Ictal Video‐EEG Recording of Three Partial Seizures in a Patient with the Benign Infantile Convulsions Associated with Mild Gastroenteritis

Abstract

Summary: Purpose: In infants, benign convulsions can be triggered by febrile illness or mild diarrhea such as Rotavirus gastroenteritis. The triggering mechanism of these convulsions is still unknown. In spite of several reports concerning clinical features, the ictal EEG recordings were rarely analyzed by a video-EEG monitoring system. To reveal a clue for the triggering mechanism of these convulsions, we analyzed the correlation of clinical manifestations and the EEG discharges during the ictal events and compared with previous reports.Methods : The ictal EEG of a cluster of three afebrile convulsions associated with mild gastroenteritis was recorded by an EEG closed-circuit TV (EEG-CCTV) monitoring system in a 6-month-old healthy female infant.Results: All seizures began as complex partial seizures (CPSs), which exhibited a motionless stare with or without leftward deviation of both eyes, and evolved to secondarily generalized tonicxlonic seizures (SGTCSs) for -90 s. Each of three ictal discharges began from the right occipital, right centroparietotemporal, and left occipital regions, respectively.Conclusions: Although initiating sites of ictal discharges of benign infantile convulsions associated with mild gastroenteritis (BICE) were previously reported to be variable among patients, these results indicated that those differ among seizures even in a same infant. Key Words: Benign infantile convulsion-Benign partial epilepsy in infancy-Mild gastroenteritis-EEG-video monitoring.In infants, afebrile convulsions with good prognosis triggered by mild diarrhea, such as Rotavirus gastroenteritis, have been called "benign infantile convulsions precipitated by mild diarrhea" (BICD) (I), which was later called "benign infantile convulsions associated with mild gastroenteritis (BICE) ( 2 ) . Although clinical features of such cases were reported (3-6), the ictal EEG recordings were rarely analyzed by a video-EEG monitoring system (7).We report here a female case of BICE. Three convulsions were recorded by a video-EEG monitoring system. We analyzed the correlation of clinical manifestations and the EEG discharges during the ictal events and compared them with those of previous reports.

Clinical characteristics of seizures associated with viral gastroenteritis in children

“…Both febrile seizures and CwG are considered situationrelated seizures, which are essentially transient and functional disorders in infants and young children that are supposedly related to immaturity of the brain (Uemura et al, 2002;Specchio and Vigevano, 2006;Komori et al, 1995;Imai et al, 1999). However, CwG is not a separate classification according to the International League against Epilepsy (Proposal for revised classification of epilepsies and epileptic syndromes, 1989).…”

“…Febrile seizures and CwG are thought to have significant differences in their clinical entities and optimal management (Morooka, 1982;Uemura et al, 2002;Kawano et al, 2007;Imai et al, 1999;Fukuyama, 1963;Sakauchi, 1997). Febrile seizures are heterogeneous syndromes caused by miscellaneous diseases, in which fever is regarded as the main trigger of the pathogenesis (van Zeijl et al, 2002;Nakayama and Arinami, 2006).…”

“…The clinical manifestations of this condition are characterized as follows: (1) typical age at presentation between 6 months and 3 years, (2) afebrile generalized convulsions associated with symptoms of gastroenteritis, which involve CPS often evolving to secondary generalization, and frequently occur in clusters, (3) seizures usually developing 1-5 days after the onset of the symptoms of gastroenteritis, (4) no paroxysmal discharges on interictal EEG, (5) normal blood electrolytes and other blood chemistry values, and (6) a benign prognosis (Uemura et al, 2002;Kawano et al, 2007;Imai et al, 1999). These seizures are also occasionally induced by pain and/or crying.…”

“…However, CwG is not a separate classification according to the International League against Epilepsy (Proposal for revised classification of epilepsies and epileptic syndromes, 1989). Febrile seizures are triggered by fever and CwG by gastroenteritis, both of which are considered to lower the seizure threshold and contribute to the occurrence of seizures (Uemura et al, 2002;Specchio and Vigevano, 2006;Komori et al, 1995;Imai et al, 1999).…”

“…In Japan and East Asia in particular, benign seizures in the presence of fever associated with acute illness, including gastroenteritis, are considered ''febrile seizures,'' whereas benign convulsions without fever during mild gastroenteritis have been commonly recognized as ''convulsions with mild gastroenteritis'' (CwG). Both febrile seizures and CwG are considered situation-related seizures, which are essentially transient and functional disorders in infants and young children that are supposedly related to immaturity of the brain (Uemura et al, 2002;Specchio and Vigevano, 2006;Komori et al, 1995;Imai et al, 1999), but the two have significant differences in the clinical entities and the optimal management (Morooka, 1982;Fukuyama, 1963;Sakauchi, 1997;Okumura et al, 1999Okumura et al, , 2004Matsufuji et al, 2005). There are few reports examining the relationship between febrile seizures and CwG during viral gastroenteritis (Minamiura et al, 1997;Zifman et al, 2011).…”