Electroencephalographic Findings, Antiepileptic Drugs and Risk Factors of 433 Individuals Referred to a Tertiary Care Hospital in Ethiopia

Little is known about the characteristics of electroencephalogram (EEG) findings in epileptic patients in Ethiopia. The objective of this study was to characterize the EEG patterns, indications, antiepileptic drugs (AEDs), and epilepsy risk factors. METHODS: A retrospective observational review of EEG test records of 433 patients referred to our electrophysiology unit between July 01, 2020, and December 31, 2021. Results: The age distribution in the study participants was right skewed unipolar age distribution for both sexes and the mean age of 33.8 (SD=15.7) years. Male accounted for 51.7%. Generalized tonic clonic seizure was the most common seizure type. The commonest indication for EEG was abnormal body movement with loss of consciousness (35.2%). Abnormal EEG findings were observed in 55.2%; more than half of them were Interictal epileptiform discharges, followed by focal/or generalized slowing. Phenobarbitone was the commonest AEDs. A quarter (20.1%) of the patients were getting a combination of two AEDs and 5.2% were on 3 different AEDs. Individuals taking the older AEDs and those on 2 or more AEDs tended to have abnormal EEG findings. A cerebrovascular disorder (27.4%) is the prevalent risk factor identified followed by brain tumor, HIV infection, and traumatic head injury respectively. CONCLUSION: High burden of abnormal EEG findings among epileptic patients referred to our unit. The proportion of abnormal EEG patterns was higher in patients taking older generation AEDs and in those on 2 or more AEDs. Stroke, brain tumor, HIV infection and traumatic head injury were the commonest identified epilepsy risk factors

Interictal epileptiform discharges in antiepileptic drug withdrawal in patients with epilepsy / 中华神经科杂志

Approximately two-thirds of patients with epilepsy become seizure-free with the adequate antiepileptic drug therapy.It is generally believed that antiepileptic treatment might be gradually withdrawn until stopped after a minimum period of two years of seizure freedom,as well as making a careful evaluation of the risk/benefit ratio.In the antiepileptic drugs discontinuance literature,the most consistent risk factors predictive of relapse are remote symptomatic causes,abnormal electroencephalogram and special epilepsy syndrome.The impacts of abnormal electroencephalogram,especially interictal epileptiform discharges on the seizure relapse after antiepileptic drugs withdrawal are not completely clear for now.In this article the literature describing the predictive value of interictal epileptiform discharges in different withdrawal periods is reviewed.

Relationship between abnormal monitoring of VEEG and prognosis in patients with refractory epilepsy / 实用医学杂志

Objective To investigate and study the relationship between abnormal monitoring and prognosis of long range video electroencephalogram(VEEG)in patients with intractable epilepsy. Methods 100 patients from March 2012 to May 2017 in our hospital whose diagnosis and treatment of refractory epilepsy were the research object,all patients were given VEEG monitoring records,epilepsy typing characteristics and antiepileptic drug(AEDs)use survey,prognosis of all patients and the correlation analysis. In 100 cases,GTCS 60 cases,CPS 30 cases,CPS-GTCS 10 cases;56 cases treated with sodium valproate,lamotrigine treatment in 44 cases. Results VEEG monitored 80 cases of epileptiform discharge in 100 patients and 20 cases without epileptiform discharge. There was no significant difference in the incidence of epileptiform discharges between different epileptic patients in VEEG monitoring(P > 0.05),and there was no significant difference in the incidence of epileptiform discharges between VEEG patients in different medication groups(P > 0.05). The total effective rate of treatment in the VEEG epileptiform discharge group was 91.3%,which was significantly lower than that of the VEEG non epileptic discharge group (100%,P < 0.05). The main adverse reactions during treatment were drowsiness , abnormal behavior, abnormal sensation and gastrointestinal reaction. There was no significant difference in monitoring epileptiform discharges between VEEG patients (P > 0.05). All adverse reactions were improved after symptomatic treatment. Conclusion The VEEG plays an important role in guiding the patients with refractory epilepsy for epilepsy typing characteristics and AEDs treatment ,so it has significant correlation to the prognosis , and it also has an important significance in assessing the prognosis.

