Partial Epilepsy in Neurologically Normal Children: Clinical Syndromes and Prognosis

Abstract

A clinical and electroencephalographic study of 107 neurologically normal children with partial seizures was undertaken to verify the existence and determine the frequency of epileptic syndromes reported in selected populations. Sixty-three children had simple partial seizures, 39 had complex partial seizures, and 5 children were unclassifiable. The syndrome of benign partial epilepsy of children with rolandic spikes (BPEC, 38 cases) was clearly identified and its uniformly benign final prognosis was confirmed even if some of these children had at times severe or poorly controlled seizures. Among the children with simple partial seizures outside the BPEC (25 cases) and complex partial seizures (39 cases), no homogeneous clinical or electroclinical subgroup could be found. Two children with benign partial epilepsy and myoclonic-astatic seizures ("atypical benign partial epilepsy of childhood") and one child with "benign epilepsy with occipital spike-waves" were identified. 74% of children with epilepsy with complex partial seizures (ECP) had a 1-year seizure-free interval, and many children with epilepsy with simple partial seizures outside the BPEC group (ESP) had no more than two seizures. A benign course is thus not limited to the BPEC but is difficult to predict. Prospective studies are necessary to confirm the existence of well-defined benign syndromes among the idiopathic partial epilepsies of childhood, which appear quite rare outside the BPEC.

Benign Epilepsy of Childhood With Centrotemporal Spikes

“…Although seizure duration is usually brief, lasting from seconds to several minutes, status epilepticus may be seen. The prevalence of this complication varies from 7 to 11% (19,20). Fejerman and Di Blasi (21)' were the first t6 describe two patients with BECT who developed continuous focal facial seizures lasting between 5 days and 1 month.…”

“…Post-ictal Todd's paresis has been reported in BECT in 7-16% of cases (15,19,20). Loiseau and Beaussart (15) found that post-ictal paresis was present in a significant number of cases of BECT with a history of an apparently primarily generalized seizure, suggesting that many generalized seizures in fact have a focal onset.…”

“…Deonna et al (20) reported that one-third of their group of children with BECT had persistent seizures despite treatment and 24% had severe seizures. Beaussart (10) noted that 14% of his population had seizures that persisted for more than 1 year despite medication, or recurred after 1 to many years.…”

Padrão eletrográfico ictal subclínico em um caso de epilepsia parcial benigna da infância com pontas centro-temporais

“…A descrição dos familiares de uma crise generalizada e o dé-ficit pós-ictal no membro superior esquerdo sugerem uma crise generalizada com maior envolvimento da área motora central direita, dados que seriam compatíveis com EPCT ou com uma epilepsia frontal sintomática. Paralisia de Todd tem sido registrada em 7-16% dos casos de EPCT [15][16][17] .…”

Tratamento cirúrgico das epilepsias na criança

“…O índice de remissão para as epilepsias parciais sintomáticas ou criptogênicas varia de 10 a 62% 5,[32][33][34][35][36] . No grupo específico das epilepsias do lobo temporal, encontramos baixos índices de remissão 5,36 .…”