Clinical Course and EEG Findings of 25 Patients Initially Diagnosed with Childhood Absence Epilepsy

Transcription

1 Med. Bull. Fukuoka Univ.403/ Clinical Course and EEG Findings of 25 Patients Initially Diagnosed with Childhood Absence Epilepsy Noriko NAKAMURA, Sawa YASUMOTO, Takako FUJITA, Yuko TOMONOH, Yukiko IHARA, Shinya NINOMIYA, Hiroshi IDEGUCHI, Takahito INOUE and Shinichi HIROSE Department of Pediatrics, Faculty of Medicine, Fukuoka University Abstract Rationale: The prognosis of childhood absence epilepsy CAEis good, and remission usually occurs before the age of 12 years. However, some patients progress to juvenile myoclonic epilepsy JME, requiring continuous treatment after adolescence. Purpose: To determine the risk factors for being unable to discontinue treatment for CAE during childhood. Methods: We divided the 25 patients with CAE into two groups according to their clinical course: Group A included nine patients who could not discontinue treatment during childhood and group B included 16 patients who discontinued treatment because of remission. We evaluated both the EEG findings and the clinical aspects of patients initially diagnosed with CAE. Results: 1All 25 patients started with typical absence seizures TAS, and 44% of the patients in group A developed generalized tonic-clonic seizures GTCSconcomitant with the stage of active TAS 2The EEG findings of group A showed that six patients had a photoparoxysmal response PPRon inter-ictal EEG, seven patients had focal spike and wave complexes SWCin the frontal lobe. The EEG findings of group B showed that two patients had PPR and one patient had focal SWC in the frontal lobe. Three patients 12% progressed to juvenile absence epilepsy and two patients 8%progressed to JME. Conclusions: The risk factors for a worse prognosis of CAE are GTCS observed during the active stage of TAS, PPR or focal SWC in the frontal lobe. Key wordsgeneralized tonic-clonic seizures, Juvenile myoclonic epilepsy, Photoparoxysmal responses, Focal spike and wave complexes, Juvenile absence epilepsy 25 CAE 12 JME CAE CAE 25 A Tel: Fax: nor-naka@live.jp

2 106 B 16 A 4 44 GTCS 3Hz A 6 66B 2 12, A 7 78B JME 2 8 CAE GTCS Childhood absence epilepsy : CAE Typical absence seizures : TAS CAE 12 1 generalized tonic-clonic seizures : GTCS Juvenile myoclonic epilepsy :JME CAE 25 A B A B

3 A B A 22 B 31 A 55 B 12 TAS A 44 TAS GTCS VPAA 77B 56 A 1 VPA B 5 B 1 B 1 A 1 A 9.6 B 5.4 A 2 3 B 1 6 3Hz A B 6 3Hz 3 5 A 33 B 31 A 22B 19 B 6 0 B A 2 A GTCS JME GTCS 3 JAE GTCS 21 JME JME Hz A 78 B 6A A 66 B 12A CAE 1989 ILAE A

4 108 JAEJME CAE JAE 3 CAE JME 2 JME ILAE CAE GTCS GTCS CAE CAE 5 67 Wakamoto GTCS 8 GTCS 4 4 GTCS CAE TAS Hirsh TAS GTCS GTCS TAS GTCS 4 Loiseau CAE 52 GTCS 13 25% 10 9 A GTCS TAS GTCS GTCS 7 GTCS CAE TAS TAS GTCS 21 TAS 1 JME CAE 3Hz CAE CAE 10 CAE CAE

5 A 6 JME 2 11 CAE A CAE GTCS 15 A CAE Wirrell JME JAE 3 12 JME 2 8CAE GTCS CAE JAE 12JME 8 CAE GTCS Childhood absence epilepsy Pyknolepsy pp Wirrell EC, Camfield CS, Camfield PR, Gordon KE, Dooley JMLong-term prognosis of typical childhood absence epilepsy. Neurology , Trinka E, Baumgartner S, Unterberger I,Unterrainer J, Luef G, Haberlandt E, Bauer GL ong-term prognosis for childhood andjuvenile absence epilepsy. J Neurol , Hirsch E, Panayiotopoulos CPChildhood absence epilepsy and related syndromes. In Roger J, Bureau M, Dravet Ch,Genton P, Tassinari CA, Wolf PEpileptic Syndromes in Infancy, Childhood and Adolescence 4 th edn, John Libbey Eurotext Ltd, pp , Grosso S, Galimberti D, Vessosi P, Farnetani M, DiBartolo RM, Bazzotti S, Morgese G, Balestri P: Childhood absence epilepsy: Evolusion and prognostic factors. Epilepsia 46: , Sadleir LG, Farrell K, Smith S, Connolly MB, Scheffer IEElectroclinical features of absence seizures in childhood absence epilepsy. Neurology 67: , Ma X, Zhang Y, Yang Z, Liu X, Sun H, Qin J, Wu X, Liang J: Childhood absence epilepsy: Electroclinical features and diagnostic criteria. Brain&Development 33: , Wakamoto H, Hukuda M, Shigemi R, Murakami Y, Motoki T, Ohmori H, Ishii E: Atypical childhood absence epilepsy with preceding or simultaneous generalized tonic clonic seizures. Brain&Development 33: , Loiseau P, Duché B, Pédespan JM: Absence epilepsies. Epilepsia 36: , , , , Yoshinaga H, Ohtsuka Y, Tamai K, Tamura I, Ito M, Ohmori I, Oka E: EEG in childhood absence

6 110 epilepsy. Seizure 13: , Lombroso CTConsistent EEG focalities detected in subjects with primary generalized epilepsies monitored for two decades. Epilepsia 38: , Hedström A, Olsson I: Epidemiology of absence epilepsy: EEG findings and their predictive value. Pediatr Neurol 7: ,