Effect of subclinical epileptiform discharges on cognitive function in adult epilepsy / 中华神经科杂志

Objective To investigate the effect of subclinical epileptiform discharges (SED) on the cognition of adult patients with epilepsy,exploring the mechanism of SED that leads to cognitive impairment in adult patients with epilepsy to raise physicians' attention about SED.Methods Patients were collected in the Department of Neurology,China-Japan Union Hospital of Jilin University from March 2016 to March 2017.Sixty adult patients with epilepsy without clinical episodes in the last three months were selected as SED group and 40 healthy volunteers as control group.Medical history of the SED group was recorded in detail.All patients were examined by Self-rating Anxiety Scale,Self-rating Depression Scale,Pittsburgh Sleep Quality Index scale in order to exclude organic brain disorders,metabolic diseases,anxiety,depression,sleep disorders and drug-induced cognitive dysfunction.Subjects in the two groups received Montreal Cognitive Assessment (MoCA),electroencephalogram and blood oxygen level dependent functional magnetic resonance imaging examination.Finally,the results were compared between the two groups.Results ①SED had different effects on cognitive function in adult patients with epilepsy,and the MoCA score (26(22,27)) showed statistically significant difference compared with the control group (29 (28,29),Z =-6.26,P =0.00).②Different discharges indexes showed different effects on cognitive function aspects.Cognitive impairment was significant when the discharges indexes were ＞ 10％ (discharges indexes 1％-10％:MoCA score 26(26,28),discharges indexes 10％-50％:MoCA score 22(19.5,25),Z =-4.74,P =0.00).③The cognitive function of epilepsy patients was positively correlated with the duration of education (r =0.41,P =0.00) and the time interval to recent seizure (r =0.31,P =0.02),and negatively correlated with SED (r =-0.57,P=0.17).There was no correlation between cognitive function and duration of disease and onset age.The SED was the main influencing factor of cognitive function in epilepsy.④Compared with healthy people,epilepsy patients with SED showed differences in resting brain function network connection,with strong connective regions at the right inferior temporal gyrus,right hippocampus,bilateral thalamus,with weak connective regions at the double medial upper frontal gyrus,lateral dorsal frontal gyurs.Conclusions SED had an effect on the cognitive function of adult patients with epilepsy.The mechanism of cognitive impairment in adult epilepsy with SED may be related to abnormal brain function in cognitive-related areas.

Comparative study on the interictal electrophysiological characteristics of symptomatic temporal lobe epilepsy and extratemporal lobe epilepsy patients / 临床神经病学杂志

Objective To analyze the characteristics and some related influences of interictal epileptiform discharges (IEDs) for symptomatic temporal lobe epilepsy(TLE) and extratemporal lobe epilepsy(ETLE) patients in whom with focal lesion on structural imaging .Methods The electrophysiological and clinical data of 257 epilepsy patients were retrospectively analyzed , all of whom had a focal lesion revealed by structural imaging .Patients were divided into 2 groups according to the locaton of the lesion:TLE group and ETLE group , patients were also divided into 3 subgroups according to the relationship between the location of IEDs and the lesion :TLE-1/ETLE-1 subgroup with a norm interictal EEG; TLE-2/ETLE-2 subgroup with IEDs absolutely located in brain lobes in which lesion located;TLE-3/ETLE-3 subgroup with IEDs exceed or absolutely not located in the lobes in which lesion located . Results The proportion of TLE-1 was significantly lower than ETLE-1 ( P<0.01 ) , while the proportion of TLE-2 was significantly higher than ETLE-2(P<0.01).The proportion of the TLE-3 subgroup increased along with a longer duration, and the proportion of ETLE-3 subgroup decreased along with a lower seizure frequency , and also the older the age at onset .Conclusions The positive rate of IEDs and its positioning accuracy are significantly higher in symptomatic TLE than that in ETLE patients .The distribution of IEDs is more likely to be affected by epilepsy duration in TLE , while it is more easily to be affected by seizure frequency and age at onset in ETLE .

