摘要:

Summary:Polygraphic all‐night sleep records of 11 children with typical benign epilepsy of childhood with rolandic spikes (BERS) and those of eight nonepileptic controls were investigated with regard to sleep pathology. Basic properties of sleep organization and elec‐tromorphology were preserved in both groups. Seventeen quantitative sleep parameters were measured. Except for more waking in the BERS group, no sleep parameter showed significant differences between the BERS and the control group, but differences existed in comparison to normative values. We interpret our results as showing that in BERS epileptic neuronal malfunctioning does not affect sleep organization in a characteristic manner. The lack of detrimental interactions between epileptic neuronal behavior and pathological sleep alterations may be an additional cause of the benign course of BERS.RÉSUMÉLes caractéristiques du sommeil ont étéétudiées par enregis‐trement polygraphique du chez 11 enfants présentant une épilepsie partielle bénigne à paroxysmes rolandiques (EPR) typique et chez 8 témoins non épileptiques. Les caractéristiques fonda‐mentales de ľorganisation et des figures physiologiques du sommeil sont conservées dans les deux groupes. Nous avons évalué 17 paramètres quantitatifs du sommeil. En dehors ď;un temps ď;éveil plus long dans le groupe des EPR, nous n'avons constaté aucune différence significative entre les deux groupes, mais en revanche des difference par rapport aux valeurs de référence. Ces résultats démontrent ľabsence ď;effet caractéristique dans ľEPR du dysfonctionnement neuronal épileptique sur ľorganisation du sommeil. II est possible que Íabsence ď;interaction négative entre le comportement neuronal épileptique et les altérations du sommeil représente un des mécanismes de la bénignité des EPR.RESUMENDesde el punto de vista de la patología del suen̄o se han estu‐diado los registros poligráficos durante la totalidad del suen̄o nocturno de 11 nin̄os con epilepsia benigna típica con puntas rolándicas (BERS) y los trazados de 8 controles no epilépticos. Las propiedades básicas de organización del suen̄o y la electro‐morfología han sido preservadas en ambos grupos. Se midieron 17 parámetros cuantitativos del suen̄o. Con la excepción de una mayor vigilia en el grupo de los BERS, ningún parametro del suen̄o mostró cambios significativos entre los BERS y el grupo control, pero se observaron diferencias en comparación con los valores normales. La interpretación de los resultados induce a pensar que en los BERS la disfunción neuronal epiléptica no afecta la organización del suen̄o de una manera característica. Es posible que la ausencia de interacciones perturbadoras entre el comportamiento epiléptico neuronal y las alteraciones patológicas del suen̄o constituya una causa adicional de la evolución benigna de los BERS.ZUSAMMENFASSUNGBei 11 Kindern mit typischer benigner Epilepsie mit Rolandi‐Spikes und 8 nicht‐epileptischen Kontrollkindern sollte die Frage der Schlafpathologie mit polygraphischen Nachtablei‐tungen geklärt werden. Bei beiden Gruppen waren die Grundei‐genschaften der Schlaforganisation und der Elektromorphologie erhalten. 17 quantitative Schlafparameter wurden ausgewertet. Außer häufigerem Erwachen bei der BERS‐Gruppe fanden sich keine signifikanten Unterschiede zwischen BERS und Kon‐trollen; jedoch bestanden Unterschiede beim Vergleich mit Nor‐malwerten. Die Ergebnisse sprechen dafür, daß bei BERS die neuronalen Fehlfunktionen nicht die Schlaforganisation beein‐trächtigen.Möglicherweise ist der benigne Verlauf der BERS auch durch dasFehlenzer

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb03616.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well‐defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharm

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb05768.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Polygraphic all‐night sleep recordings of 11 children with benign epilepsy of childhood with rolandic spikes (BERS) were investigated from the viewpoint of spike distribution. Spike/min ratios were calculated with regard to different sleep stages and waking, identical stages of the consecutive cycles, and stages 1–2 taking place on the descending versus the ascending slopes of sleep cycles. Maximum spike/min ratios were related to slow sleep stages, especially delta sleep, and in general to the first cycle. Stages 1–2 on the descending (DESC) slopes of consecutive cycles showed a decrease in spike density during the night, as opposed to the increasing rate of activation of the same stages on the ascending (ASC) slopes. Based on our results, we suggest that the actual drive of spiking as well as seizures in BERS is the functional overweight of sleep‐inducing mechanisms.RESUMENDesde el punto de vista de la distribución de las puntas se han estudiado 11 nin̄os con epilepsia benigna con puntas rolándicas mediante registros poligráficos durante la totalidad del suen̄o nocturne Le relación punta/min se calculó con respecto a los diversos estadíos del suen̄o y de vigilia, en relación con estadíos idénticos de ciclos consecutivos, y en relación con estadíos su‐perficiales del suen̄o que tienen lugar en los momentos descen‐dentes o ascentes de los ciclos del suen̄o. Los resultados máximos de la relación punta/min se relacionaron con estadíos de suen̄o lento, especialmente suen̄o delta, y en general con el primer ciclo. El suen̄o superficial durante las fases descen‐dientes de ciclos consecutivos mostró una reductión en la potencia de activación durante la noche en contrapositión al incre‐mento del ritmo de activación de los mismos estadíos durante las fases ascendentes del suen̄o. Basándose en estos resultados los autores sugieren que el motor real de producción de puntas y de ataques en la epilepsia benigna infantil reside en el exceso de mecanismos inductores del suen̄o.ZUSAMMENFASSUNGPolygraphische Schlaf‐Nachtableitungen bei 11 Kindern mit BERS wurden ausgewertet unter Berücksichtigung der Spike‐Verteilung. Das Spike/Minute Verhältnis wurde berechnet für die verschiedenen Schlafstadien und Wachzeiten, für die iden‐tischen Stadien aufeinanderfolgender Schlafzyklen und für den Leichtschlaf beim Übergang vom Erwachen zum Wiedereinsch‐lafen. Das Maximum der Spike/Minute Werte war gebunden an die langsamen Schlafstadien, besonders an den Deltaschlaf und meistens an den ersten Cyclus. Im Leichtschlaf, im abstei‐genden Schenkel des nachfolgenden Cyclus, nahm das Akti‐vierungspotential im Laufe der Nacht ab, während es beim aufsteigenden Schenkel des gleichen Stadiums zu einer Zu‐nahme der Aktivierung kam. Aufgrund der Ergebnisse nehmen die Autoren ein funktionelles Ubergewicht schlafinduzierender Mechanismen a

