We studied recurrence risks and predictive factors of relapse after antiepileptic drug (AED) discontinuation in a prospective analysis of 425 children with epilepsy who had not had a seizure for at least 2 years (follow-up after withdrawal 1.6-12 years, mean 8 years). Factors closely related by multivariate analysis to relapse were neurologic abnormalities, mental retardation, seizure type (infantile spasms, absence seizures), and appearance or persistence of EEG abnormalities during the course of the illness and before discontinuation. When multivariate analysis was performed to evaluate outcome of patients with a first relapse (isolated vs. multiple relapses), the variables closely related to a poor prognosis were etiologic factors, first relapse characterized by more than one seizure in a 24-h period, seizure-free period less than 4 years, unchanged seizure type at first relapse, more than one AED for seizure control, and abnormal EEG before the first relapse. In itself, resumption of therapy did not influence outcome. At the study cutoff point, 88% of patients with relapse were again seizure-free. We conclude that AEDs can safely be discontinued if predictive factors are considered to individualize the risk of relapse for each patient.

We evaluated photosensitivity and pattern sensitivity in 74 epileptic children (38 males, 36 females aged 4.4-19 years; mean age 11.9 years) with reflex seizures induced by environmental visual stimuli and analyzed clinical and EEG characteristics of patients according to type of sensitivity. Standard procedures of visual stimulation were used in all cases. Seven children were excluded because of poor cooperation (3) or no activation (4). Fifty-one percent of the remaining 67 patients showed sensitivity to both light and pattern, whereas 33% showed photosensitivity and 16% showed pattern sensitivity. Generalized abnormalities were more frequently elicited by intermittent light stimulation than by pattern (73 vs. 36%, p < 0.001). Significant differences in clinical and EEG findings were noted among patients according to their sensitivity to light or/and pattern. In particular, pattern-sensitivity patients without photosensitivity had a higher occurrence of localization-related symptomatic epilepsies, neurologic abnormalities, and epileptiform EEG abnormalities, mainly focal, at rest.

We have tried to ascertain whether the increased visual evoked potential (VEP) amplitude found in adult migraineurs is present also in children with migraine. We investigated 43 children, 26 male and 17 female, with a mean age of 11.4 years, 24 with common and 19 with classic migraine, and compared them with a control group of 20 children, 11 male and 9 female, with a mean age of 9.7 years. Flash and pattern reversal VEPs were recorded in both groups, and the study was carried out in the pain-free interval between attacks. The children with migraine showed a significant (p less than 0.01) increase in VEP amplitude on flash stimulation but not on pattern reversal. There were no differences between classic and common migraine. The abnormal responsiveness of the visual system seems to be related to variations in light intensity rather than to spatial contrasts.

We studied five children (1 boy and 4 girls) with self-induced pattern-sensitive epilepsy. All patients had refractory epilepsy with multiform, though mainly myoclonic, seizures and medium grade to severe mental retardation. Spontaneously self-induced seizures were documented in all cases by EEG. All the patients underwent full neurophysiological assessment (baseline EEG recording, with activation: eyelid closed, hyperventilation, ILS, EEG during the randomized presentation of 3 types of spatial structured stimuli, VEP-F and VEP-PR). The pattern that triggered the EEG anomalies was highly specific and selective for each patient. Clinical seizures were reproduced by the same patterns as the ones used by the patients to bring on the seizures at will. Authors stress the importance of identifying such peculiar type of epilepsy and of attempting adequate treatment.

Summary:Purpose: To evaluate the long-term outcome of patients with pattern-sensitive epilepsy.Methods: We prospectively studied 35 patients (21 females and 14 males) with pattern-sensitive epilepsy (follow up ≥5 years; mean 13.9; range 6.4 -27.6). All cases had regular clinical examinations and serial electroencephalographic (EEG) recordings. Photosensitivity and pattern sensitivity were ascertained neurophysiologically in all cases. Outcome was evaluated according to the following variables: duration of photosensitivity, rate of remission (seizure-free period ≥ 2 years), withdrawal of therapy, and recurrence after drug discontinuation.Results: The epilepsy was generalized in 18 cases (17 idiopathic, one symptomatic) and partial in 17 (13 idiopathic, four symptomatic). Sixteen patients (46%) had a family history of seizures. The mean age at the last examination was 21.4 years (range 11.2-35.5 years). Five patients (14%) had only reflex seizures. The most common type of spontaneous seizures was generalized (60%), whereas reflex seizures were more frequently partial (74%). Mean epilepsy duration was 8.7 ± 6.3 years. Patients with only reflex seizures were instructed to avoid precipitating stimuli and were not treated with antiepileptic drugs. Treatment was gradually withdrawn in 10 out of 30 treated patients, with relapse in only two cases. At the end of follow up, 28 patients (80%) were seizure-free.Conclusion: The long-term outcome of patients with patternsensitive epilepsy indicates a good prognosis with a favorable course for both spontaneous and reflex seizures.