Scalp acupuncture for epileptiform discharges of children with cerebral palsy / 中国针灸

<p><b>OBJECTIVE</b>To explore the effect of scalp acupuncture for children with cerebral palsy whose video-electroencephalogram(VEEG) showed epileptiform discharges.</p><p><b>METHODS</b>A total of 184 children with cerebral palsy whose VEEG showed epileptiform discharges or those combined with epilepsy were randomly assigned into a combination group (99 cases) and a rehabilitation group (85 cases). All the cases were treated with the original antiepileptic drugs. The conventional physical training and massage were applied in the rehabilitation group for 3 courses with 20 d at the interval, once a day, 5 times a week and 15 times as one course. Based on the treatment as the rehabilitation group, scalp acupuncture was used in the combination group for 3 courses with 15 d at the interval, once the other day and 10 times as one course. Shenting (GV 24), Benshen (GB 13), Sishencong (EX-HN 1) were selected as the main acupoints, combined with motor zone, foot motor-sensory area, balance zone,and temple-three-needle etc. Clinical onset and VEEG results were observed before and after treatment.</p><p><b>RESULTS</b>After treatment in the combination group, 27 cases improved; 47 cases had no effect; 25 cases aggravated. While in the rehabilitation group, 11 cases improved; 46 cases had no effect; 28 cases aggravated. There was no statistically significance between the two groups (>0.05). As for the cases with epilepsy onset in the combination group, 8 cases improved; 4 cases had no effect; 4 cases aggravated. In the rehabilitation group, 4 cases had no effect; 7 cases aggravated. The result in the combination group was better than that in the rehabilitation group (<0.05). As for the cases with epileptiform discharges in the combination group, 19 cases improved; 43 cases had no effect; 21 cases aggravated. In the rehabilitation group, 11 cases improved; 42 cases had no effect; 21 cases aggravated. There was no significance between the two groups (>0.05).</p><p><b>CONCLUSIONS</b>Scalp acupuncture therapy does not increase the risk of onset or epileptiform discharges in the children with cerebral palsy combined with epilepsy or epileptiform discharges. Scalp acupuncture combined with rehabilitation is better than simple rehabilitation for thosewith cerebral palsy and epilepsy onset.</p>

Assessment of EEG as a Diagnostic and Prognostic Indicator Tool in the Febrile Seizures.

Objective: To assess the sensitivity, specificity, and predictive value of EEG as a diagnostic and prognostic tool in the febrile seizures. Method: This study was conducted on 50 consecutive children with febrile seizures attending the pediatric OPD of a tertiary care hospital. The children were prospectively identified and EEG was carried out on two occasions. First EEG was done within one week of febrile seizure episode and second EEG was done after 03 months of first EEG. EEG records were obtained with the standard international protocols for duration of 35 minutes which included 25 minutes of sleep record in all the children. Photic stimulation, hyperventilation and sleep deprivation were used as activation procedures. Descriptive analysis of EEG tracings was done in terms of background activity and presence of abnormal waveforms. Result: Paroxysmal EEG abnormalities were present in 54% of children. Most common epileptiform discharges were of generalized epileptic discharge followed by focal polyspikes. Sleep deprivation was the most effective activation procedure in evaluating febrile seizure with abnormal epileptiform discharge patterns. Validity measures of EEG in febrile seizure were found to have 90% sensitivity, 70% specificity, 72% positive predictive value and 88% negative predictive value within 95% confidence interval. Conclusion: EEG is a sensitive method for identifying and quantifying electrical activity in febrile seizures. EEG is useful as a diagnostic and prognostic tool in febrile seizures and can provide information regarding presence of abnormalities, degree of encephalopathy and electrographic features but like all diagnostic tool it is not fully infallible and requires further alternative diagnostic and clinical support.

A study on circadian rhythm of interictal epileptiform discharges in patients with localization related epilepsy / 中华行为医学与脑科学杂志

Objective To investigate the effects of circadian rhythm on interictal epileptiform discharges in patients with localization-related epilepsy.Methods Patients diagnosed with epilepsy in Sanbo Brain Hospital from January 2011 to January 2012 participated in this study.All patients were subjected to comprehensive evaluation,which included prolonged video-electroencephalogram (EEG),magnetic resonance imaging.Intracranial electrodes,PET,SPECT were also adopted if necessary.Circadian rhythm was divided into four stages:REM,NREM Ⅰ-Ⅱ,NREM Ⅲ-Ⅳ,and waking.The amount and distribution of ⅡD were compared by ANOVA.Results Significant differences in the amount and distribution of ⅡD were found among NREM Ⅰ-Ⅱ,NREM Ⅲ-Ⅳ,REM,and waking.However,no differences in the amount and distribution of ⅡD were noted between NREM Ⅰ-Ⅱ and NREM Ⅲ-Ⅳ as well as between REM and waking.Conclusion The amount of ⅡD is higher in NREM than in REM and waking;thus,NREM is more sensitive to diagnose epilepsy.The distribution of ⅡD in REM and waking is more restricted than that in NREM.

