletrencefalográfico, captado durante as estimulações, foram analisadas e comparadas com a atividade elétrica cerebral de base, com o objetivo de estudarmos a relação entre a estimulação cognitiva e a análise especial da freqüência dos ritmos cerebrais. A atividade elétrica cerebral foi registrada em um eletrencefalógrafo digital e foi avaliado o parâmetro: freqüência dominante (Hz), para todas as faixas clássicas de freqüência (delta, teta, alfa, beta 1, beta 2 e beta 3), sendo que os resultados significantes foram aqueles relacionados às freqüências alfa e beta1. No Grupo Controle Masculino, durante as estimulações, houve um, aumento da freqüência alfa em todos as regiões cerebrais analisadas, enquanto no Grupo Controle Feminino houve uma diminuição da mesma freqüência em todas as regiões estudadas. No Grupo Controle Masculino, durante a audição do Canto Gregoriano, houve uma diminuição da freqüência beta l em todos as regiões cerebrais analisadas, enquanto no Grupo Controle Feminino, houve um aumento da mesma freqüência beta 1. No Grupo Epiléptico Esquerdo Masculino, durante a audição do Canto Gregoriano, houve uma tendência à diminuição da freqüência alfa, diferente do que ocorreu com o Grupo Controle Masculino. Durante o Cálculo Matemático, o Grupo Epiléptico Esquerdo comportou-se como o Grupo Controle Masculino. O Grupo Epilético Direito Masculino, durante o Teste Dicótico, a audição do Canto Gregoriano e o Cálculo Matemático, comportou-se como o Grupo Controle Masculino, com aumento da freqüência alfa. No Grupo Epilético Esquerdo Feminino, durante o Teste Dicótico, houve uma tendência à diminuição da freqüência alfa e, o Canto Gregoriano, houve uma tendência ao aumento da freqüência beta 1 ...(au)