Generalized 3-Hz spike-and-wave complexes emanating from focal epileptic activity in pediatric patients

Kakisaka, Yosuke; Alexopoulos, Andreas V.; Gupta, Ajay; Wang, Irène; Mosher, John C.; Iwasaki, Masaki; Burgess, Richard C.

doi:10.1016/j.yebeh.2010.10.025

Cited by 20 publications

(15 citation statements)

References 12 publications

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“…It has been suggested that one should not overinterpret “generalized” EEG abnormalities (such as hypsarrhythmia, slow spike‐wave complexes, (poly‐)spike‐wave complexes, polyspikes, and electrodecrement) as arguments against surgical epilepsy treatment in lesional patients . Classical 3/s spike waves, however, were not explicitly mentioned in this study. The hypothesis that even classical 3/s spike‐wave complexes may emanate from focal epileptogenic lesions and can be cured by epilepsy surgery was postulated by Kakisaka et al (2011) . However, evidence for that hypothesis was based on only one patient with a temporomesial ganglioglioma in whom 3/s spike waves disappeared after epilepsy surgery. Although there are clinical and EEG diagnostic criteria for the diagnosis of generalized genetic epilepsies by ILAE, in cases with more irregular findings, the diagnosis remains difficult.…”

Section: Discussionmentioning

confidence: 80%

Genetic generalized epilepsies with frontal lesions mimicking migratory disorders on the epilepsy monitoring unit

et al. 2020

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractObjective: Some patients with genetic generalized epilepsy (GGE) may present with ambiguous and atypical findings and even focal brain abnormalities. Correct diagnosis may therefore be difficult. Methods: We retrospectively collected six patients investigated on the epilepsy monitoring unit with MRI abnormalities mimicking focal cortical dysplasia (FCDlike) or heterotopias, but with semiology and EEG features of GGE. We compared them to four additional patients with GGE and nonmigratory abnormalities. Results: All six patients presented with frontal MRI lesions: radial ("transmantle," n = 4), cortical-subcortical (n = 1), and periventricular heterotopia (n = 1). Five had positive family histories. Semiologic lateralizing signs compatible with the lesion were seen in four. Five patients had 3/s spike-wave complexes, with an asymmetric appearance in three. Regional EEG changes matched with the side of the abnormality in three patients. Invasive EEG (n = 2) or postoperative outcomes (n = 3) argued against an ictogenic role of the MRI abnormalities. Histology showed mild malformation of cortical development, but no focal cortical dysplasia. The six patients were finally diagnosed with juvenile myoclonic epilepsy (n = 2), juvenile absence epilepsy (n = 2), or GGE not further specified (nfs, n = 2). Compared to these patients, the other four (final diagnoses: childhood absence epilepsy, n = 1; perioral myoclonia with absences, n = 1; and GGE nfs, n = 2) had no lateralizing EEG findings. Significance: Patients with GGE may have coincidental MRI abnormalities. These cases are challenging as frontal epilepsy and GGE can present with similar semiologies. GGE with coincidental FCD-like lesions/heterotopias is in particular difficult to diagnose as patients have more lateralizing features (in semiology and EEG) than those with tumors. A detailed noninvasive presurgical evaluation may be justified. We point out red flags that may help to distinguish GGE from frontal epilepsy, even in the presence of brain abnormalities: 3/s spike waves (even if asymmetric), changing lateralizing signs at different times, and a positive family history hinting at GGE.

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Section: Discussionmentioning

confidence: 80%

Genetic generalized epilepsies with frontal lesions mimicking migratory disorders on the epilepsy monitoring unit

et al. 2020

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“…Generalized discharges, resulting from secondary bilateral synchrony from a focal lesion, classically tend to be slower (<3 Hz) and have more irregular morphology. However, Kakisaka 8 reported one case with left mesial temporal lesion who had both temporal spikes and 3 Hz generalized spike-and-waves. The 3-Hz spike-and-waves disappeared after focal resection of the lesion.…”

Section: Discussionmentioning

confidence: 99%

Misleading Focal Clinical, Neurophysiologic, and Imaging Features in 2 Children With Generalized Epilepsy Who Underwent Invasive Electroencephalographic (EEG) Monitoring

et al. 2020

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Children and adults with genetic generalized epilepsy may have focal clinical seizure symptoms as well as electroencephalographic (EEG) findings. This may pose a diagnostic challenge to clinicians, especially when concomitant focal neuroimaging findings exist and the epilepsy is medically refractory. We sought to highlight the challenges that clinicians may face through the description of 2 children with suspected genetic generalized epilepsy who had both focal seizure symptoms and EEG/neuroimaging findings and underwent invasive EEG monitoring. Ultimately, invasive monitoring failed to demonstrate a focal origin for the seizures in both cases, and instead confirmed the presence of genetic generalized epilepsy. We demonstrate that ≥3-Hz generalized monomorphic spike and waves are less likely to represent secondary bilateral synchrony, that focal neuroimaging findings may not always be causal and that repeated hyperventilation is an essential activation procedure for genetic generalized epilepsy.

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“…As far as seizure semiology was concerned (3, 7), the presence of generalized seizures was related to unfavorable seizure outcomes ( OR = 1.84, 95% CI = 1.18–2.89, P = 0.008). It is reported that the immature structural and functional brains of younger children are more likely to experience generalized seizures than adult brains (12, 13). However, we did not determine any correlation between the presence of generalized seizures and unfavorable prognosis, although younger children constituted a large proportion of the cases in this study.…”

Section: Discussionmentioning

confidence: 99%

Seizure Outcome and Its Prognostic Predictors After Hemispherotomy in Children With Refractory Epilepsy in a Chinese Pediatric Epileptic Center

Liu

Wang

et al. 2019

Front. Neurol.

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Object: To explore the post-hemispherotomy seizure outcome and its prognostic predictors in children with refractory epilepsy. Methods: We reviewed 83 consecutive child patients with refractory epilepsy who underwent a hemispherectomy from June 2014 to January 2017 at our Pediatric Epilepsy Center. Demographic, clinical, EEG, neuroimaging, and surgical data were collected. Seizure outcome data were collected via outpatient clinics as well as telephone visits and were graded according to Engel criteria. Logistic regression model and Cox proportional hazard regression model were, respectively, applied to explore the related factors predicting the seizure outcomes of children after a hemispherotomy. Results: Of the 83 patients, 55 (63.2%) were male. The mean seizure onset age was 1.9 years (0–8.7 years), and the mean surgery age was 5 years (0.8–14 years). At a mean follow-up of 3 years, 69 children (83.1%) were seizure free, and 14 (16.9%) exhibited seizure recurrence. In a univariate analysis, whether or not considering follow-up time, a non-lateralized interictal EEG pattern, bilateral PET abnormalities and acute postoperative seizures (APOS) could all predict poor seizure outcomes post-hemispherotomy. Bilateral PET abnormalities were independently correlated with unfavorable seizure outcomes in the multivariate Logistic regression analysis (Odds ratio( OR ) = 13.05, 95% CI = 1.52–112.29 , P = 0.019) and in the multivariate Cox proportional hazard analysis( OR = 13.99, 95% CI = 2.75–71.17, P = 0.001). Conclusions: Child epileptic patients with bilateral PET abnormalities may have poor seizure outcomes after a hemispherotomy procedure. This study will facilitate better candidate selection for hemispherotomies and early identification of unfavorable seizure outcomes.

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Generalized 3-Hz spike-and-wave complexes emanating from focal epileptic activity in pediatric patients

Cited by 20 publications

References 12 publications

Genetic generalized epilepsies with frontal lesions mimicking migratory disorders on the epilepsy monitoring unit

Genetic generalized epilepsies with frontal lesions mimicking migratory disorders on the epilepsy monitoring unit

Misleading Focal Clinical, Neurophysiologic, and Imaging Features in 2 Children With Generalized Epilepsy Who Underwent Invasive Electroencephalographic (EEG) Monitoring

Seizure Outcome and Its Prognostic Predictors After Hemispherotomy in Children With Refractory Epilepsy in a Chinese Pediatric Epileptic Center

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