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb03617.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic‐clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new‐onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady‐state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic‐clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb05774.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Twenty‐four patients (16 men, 8 women) underwent corpus callosum section specifically for improvement of control of atonic or tonic seizures that resulted in falls and injuries. All patients suffered from multiple seizure types, including complex partial (CP) and tonic‐clonic (TC) seizures, in addition to the tonic or atonic episodes. Preoperative seizure frequency was quantified for all types for 1 year immediately before surgery and for the most recent year since the procedure; average monthly counts were obtained for each seizure type. The period of follow‐up since surgery averaged 43 months (range, 23–79 months). Statistically significant improvements were documented, not only for the atonic/ tonic seizures (p<0.0001) for all patients, but also for TC seizures (17 patients; p<0.001) and CP seizures (20 patients; p<0.02). Six patients experienced an exacerbation of CP seizures postoperatively, and three developed new simple partial (SP) seizures. In all of the CP group and all three of the SP group, ictal video and EEG features suggested that the new seizures were an aborted expression of the previously generalized seizures. From these data, we conclude that callosotomy is an effective treatment for tonic, atonic, and TC seizures intractable to anticonvulsant medications. Three patients became seizure free. The procedure may also be useful for certain specific subgroups of CP epilepsy, but further studies are required before expanding callosotomy to intractable CP seizures not amenable to focal resection.RÉSUMÉ24 patients (16 hommes, 8 femmes) ont bénéficiéď;une section du corps calleux dans le but ď;améliorer le contrôle de crises atoniques ou toniques responsables de chutes et de blessures. Tous présentaient ľassociation de plusieurs types de crises, y compris partielles complexes (PC) et tonico‐cloniques (TC). La fréquence préopératoire des crises a été quantifiée pour chaque type de crise pendant toute une année avant ľintervention, et pendant la dernière année depuis ľintervention. Le nombre moyen de crise par mois a étéétabli pour chaque type de crise. La durée de la surveillance post‐opératoire a été en moyenne de 43 mois (23 à 79 mois). Nous avons constaté une amélioration statistiquement significative, non seulement pour les crises atoniques et toniques (p<0.00001) chez tous les patients, mais aussi pour les crises TC (17 patients, p<0.001) et PC (20 patients, p<0.02). 7 patients ont présenté une augmentation post‐opératoire de la fréquence des crises PC; 3 patients ont présenté des crises partielles simples (PS) qu'ils n'avaient pas auparavant. Chez 6 des patients du groupe CP, et chez les 3 patients du groupe PS, les caracteristiques vidéo et EEG critiques laissent penser que les nouvelles crises sont ľexpression abortives des crises généralisées antérieures. Nous concluons que la calloso‐tomie est un traitement efficace des crises toniques, atoniques et TC inaccessibles aux médications anticomitiales. 3 patients n'ont plus présenté de crise. Ce traitement peut aussi se révéler intéressant dans certains sous‐groupes ď;épilepsies avec crises PC, mais ď;autres travaux sont nécessaires avant que ľon puisse envisager ď;étendre la cal

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb03618.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Pregnancies occurring in women who are epileptic are considered to be high risk. These women are at increased risk of seizures during pregnancy, labor, and delivery and of pregnancy complications and adverse pregnancy outcomes. Pregnancy alters the pharmacokinetics of anticonvulsant drugs, the levels of which decline as pregnancy advances. Not all drugs are altered in a similar manner, however. The rate of congenital malformations in infants of epileptic mothers is 2.4 times higher than in the general population. Malformations occur with all of the commonly used anticonvulsant drugs. The possible mechanisms of teratogenicity include folic acid antagonism, fetal tissue binding, and toxic effects of metabolic intermediates. Therapy with more than one drug increases the risk of congenital malformations. A unique hemorrhagic phenomenon in the infants of epileptic mothers has been reported and appears to be the result of a deficiency of vitamin K‐dependent clotting factors. When taken by a pregnant woman, all antiepileptic drugs except valproic acid manifest themselves in breast milk, but only if the infant exhibits evidence of sedation should breastfeeding be discontinued. The dilemma for the physician treating the pregnant epileptic woman is to protect the mother from seizures and the fetus from unnecessary exposure to anticonvulsant medication

