A child with refractory complex partial seizures, right temporal ganglioglioma, contralateral continuous electrical status epilepticus, and a secondary Landau–Kleffner autistic syndrome

Mikati, Mohamad A.; El-Bitar, Mohamad K.; Najjar, Marwan; Rbeiz, Jean J.; Barada, Wissam; Najjar, Vicky F.; Yaktin, Umayma; Tourjuman, O. El

doi:10.1016/j.yebeh.2008.06.006

Cited by 16 publications

(5 citation statements)

References 46 publications

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“…Thus, it is important to keep a high index of suspicion for seizures, especially subclinical seizures, in children with ASD since the symptoms of subclinical seizures can be subtle [24]. In addition, partial complex seizures, especially that originate in the temporal or frontal lobes can present as complex behaviors and automatisms that may be difficult to differentiate ASD behaviors [25-30]. This may be true especially in non-verbal and/or non-communicative children who cannot express symptoms and in whom paradoxical symptoms, such as speech arrest, cannot be easily observed.…”

Section: Discussionmentioning

confidence: 99%

Traditional and non-traditional treatments for autism spectrum disorder with seizures: an on-line survey

2011

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BackgroundDespite the high prevalence of seizure, epilepsy and abnormal electroencephalograms in individuals with autism spectrum disorder (ASD), there is little information regarding the relative effectiveness of treatments for seizures in the ASD population. In order to determine the effectiveness of traditional and non-traditional treatments for improving seizures and influencing other clinical factor relevant to ASD, we developed a comprehensive on-line seizure survey.MethodsAnnouncements (by email and websites) by ASD support groups asked parents of children with ASD to complete the on-line surveys. Survey responders choose one of two surveys to complete: a survey about treatments for individuals with ASD and clinical or subclinical seizures or abnormal electroencephalograms, or a control survey for individuals with ASD without clinical or subclinical seizures or abnormal electroencephalograms. Survey responders rated the perceived effect of traditional antiepileptic drug (AED), non-AED seizure treatments and non-traditional ASD treatments on seizures and other clinical factors (sleep, communication, behavior, attention and mood), and listed up to three treatment side effects.ResultsResponses were obtained concerning 733 children with seizures and 290 controls. In general, AEDs were perceived to improve seizures but worsened other clinical factors for children with clinical seizure. Valproic acid, lamotrigine, levetiracetam and ethosuximide were perceived to improve seizures the most and worsen other clinical factors the least out of all AEDs in children with clinical seizures. Traditional non-AED seizure and non-traditional treatments, as a group, were perceived to improve other clinical factors and seizures but the perceived improvement in seizures was significantly less than that reported for AEDs. Certain traditional non-AED treatments, particularly the ketogenic diet, were perceived to improve both seizures and other clinical factors.For ASD individuals with reported subclinical seizures, other clinical factors were reported to be worsened by AEDs and improved by non-AED traditional seizure and non-traditional treatments.The rate of side effects was reportedly higher for AEDs compared to traditional non-AED treatments.ConclusionAlthough this survey-based method only provides information regarding parental perceptions of effectiveness, this information may be helpful for selecting seizure treatments in individuals with ASD.

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Section: Discussionmentioning

confidence: 99%

Traditional and non-traditional treatments for autism spectrum disorder with seizures: an on-line survey

2011

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“…Beyond driving behavioral symptoms, epileptogenic lesions may be associated with psychiatric disease; however, this relationship is understudied and sporadically reported in the literature. Only a few case reports have described ASD associated with epileptogenic tumors, specifically in the cerebellum [25,26] and mesial temporal lobe [27][28][29]. Two of the cases with temporal tumors saw major improvements in ASD symptoms [27,28], and the last case demonstrated full clinical recovery from ASD, after surgery [29].…”

Section: Discussionmentioning

confidence: 99%

“…Only a few case reports have described ASD associated with epileptogenic tumors, specifically in the cerebellum [25,26] and mesial temporal lobe [27][28][29]. Two of the cases with temporal tumors saw major improvements in ASD symptoms [27,28], and the last case demonstrated full clinical recovery from ASD, after surgery [29]. The latter patient was a 3-year-old boy who had ASD and developed a mesial temporal lobe ganglioglioma with seizures [29].…”

Section: Discussionmentioning

confidence: 99%

Behavioral Improvements following Lesion Resection for Pediatric Epilepsy: Pediatric Psychosurgery?

et al. 2023

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Introduction: Resection of brain lesions associated with refractory epilepsy to achieve seizure control is well-accepted. However, concurrent behavioral effects of these lesions such as changes in mood, personality, and cognition and the effects of surgery on behavior have not been well characterized. We describe 5 such children with epileptogenic lesions and significant behavioral abnormalities which improved after surgery. Case Descriptions: Five children (ages 3-14 years) with major behavioral abnormalities and lesional epilepsy were identified and treated at our center. Behavioral problems included academic impairment, impulsivity, self-injurious behavior, and decreased social interaction with diagnoses of ADHD, oppositional defiant disorder, and autism. Pre-operative neuropsychiatric testing was performed in 4/5 patients and revealed low-average cognitive and intellectual abilities for their age, attentional difficulties, and poor memory. Lesions were located in the temporal (2 gangliogliomas, 1 JPA, 1 cavernoma) and parietal (1 DNET) lobes. Gross total resection was achieved in all cases. At mean 1-year follow-up, seizure freedom (Engel 1a in 3 patients, Engel 1c in 2 patients) and significant behavioral improvements (academic performance, attention, socialization, and aggression) were achieved in all. Two patients manifested violence pre-operatively; one had extreme behavior with violence towards teachers and peers despite low seizure burden. Since surgery, his behavior has normalized. Conclusion: We identified five patients with severe behavioral disorders in the setting of lesional epilepsy, all of whom demonstrated improvement after surgery. The degree of behavioral abnormality was disproportionate to epilepsy severity, suggesting a more complicated mechanism by which lesional epilepsy impacts behavior. We propose a novel paradigm in which lesionectomy may offer behavioral benefit even when seizures are not refractory. Thus, behavioral improvement may be an important novel goal for neurosurgical resection in children with epileptic brain lesions.

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“…Seizures of LKS often respond well to treatment with AED, but the speech and language impairments often persist, despite seizure control [100]. Occasional cases can be secondary to structural lesions such as benign temporal lobe tumors with improvement after focal resection [101].…”

Section: Etiologymentioning

confidence: 99%

Epileptic Encephalopathies in Infants and Children

Fernández-Concepción¹,

López-Jiménez²

2019

Epilepsy - Advances in Diagnosis and Therapy

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Epileptic encephalopathies represent a group of devastating epileptic disorders that appear early in life. They are characterized by pharmacoresistant generalized or focal seizures, persistent severe EEG abnormalities, and cognitive dysfunction or decline. The ictal and interictal epileptic discharges are age-specific and either are the main cause or contribute to cognitive deterioration in the idiopathic or symptomatic group, respectively. Despite choosing the most appropriate antiepileptic drugs for the seizure type and syndrome, the results are often disappointing, and polytherapy and/ or alternative therapy becomes unavoidable; in those cases, consideration should be given to the quality of life of the child and carers. In this chapter, we will discuss the clinical and electroencephalographic characteristics and evolution and management of age-related epileptic encephalopathies, recognized by the International League Against Epilepsy, as follows: early infantile epileptic encephalopathy (Ohtahara syndrome), early myoclonic encephalopathy, epilepsy of infancy with migrating focal seizures, infantile spasms (West syndrome), severe myoclonic epilepsy in infancy (Dravet syndrome), myoclonic-atonic epilepsy (Doose syndrome), Lennox-Gastaut syndrome, epileptic encephalopathy with continuous spike-and-wave during sleep, and Landau-Kleffner syndrome. Their clinical features, prognosis, etiologies, and treatment are presented and updated.

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A child with refractory complex partial seizures, right temporal ganglioglioma, contralateral continuous electrical status epilepticus, and a secondary Landau–Kleffner autistic syndrome

Cited by 16 publications

References 46 publications

Traditional and non-traditional treatments for autism spectrum disorder with seizures: an on-line survey

Traditional and non-traditional treatments for autism spectrum disorder with seizures: an on-line survey

Behavioral Improvements following Lesion Resection for Pediatric Epilepsy: Pediatric Psychosurgery?

Epileptic Encephalopathies in Infants and Children

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