Current Source Distribution of Periodic Lateralized Epileptiform Discharge: Comparison With Diffusion-Wighted MR Imaging in Viral Encephalitis

BACKGROUND: Periodic lateralized epileptiform discharges (PLEDs) are the main electroencephalograph (EEG) findings that imply the existence of acute or subacute structural lesions. The purpose of this study was to investigate the electrophysiologic characteristics of PLEDs by identifying the relationship between the current-source distribution (CSD) of PLEDs and the high signal intensity of diffusion-weighted magnetic resonance imaging (MRI; HSI-DWI) in viral encephalitis. METHODS: Six patients were enrolled. Twenty typical EEG, 1-s epochs, including the negative peak of the PLEDs, were averaged into an averaged-PLED (a-PLED). The CSD at the negative peak point of the a-PLED was located on the Talairach human brain map in each patient. The CSDs of the patients were compared with the anatomic locations of encephalitic lesions observed on diffusion-weighted MRI. RESULTS: In all patients, the locations with HSI-DWI were observed in the cortical areas. In two out of the six patients the locations of CSD and those of HSI-DWI were matched. In the other patients, they were partly matched. The matched areas were observed in the frontal, temporal, and parietal areas. The additional areas of CSD were in both insular areas, and those of HSI-DWI were in the frontal, temporal, parietal, and occipital areas. CONCLUSIONS: This study showed that the CSDs of PLEDs in viral encephalitis were mostly matched with the HSI-DWI in the cortical area of the frontal, temporal, and parietal areas. The cortical lesion itself in viral encephalitis may be part of the neural generator of PLEDs.

Correlation between Patterns of Focal Epileptiform Discharges and Brain Lesions in Children with Focal Epilepsy / 대한소아신경학회지

PURPOSE: The objective of this study was to evaluate the correlation between patterns of focal epileptiform discharge (ED) and brain lesions diagnosed by MRI in children with focal epilepsy. METHODS: We retrospectively reviewed routine scalp EEGs, medical records, and results from brain MRIs in 149 children who had been diagnosed as epilepsy with focal epileptiform discharges in our hospital between 2008 and 2010. We classified the patterns of focal ED into spikes, sharp waves, and polyspikes. EEGs with homogenous patterns of ED were termed single-form ED and those with heterogenous patterns of ED were termed multi-form ED. We evaluated the relationship between the specific patterns of focal ED and brain lesions in pediatric epilepsy. RESULTS: Fifty-six of 149 (37.6%) patients had brain lesions on brain MRI. 67.8% (101/149) patients exhibited single-form ED and 32.2% (48/149) patients revealed multi-form ED. Thirty of 48 patients (62.5%) with multi-form ED showed brain lesions, which was higher than those for patients with single-form ED (25.7%, 26/101) (P <0.001). 27.5% (41/149) patients had and 25/41 (61.0%) also had brain lesion, which was higher than those for patients without polyspikes (28.7%, 31/108) (P <0.001). 19 of 82 patients (23.2%) with single-form ED with spikes only had brain lesion on brain MRI, which was significantly lower than those of remaining patients (55.2%, 37/67) (P <0.001). CONCLUSION: We suggest that a heterogenous pattern of ED or polyspikes lead to a higher incidence of brain lesions in children with focal epilepsy.

Effects of N-methyl-N-cis-styryl-cinnamamide on Penicillin-induced Epileptiform Discharges in Rats / 中山大学学报(医学科学版)

[Objective]To investigate the effects of the seed extract of Clausena lansium,N-methyl-N-cis-styryl-cinnamamide,on the penicillin-induced epilepsy in rats.[Methods]Thirty-two Sprague-Dawely rata were randomly divided into four groups with 8 rats in each group:normal control(20 mL/L Tween 80+Normal Saline),model control(20 mL/L Tween 80+Penicillin),low dose treatment(Cinnamamide 75 mg/kg+Penicillin),hish dose treatment(Cinnamamide 150 mg/kg+Penicillin).The epilepsy rat model was established by localized intracortical injections of penicillin.The effects of pretreatments of the rats with N-methyl-N-cis-styryl-cinnamamide(intraperitoneal injection,ip)on the penicillin-induced seizure activities and the epileptiform discharges recorded by electrocorticogram(ECoG)were observed.[Results]The penicillin-induced seizure was significantly lightened in both the pretreatment groups(75 and 150 mg/kg N-methyl-N-cis-styryl-cinnamamide),compared with the model group.N-methyl-N-cis-styryl-cinnamamide(75 and 150 mg/kg)could significantly prolonged the latency of epileptiform activities,shorten the duration of epileptiform discharges and decreased the mean spike frequency in the late stage(P＜0.05 or P＜0.01).However,there was no significant difference in the highest value or the lowest value of the epileptiform waves between the model and cinnamamide treatment groups.[Conclusion]The seed extract of Clansena lansium,N-methyl-N-cis-styryl-cinnamamide,can significantly inhibit the seizure and epileptiform discharges caused by penicillin-localized injections in the cortex of rats,suggesting that the natural substance has an anticonvulsive function.

Clinical Review of Subclinical Epileptiform Discharges in Children with Cerebral Palsy / 中国康复理论与实践

@# The effects of subclinical epileptiform discharges (SEDs) on children with cerebral palsy cannot be ignored. Data from neurodevelopmental clinic studies showed that the overall incidence of SEDs in cerebral palsy was 18%～40%, with the highest in spastic hemiplegia and diplegia. The major pattern of SEDs was focal and multifocal, and was usually found in centro-temporal and parietal regions. The cortex impairment and other complications were risk factors related to SEDs in cerebral palsy. Paroxysmal or frequent long-time SEDs, with the Results of transient or chronic cognitive impairment, have been found to lead to subsequent death of cortical neurons of cerebral palsy patients thereby worsening their prognosis. Valproic acid (VPA), benzodiazepines (BZs) and lamotrigine (LTG) have a role in inhibiting SEDs, while adrenocorticotropic hormone (ACTH) and glucocorticoids have a great role in it.

Effect of Sleep on Epileptiform Discharges in Epileptic Patients with Structural Lesion: Based on Routine EEG / 영남의대학술지

BACKGROUND: It is well known that non-rapid eye movement(NREM) sleep activates the occurrence of interictal epileptiform discharges(IED) in many epileptic syndromes. We performed this study to assess the effect of NREM sleep on IED in epileptic patients with organic brain lesions. MATERIALS AND METHODS: We analyzed awake and sleep electroencephalopathy(EEG) recorded simultaneously after partial sleep deprivation in 50 patients. We calculated the awake and sleep spike index (ASI and SSI, spikes/epoch), and the percentage increase of ASI and SSI during sleep. RESULTS: In the 50 patients, the IEDs were recorded exclusively during the awake state in 1 (2%) patient, and during the sleep state in 13(26%) patients. The SSI was higher in 44 (88%) patients, and the ASI was higher in 5 (10%) patients. The mean ASI and the SSI in patients with organic brain lesions were 0.058+/-0.121 and 0.148+/-0.187, and it was 0.081+/-0.150 and 0.174 +/-0.226 in patients without organic brain lesions. There were significant increases in the spike index (P0.05). CONCLUSION: The IEDs were activated significantly during NREM sleep both in patients with and without organic brain lesions, but there were no differences in the degree of activation in both groups. The activating effect of NREM sleep was not correlated with clinical factors such as, frequent nocturnal seizures, frequent generalized tonic clonic seizures, type of epilepsy and taking anticonvulsants. We conclude that the routine EEG used to evaluate epileptiform discharges in epileptic patients should include sleep recordings after partial sleep deprivation.

Ictal Scalp EEG in Mesial Temporal Lobe Epilepsy Patients with Unilateral versus Bilateral Interictal Epileptiform Discharges

BACKGROUND: Interictal and ictal scalp EEG is the most often used and relied-on method of noninvasive presurgical evaluation in temporal lobe epilepsy. We attempted to compare unitemporal interictal epileptiform discharges (UIED) with bitemporal interictal epileptiform discharges (BIED) groups for lateralizing value and propagation patterns of ictal scalp EEGs. METHODS: We investigated ictal scalp EEGs in 48 patients who had undergone anterior temporal lobectomies. We divided them into UIED and BIED groups by cut-off value of 90% in the laterality of IED. RESULTS: We analyzed ictal EEG patterns in 201 seizures of 32 patients with UIED and 86 seizures of 16 patients with BIED. Ictal scalp EEG was correctly lateralized significantly more often in the UIED group compared with the BIED group; 93.5% versus 57.0% in seizures and 93.8% versus 62.5% in patients, respectively. Bilateral independent onset was seen more frequently in the BIED group whereas the maintenance of ictal discharges in the unilateral temporal or hemisphere occurred more frequently in the UIED group. Lateralization by a later significant pattern (LSP) presents additional value of correct lateralization rather than pattern at onset (PAO) only. CONCLUSIONS: Interpretation of ictal scalp EEGs must be considered more cautiously in patients with BIED because BIED may be correlated with bitemporal excitability.

Basic Electrophysiology of the Electroencephalography

Although neuroimaging techniques and other diagnostic procedures has been developed, electroencephalography(EEG) is still very important for the evaluation of various brain diseases and functional studies of human brain. EEG is formed mainly by spatial and temporal summations of postsynaptic potentials generated from a large population of pyramidal cells that can be considered as a collection of oscillating dipoles. EEG shows continuous rhythmic oscillation depending on sleep-waking state. Alpha rhythms are generated in cortical areas acting as epicenters with local spread, although the precise cellular mechanism is still unknown. It's been known that neurons in the nucleus reticular thalami are the pacemakers of sleep spindle. Alterations in the circuit of the reticular nuclei-thalamocortical relay neuron-cortical neuron are responsible for generalized spike and wave complexes. At the intracellular level, large paroxysmal depolarizing shifts produce focal epileptic spikes. Slow waves of EEG appear to be related to thalamocortical and/or corticothalamic deafferentation. The interpretation of routine EEG requires a well training from a qualified EEG teacher and reading adequate amount of EEG under supervision. Frequent misinterpretations of routine EEG have been observed in both local clinics and general hospitals. The most common findings of normal routine EEG misinterpreted as abnormal are normal variants and artifacts of various sources. There are considerable variations of normal EEG rhythms and pseudoepileptiform discharges. Eyeball movements produce prominent or subtle EEG changes over the frontal regions that are sometimes hard to be differentiated from abnormal slow waves over that region. Systematic approach was described for a good interpretation of routine EEG.

A Study on the Clinical Significance of Periodic Lateralized Epileptiform Discharges and Relation to Brain Imaging Study in Children

PURPOSE: Periodic lateralized epileptiform discharges (PLEDs), initially described by Chatrian et al in 1964, are an EEG phenomenon characterized by lateralized or focal spike-and-wave complexes with moderate to high voltage which occur in a periodic or semiperiodic pattern. This study was performed to assess the clinical significance of PLEDs and its relation to an imaging study of the brain. MEHTODS: Twenty children (10 males and 10 females), from 2 days to 14 years of age, who had been hospitalized at Hanyang University Hospital were studied retrospectively. Their medical records, EEG results and brain imaging study were reviewed. RESULTS: Of the 20 patients studied, 15 patients showed unilateral PLEDs and 5 had bilateral PLEDs in EEG. Brain imaging studies were done for 18 of the patients, revealing abnormalities in 15 patients in this order of frequency: intracranial hemorrhage, diffuse cerebral atrophy, leukomalacia, cerebral infarctions, cerebral edema and hydrocephalus. PLED sites were not significantly correlated with the results of the imaging study. Finally, 3 patients died and 17 patients survived, and among the surviving 17 patients, 5 had recurrent seizures, 1 had recurrent seizures with mental regression, 3 had neurologic sequelae without seizures and 8 had no neurologic sequelae. CONCLUSION: We conclude that children who show PLEDs in EEG are more commonly associated with acute cerebral lesions and there is a high incidence of subsequent seizures and/or other neurological sequelae in surviving children with PLEDs.

A Study on the Clinical Significance of Periodic Lateralized Epileptiform Discharges and Relation to Brain Imaging Study in Children

PURPOSE: Periodic lateralized epileptiform discharges (PLEDs), initially described by Chatrian et al in 1964, are an EEG phenomenon characterized by lateralized or focal spike-and-wave complexes with moderate to high voltage which occur in a periodic or semiperiodic pattern. This study was performed to assess the clinical significance of PLEDs and its relation to an imaging study of the brain. MEHTODS: Twenty children (10 males and 10 females), from 2 days to 14 years of age, who had been hospitalized at Hanyang University Hospital were studied retrospectively. Their medical records, EEG results and brain imaging study were reviewed. RESULTS: Of the 20 patients studied, 15 patients showed unilateral PLEDs and 5 had bilateral PLEDs in EEG. Brain imaging studies were done for 18 of the patients, revealing abnormalities in 15 patients in this order of frequency: intracranial hemorrhage, diffuse cerebral atrophy, leukomalacia, cerebral infarctions, cerebral edema and hydrocephalus. PLED sites were not significantly correlated with the results of the imaging study. Finally, 3 patients died and 17 patients survived, and among the surviving 17 patients, 5 had recurrent seizures, 1 had recurrent seizures with mental regression, 3 had neurologic sequelae without seizures and 8 had no neurologic sequelae. CONCLUSION: We conclude that children who show PLEDs in EEG are more commonly associated with acute cerebral lesions and there is a high incidence of subsequent seizures and/or other neurological sequelae in surviving children with PLEDs.

The Clinical Study on the Epileptiform Discharges and Imaging Study in Newborn with Seizures / 대한소아신경학회지

PURPOSE: Neonatal seizures are mostly symptomatic and have variable atypical clinical features with very different EEG findings from those of post-neonatal period. This study was performed to determine the common types of epileptiform discharges and their relationship with abnormalities in imaging study in neonates with seizures. METHODS: Fourty one neonates under 7 days of age who had been hospitalized at the Hanyang university hospital from June 1993 to May 1997 were studied retrospectively. Their medical records, results of EEG and brain imaging study were reviewed. RESULTS: 1) The types of neonatal seizures were subtle, generalized tonic, multifocal clonic, focal clonic, myoclonic in order of frequency. 2) The most common epileptiform discharge was excessive sharp transients recorded in 28 cases and the rest showed multifocal spikes, sharp waves, repetitive alpha, repetitive theta in order. Epileptiform discharges appeared on the both hemisphere in 24 cases, right hemisphere in 9 cases and left hemisphere in 8 cases. 3) Imaging study showed no abnormal findings in 27 cases and abnormal findings in 14 cases such as brain edema, intracranial hemorrhage, leukomalacia, subarachnoid hemorrhage, cephalhematoma, craniosynostosis. 4) Among 14 cases with radiological abnormalities, 5 cases had localized abnormalities and 3 of them had the abnormal EEG discharges on the same area concomittantly. But in total only 3 cases of 17 cases with localized epileptiform discharges had abnormalities in imaging study on the same site and so significant relationship between two studies was not observed. 5) As for the prognosis of seizures, subsided in 23 cases without any antiepileptic drugs, 13 cases had no seizure after taking medicine for few days and 5 cases needed continuous antiepileptic drug. CONCLUSION: This study showed no meaningful relationship between abnormal EEG findings and localization by imaging study in neonatal seizure but we concluded that brain imaging study was needed to determine degree of encephalopathy in neonatal seizures.

Influence of subclinical epileptiform discharges on mathematics cognitive function / 临床神经病学杂志

Objective To explore the influence of subclinical epileptiform discharge(SED) on mathematics cognitive function. Methods Using event-related potential (ERP) detection method by stimulation of mathematical operation,11 patients with benign epilepsy of children with centrotemporal spikes (BECTS group),who treated with Valproate sodium (VPA) and clinical seizures got under control,but had frequent SED,and 11 normal children (NC group) were detected. The results were analysed. Results Compared with NC group,the P3 latencies of all leads in BECTS group were significantly prolongation (all P