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb05775.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Stories were elicited from 29 epileptic patients with generalized, simple partial, and complex partial seizures with bilateral, right, or left foci, and from 32 persons in two control groups. Four older epileptic patients with long histories of left complex partial seizures were verbose. Their stories involved trivial and subjective details, consistent with circumstantiality and suggesting the substrate for a hallucinatory syndrome.RÉSUMÉNous avons 0interrogé 30 patients épileptiques présentant des crises généralisées, partielles simples ou partielles complexes avec foyers bilatéraux, droits ou gauches, et 32 sujets témoins répartis en deux groupes. 4 patients épileptiques anciens, avec un long passé de crises partielles complexes gauches, se sonl montrés verbeux. Leurs discours contenaient des détails triviaux et subjectifs, témoignant ď;une adhésion non critique aux circonstances et suggérant ľexistence ď;un terrain de syndrome hallucinatoire.RESUMENSe han extraído los relatos de 30 epilépticos con ataques gen‐eralizados, simples parciales y ataques parciales complejos con focos bilaterales derechos o izquierdos y también los relatos de 32 personas en 2 grupos control. Cuatro epilépticos ancianos con historias prolongadas de ataques parciales complejos resultaron poseer importante verbosidad. Los relatos siempre contenían detalles triviales y subjetivos de caracter circunstancial que par‐ecian ser el sustrato de un sìndrome alucinatorio.ZUSAMMENFASSUNGDie Berichte von 30 Anfallskranken mit generalisierten, einfa‐chen Partial‐ und komplexen Partialanfällen mit bilateralen, rechts‐ und linksseitigen Foci und von 32 Kontrollpersonen wurden analysiert. 4 ältere Patienten mit langer Anamnese von linksseitigen, komplexen Partialanfällen waren weitschweifig. Ihre Berichte enthielten triviale und subjektive Details, die mit Umstandlichkeit vereinbar waren und auf ein hall

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb03619.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Seizures are common in infants and children and must be differentiated from a wide variety of other neurological and nonneurological disorders which include episodic disturbances of behavior. If the diagnosis is clear, then one must decide if the seizure is an isolated event and unlikely to recur (as are many afebrile generalized convulsive seizures in early childhood), a symptom of underlying cerebral pathology, or part of an epileptic syndrome. The latter may be a potentially lethal neurodegenerative disease or a benign epilepsy with excellent outcome. This review will discuss the various aspects of epilepsy in the pediatric age group, emphasize the benign nature of most seizures in children (including many forms of partial, or focal, seizures), and present an overview of the more serious epileptic syndromes. The myoclonic epilepsies will be used as a model to illustrate the wide scope of epileptic phenomena in infants and children.

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb05755.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb05776.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Summary:We report three patients with recurrent tonic‐clonic seizures associated with unilateral pulmonary edema. Each lung was involved on separate occasions in one patient. The mechanisms of seizure‐related pulmonary edema are discussed. Although accurate diagnosis of unilateral postictal pulmonary edema may be difficult because of its rarity, not all pulmonary abnormalities that follow seizures represent pneumonia.RÉSUMÉNous rapportons 3 observations de patients présentant des crises tonico‐cloniques répétées s'accompagnant ď;un œdème pulmonaire unilatéral. Chaque poumon était atteint à tour de röle chez un patient. Les mécanismes de ľœdème pulmonaire lié aux crises sont discutés. Bien que le diagnostic du caractère post‐critique ď;un œdème pulmonaire unilatéral soit difficile en raison de la rareté de ce phénomène, ces observations montrent que la pneumonie ne constitue pas la seule atteinte pulmonaire consécutive aux crises comitiales.RESUMENPublicamos 3 pacientes con ataques tónico‐clónicos recur‐rentes asociados a edema pulmonar unilateral. Cada pulmón es‐tuvo afectado en ocasiones diversas en un paciente. Se discuten los mecanismos de los ataques relacionados con edema pulmonar. A pesar de que el diagnóstico exacto del edema pulmonar unilateral postictal puede resultar difícil debido a su rareza no todas las anomalías pulmonares que siguen a ataques representan neumonías.ZUSAMMENFASSUNGWir berichten über 3 Patienten mit wiederholten tonischklon‐ischen Anfällen, die mit einseitigem Lungenoedem einhergingen. Jede Lungenseite konnte bei verschiedenen Anfällen betroffen sein. Die Pathophysiologic des anfallsbedingten Lungenoedems wird diskutiert. Obwohl die exakte Diagnose eines einseitigen postiktalen Lungenoedems eine Rarität darstellt, sollten nicht alle pulmonalen Auffälli

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1987.tb03620.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY