ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02463.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:We examined EEG findings from an ongoing study of 347 children with a first unprovoked seizure. EEGs were available in 321 (93%), and 135 (42%) had an abnormal EEG. EEG abnormalities included focal spikes (n = 77), generalized spike and wave discharges (n = 28), slowing (n = 43), and nonspecific abnormalities (n = 7). Abnormal EEGs were more common in children with remote symptomatic seizures (60%) than in those with idiopathic seizures (38%) (p<0.003), more common in partial seizures (56%) than in generalized seizures (35%) (p3 years (52%) than in younger children (12%) (p<0.001). Records including both awake and sleep tracings were available in 148 (46%) cases. For 122 (38%) only awake tracings and for 51 (16%) only sleep tracings were available. Fifty‐nine (40%) of the 148 patients with both an awake and asleep tracing had abnormal EEGs. Of 50 such EEGs with epileptiform abnormalities, 15 (30%) demonstrated the abnormality either only while awake (n = 8) or only while asleep (n = 7). Of 17 patients with EEG slowing, 8 showed slowing only in the awake tracing and 9 showed slowing in both the awake and asleep tracing. Children with even a single unprovoked seizure have a high incidence of EEG abnormalities. Obtaining a combined awake and sleep EEG significantly increases the yield of EEG abnormalities. In children with an idiopathic first seizure, EEG abnormalities are associated with an increased risk of seizure recurrenc

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02464.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:Video‐EEG monitoring enables correlation of behavioral activity with EEG activity, which is useful in recognition of pseudoepileptic seizures and in investigation of patients for epilepsy surgery. Because most patients are monitored for a prolonged time as in‐patients, the cost of the procedure is high. We investigated the value of brief (2–3 h) outpatient video‐EEG monitoring in 43 children with frequent seizures, most of whom had symptomatic generalized epilepsy. Indications for monitoring included differentiation of epileptic from nonepileptic behavior, seizure classification, and determination of seizure frequency. Clinical episodes were recorded in 36 of 43 children (83%). A definite diagnosis was established in 9 of the 17 patients investigated to determine the nature of the clinical behavior. Seizures were classified in 1.5 of the 25 patients investigated to determine seizure type, and classification was different from the original in 9 of the 15 children. A change in epilepsy syndrome classification was made in 9 children. The video‐EEG allowed diagnosis in 25 of the 43 children (59.5%). Video‐EEG appears to be an effective method for outpatient investigation of children with frequent seizures, particularly those with symptomatic génerali

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02465.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:We retrospectively analyzed the clinical manifestations of complex partial seizures (CPS) in children aged 10 years using video and EEG telemetry and evaluated their course, investigations, management, and seizure status at follow‐up. Seventeen patients with CPS were studied at the Prince of Wales Children's Hospital (POWCH) and Prince Henry Hospital (PHH) between 1987 and 1992. Because 1.5 of the 17 patients had intractable seizures, the population was selective. Mean age was 6.5 years; 4 patients were aged 2 years. Clinical features were normal or mild intellectual handicap (1 3); hemiplegia (5); and infantile spasms preceding CPS (4); of these, 2 also had simple partial motor seizures. Structural abnormalities were noted on scanning in 9 patients. Eighty‐seven seizures were reviewed. Mean duration of each clinical seizure was 59.7 s (total population), 108 s (subgroup 1, aged 2>years), and 48.5 s (subgroup 2, aged 2 years). Major ictal manifestations were auras (9), staring (9), autonomic changes (6), and automatisms (17). In subgroup 1, automatisms were simple and mainly oroalimentary and gestural. Two patients had no change in surface ictal recordings, and 2 had normal interictal EEGs. At follow‐up, 8 patients were seizure‐free for 6 months, 1 was partially controlled (more than two seizures a month), and 8 had intractable seizures (two or more seizures a month). Seven patients underwent operation for intractable epilepsy, and 4 achieved a class 1A outcome (Engel classifi

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02466.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:During the course of a seizure, subdural recordings often show secondary areas which develop in‐dependent electrographic sequences that may outlast the primary seizure sequence. We reviewed the subdural data on 8 patients with intraictal secondarily activated foci (ISF). In 6 patients, ISFs were documented to be capable of generating independent seizures; ISF seizures occurred during the initial subdural monitoring period in 3, but became ictal generators only after excision of the primary focus in the other 3. Prominent interictal abnormalities were observed at the ISFs in 5 of 8 patients. The ISF in 1 patient correlated with the structural lesion on magnetic resonance imaging (MRI) scan. We believe that ISFs have significant epileptogenicity and should be re‐sected when possi

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02467.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:Spectral analysis of interictal background EEG activity recorded through foramen ovale (FO) electrodes during monitoring (mean 5.8 days per patient) was studied in 10 medically refractory complex partial seizure (CPS) patients who were candidates for epilepsy surgery. Data of the spectral analysis was plotted as compressed spectral array (CSA) with spectral edge frequency (SEF) markers. For each patient, time‐varying fluctuations of the SEF markers were compared visually and by a computer‐assisted method between two symmetrical FO electrode EEG channels recording from both mesiobasotemporal lobes (MTL). The amount of asymmetrical variations of the SEF markers (“rigidity” phenomenon) was first determined visually and then quantified by the computer‐assisted method. These findings were correlated with the results of other clinical tests, including FO electrode‐recorded seizure onset (FO ict), positron emission tomography with [18F]fluorodeoxyglucose (FDG‐PET), and magnetic resonance imaging (MRI) to investigate whether the rigidity phenomenon could lateralize the primary epileptogenic zone. The rigid side had 80, 70, and 60% coincidence rates with the pathologic side indicated by FDG‐PET, FO ict, and MRI, respectively, in a single test. We conclude that the rigidity phenomenon of FO electrode‐recorded interictal background EEG activity is a valuable sign for lateralization of the primary epileptogenic zone in MTL epilepsy. The relative invariance of SEF may be caused by interictal deafferentation of

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02468.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:We analyzed pre‐ and postoperative interictal and ictal EEG patterns in relation to seizure outcome in 29 patients with intractable epilepsy who had undergone anterior callosotomy. Twenty‐two patients had generalized bilaterally synchronous sharp or spike and slow wave discharges (GSW) and 7 did not: Postoperatively, patients with preoperative GSW showed disruption of synchrony, increased amplitude asymmetry, and a decreased amount of GSW. No significant decrease was noted in the amount of total epileptic discharge after operation. There was a significant relation between seizure outcome and decrease in amount of GSW. The degree of disruption of synchrony, total amount of epileptic discharge, and pre‐ and postoperative EEG patterns were not good indicators of seizure outcome. Postoperative changes in lateralization of epileptic foci consisted either of increased lateralization, less lateralization but increased independent discharges in the previously nonpredominant hemisphere, or appearance of some lateralization. There appears to be a spectrum of GSW: Both sec‐ondary bilateral synchrony and secondarily generalized corticoreticular epileptic discharges are distributed along this s

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02469.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:A 6.5‐year‐old boy developed seizures at age 2.8 years consisting of episodes of unconsciousness and laughing attacks. By age 6 years, multiple seizure types, including generalized tonic‐clonic (GTC), complex partial (CPS) and akinetic seizures, and drop attacks were occurring several times daily. EEG showed multifocal epileptic discharges. Antiepileptic drugs (AEDs) did not control the seizures. With progression of the epilepsy, cognitive deterioration developed. There were no manifestations of precocious puberty. Neuroimaging disclosed a suprasellar mass in continuity with the hypothalamus, and a diagnosis of hypothalamic hamartoma was made. After surgical resection of the hamartoma, the seizures were completely alleviated, and the epileptic EEG discharges disappeared. Improvement of mental function was also

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02470.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:In patients with temporal lobe epilepsy (TLE), high‐resolution, magnetic resonance imaging (MRI) frequently demonstrates hippocampal atrophy and increased hippocampal signal. To assess the prognostic value of these findings, we studied 51 patients evaluated prospectively by a radiologist blinded to other preoperative evaluations. Thirty‐one of 51 (61%) patients undergoing temporal lobectomy had visually apparent hippocampal atrophy o r increased hippocampal signal on MRI (25 ipsilateral 3 contralateral, and bilateral to the operated site). Patients with ipsilateral abnormalities became seizure‐free more frequently than patients with normal scans [24 of 25 (96%) vs. 10 of 20 (50%) p<0.015]. Both ipsilateral hippocampal atrophy and ipsilateral increased hippocampal signal independently predicted a seizure‐free outcome. Qualitative MRI provides important prognostic information in patients undergoing temporal lo

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02471.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Summary:In evaluation for surgical treatment of intractable psychomotor seizures originating in the language‐dominant left mesiotemporal region, subdural grid electrodes were placed in 29 patients over the temporoparietal cortex and over the basotemporal region. In 13 patients, cortical stimulation of the basotemporal region showed interference with language processing. The most anterior border of the basotemporal language area began 1.1 cm posterior to the anterotemporal tip, and the most posterior margin of the language region was located 6.1 cm posteriorto the temporal tip. The most lateral and the most mesial border were located 1.4 and 5.9 cm, respectively, from the lateral edge of the temporal lobe. The region in which language disturbance could be elicited included the inferior temporal gyrus, the fusiform (lateral and medial occipitotemporal) gyrus, and the parahippocampal gyrus. The basotemporal area most consistently involved with language function was the fusiform gyrus (60% of affected electrodes), followed by the inferotem‐poral (30%), and the parahippocampal (10%) g

ISSN:0013-9580    

DOI:10.1111/j.1528-1157.1994.tb02472.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY