Clinical characteristics and electroencephalography features of intractable childhood epilepsy - A case series
Abstract
Background The majority of epilepsy patients have good prognosis, but lOAO% will develop intractable epilepsy. Early identification of patients v.ith risks of developing intractable epilepsy allows more intensive therapy to be performed.
Objective To study clinical characteristics and electroencephalography (EEG) features of intractable childhood epilepsy.
Methods We reviewed children \\lith intractable epilepsy attending the Pediatric Neurology and Growth and Development Clinic in Child Health Department, Cipto Mangunkusumo Hospital from 2005ô€2008. EEG examination was perfonned in epilepsy patients who had consumed two or more antiepileptic drugs for at least 18 months but still experienced seizure at least once per month. Data of clinical characteristics were collected from the medical records and information provided by the parents.
Results There were 41 subjects. Age of onset between oô€ 1 year old was found in 50% subjects, neurological impainnent in 80%, microcephaly in 50%, and abnonnal neuroimaging in 14 of 24 subjects. Seizure manifestations were mostly generalized tonic clonic, tonic, my oclonic, and complex partial seizures. Abnonnal
EEG features were found in 88% subjects and the majority showed generalized sloMng of the background activity. Focal and multifocal epileptifonn activity was found in 31 % and 28% subjects, respectively. Epileptifonn activity was located mostly in the frontal and temporal lobe.
Conclusions Most patients Mth intractable epilepsy haveage of onset before the age of 1 year. A substantialpoportionof them have neurological impairment, microcephaly,abnonnal neuroimaging, and abnormal EEG features. Seizure manifestation ismostlygeneralized seizure. Epileptiform activity in intractable childhood epilepsy is often found in the frontal and temporal lobe.
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References
2. Jensen FE, Privitera MD, Shields WD. Evolving directions in the management of epilepsy. Clinician. 2002;20:6-9.
3. Paolicchi JM. Epilepsy in adolescents: diagnosis and treatment
[homepage on the internet]. [cited 2005 Apr 6]. Available from: http://www.dcmsonline.org.
4. Chawla S, Aneja S, Kashyap R, Mallika V. Etiology and clinical predictors of intractable epilepsy. Pediatr Neurol. 2002;27,186,91.
5. Chabolla DR. Medically refractory seizures [homepage on the
internet]. [cited 2005 Apr 6]. Available from: http://www.
dcmsonline.org.
6. Sheth RD. Epilepsy surgery presurgical evaluation. Neurol ClinAm. 2002;20:1195-1215.
7. SinghviJp, Sawhney 1M, Lal V. Pathak A, Prabhakar S. Profile
of intactable epilepsy in a tertiary referral center. Neurol India. 2000;48,351,6.
8. Kwong KL, Sung WY, Wong SN, So KT. Early predictors of medical intractability in childhood epilepsy. Pediatr Neurol. 2003;29;46,52.
9. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckennan B. Early development of intractable epilepsy in children. A prospective study. Neurology. 2001 ;56: 1445-52.
10. Camfield P, Camfield after stopping aeds in seizure-free children 'With epilepsy. Neurology. 2005;64,913-5.
11. Akhondian J, Heydarian F, Ali Jafari S. Predictive factors of pediatric intractable seizures. Arch Iranian Med. 2006;9,236-9.
12. Acharya IN. Recent advances in epileptogenesis. Cuff Science. 2002;82,679-88.
13. Stafstrom CEo Back to basic: the pathophysiology of epileptic seizure: a primer for pediatricians. Pediatr Rev. 1998; 19:342-51.
14. Sirven JI, Waterhouse C. Management of status epilepticus. Am Fam Physician. 2003;68A69-76.
15. Young OM. Pediatrics, status epilepdcus [homepage on the internet]. [Updated 2008 Ju118, cited 2009 Mar 17]. Available from: http://\VWW.emedidne.com.138.
16. Ko TS, Holmes GL. EEG and clinical predictors of medically intractable childhood epilepsy. Clin Neurophysiol. 1999; 110, 1245-51.
17. Engel]. Causes of human epilepsy. In: Engel], editor. Seizures and epilepsy. Philadelphia: EA. Davis Company, 1989; p.112-30.
18. Purugganan OR, Adam HM. Abnormalities in head size. Ped Rev. 2006;27A73-6.
19. RiosA. Microcephaly. Pediatr Rev. 1996;17,386-7.
20. Beckhung E, Uvebrant P. Motor and sensory impainnent in children 'With intractable epilepsy. Epilepsia. 1993; 34:924-9.
21. Commission on Classification International League Against pilepsy. Proposal for revised classification E, editor. The treatment of epilepsy: principles and practice. 2nd ed. Pennsylvania: Williams & Wilkins,1997; p.367-75.
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Accepted 2016-10-06
Published 2010-06-30
