Ictal Characteristics of Cryptogenic Partial Epilepsies in Infancy

Abstract

Twenty-three patients with onset of partial seizures (PS) during the first 2 years of life were collected in a single neuropediatric center and ictal events were analyzed. All patients initially had normal developmental and neurologic examinations, negative etiologic investigations, and at least two nonfebrile PS of a single type. Mean follow-up from first seizure to the last contact with the patient was 51 months (SEM 8.17 months). Ictal semiology was characterized by three types of seizures: simple PS with motor signs, complex partial seizures (CPS) with impairment of consciousness at onset followed by motor manifestations, and CPS with motor activity at onset. Versive phenomena, oroalimentary automatisms, and vegetative manifestations were frequently associated. The topography of the ictal discharges and the elementary ictal events, suggested involvement of the temporal lobe and somatomotor area. The diagnosis of PS can be difficult during the first year of life since some patients beginning with generalized seizures may evolve into partial seizures. The prognosis is guarded with regard to seizure persistence, but the neurologic outcome is better as a whole than is reported for infancy-onset epilepsies.

Lateralizing signs during seizures in infants

“…Results may be partially biased by a very small number of patients taken from a preselected patient population.Although our patient group was small and highly selected, the lateralization results were based strictly on the "gold standard" of freedom from seizures after cortical resection or hemispherectomy. The results of this study indicate that contralateral focal clonic jerking, focal tonic stiffening, and postictal hemiparesis are reliable lateralizing signs and this is consistent with previous reports in adolescents and children [2,5,10,15,16]. These results are also consistent with two previous reports indicating that focal and hemiconvulsive clonic activity consistently occurred contralateral to the side of the EEG seizure onset in a total of 21 patients [10,16].…”

“…Focal tonic activity was not identified as a lateralizing sign in previous reports [2,10,16]. Two cases of postictal hemiparesis were previously observed in 46 infants, without mention of the side of the EEG-seizure pattern [2,15].…”

“…Sustained tonic eye deviation was seen both ipsilateral and contralateral to the side of seizure onset, and did not appear to be a reliable lateralizing sign in this age group. Others have also noted either adversive or contraversive eye deviation in older children [5] or in infants without confirmation of the epileptogenic zone by seizure freedom after surgery [10,15].…”

Is There a Partial Benign Epilepsy in Infancy?

“…It is therefore unlikely that cases were overlooked by classifying them as "generalized benign epilepsy." Since mental delay was nearly always present in the follow-up of the seizure-free patients of the cryptogenic group with onset before 18 months (Luna et al, 1989), it is also unlikely that patients with partial epilepsy were erroneously labeled "cryptogenic. "…”

The Syndrome of Partial Seizures in Infancy

“…Interictal tracings may be normall° or may reveal generalized or multifocal abnormalities.3 The background is often slow and attenuated in the region of ictal onset, a finding consistent with the high incidence of underlying structural pathology.l4 Morphology of the ictal transients and background rhythms are rarely diagnostic. 3,9 Approximately half of all partial seizures in infancy arise from the temporal lobes (Table 1). Compared to older patients, epileptiform discharge restricted to the anterior temporal region is unusual.…”