The antiepileptic effect of allopurinol was assessed in a double-blind, randomized, placebo-controlled, cross-over trial in 84 patients with epileptic seizures refractory to standard antiepileptic drugs (AEDs). During a retrospective baseline period, patients experienced at least four seizures of any type per month. The effects of allopurinol and matching placebo were examined for 4-month periods. Allopurinol dosage was 150 mg daily for children weighing < 20 kg and 300 mg daily for other patients. Efficacy analysis based on the Wilcoxon rank-sum test was conducted for the 80 patients who completed the study. No significant period effect or treatment-period interaction was noted. Allopurinol significantly reduced total seizures (p = 0.005), and secondarily generalized seizures (p = 0.0015). Median seizure reduction for total seizures was 10.5 and 27.9% for secondarily generalized seizures. Subjective preferences by clinicians evaluated blindly significantly favored allopurinol. No significant change occurred in the plasma concentration of concomitant AEDs between treatment periods, but serum urate decreased by 32% during allopurinol treatment. No clinically relevant side effects or changes in routine laboratory clinical chemistry or hematology were ascribed to allopurinol.

EMA (eyelid myoclonia with absences) consists of brief seizures triggered by eyelid closure and characterized by absence and palpebral myoclonia. The EEG shows brief discharges with 3 per second spike and wave complexes. The present report describes the cases of 2 monovular twins who started to have this form of epilepsy at the age of 4 1/2 years. Their seizures, after 2 years of follow-up, are greatly reduced with combined therapy of valproic acid and benzodiazepines (Clobazam).

Electrical status epilepticus during slow sleep (ESES) is characterized by an EEG picture that justifies its name. It can be accompanied by epileptic seizures, speech and behavior disturbances and in rare cases by an acquired sensory aphasia. We describe the case of a six-year-old girl, whose EEG presented the typical ESES picture, and who in the span of one year developed a complete sensory aphasia, followed by motor aphasia. After 6 months of treatment with clobazam recovery of speech was nearly complete, but after 8 months clobazam lost its effectiveness and the girl presented a speech regression. Treatment with nitrazepam led to a complete recovery of speech for a second time, while at the same time ESES in the EEG again disappeared. This case, in addition to others described in the literature, suggests the possibility of a direct correlation between electrical abnormalities of the brain and cognitive and speech disturbances.

The importance of tactile somatosensory stimuli as a triggering mechanism in provoking epileptic seizures is widely acknowledged. These seizures are mostly partial ones with secondary generalization, but may also be, rarely, primary generalized seizures. Up to now, no case of petit mal absence, triggered by somatosensory stimuli, has been described. The subject of this report is a 15-month-old girl, who for a period of 3 months presented absence induced by finger tapping on her forehead or in the parietal region; the duration of the attacks ranged from 6 to 12 seconds. The EEG showed a characteristic pattern of diffuse discharges of 3 Hz/sec spike and wave complexes. During this critical period, the child was well, except for the seizures. Possible mechanisms for triggering this type of seizure are discussed.

The International Classification of the Epilepsies defines two types of generalized epilepsies: primary (mainly functional) and secondary (organic) and only one type of partial epilepsy, (organic). Recent studies show the existence of a group of "functional" or "mostly functional" partial epilepsies. Among these, a particular place is occupied by the benign infantile epilepsies "with evoked spikes," described during the last 10 years. These are forms with a very particular development, characterized in all cases by 4 typical phases; the last one is the clinical phase with epileptic seizures. The prognosis is very good. The discussion concerns the similarities and the differences between these epilepsies versus the other partial benign epilepsies.