Journal of Pediatric Epilepsy - Volume 3, issue 2

Authors: Kanemura, Hideaki | Sano, Fumikazu | Ohyama, Tetsuo | Sugita, Kanji | Aihara, Masao

Article Type: Research Article

Abstract: We examined the effectiveness of levetiracetam (LEV) as add-on therapy after failed treatment with a first anti-epileptic drug in a prospective cohort of children with epilepsy. Eligible patients with epilepsy experienced uncontrolled seizures with the first anti-epileptic drug and were 1-15-year-old. After a 3 mo baseline period, patients were administered LEV at an initial dose of 10 mg/kg/d, which, if needed, was incrementally increased by 5 mg/kg/d weekly up to a maximum dose of 60 mg/kg/d. Seizure frequency was defined as the mean seizure frequency per month. Clinical response to LEV over the following period of at least 6 mo …was divided into five categories. A total of 37 patients were enrolled. The majority of patients (97.30%) had localization-related epilepsy. The responder rate (rate of patients with ≥50% reduction in seizure frequency) was 30/37 (81.08%). In addition, 20 of 37 (54.05%) patients showed complete seizure cessation. Mean percentage reduction in seizure frequency (all types of seizures) during the first 6 mo treatment period compared to baseline was 89.28% in responders, compared with 25.22% in non-responders. This proportion remained stable during the second 6 mo period (90.17%). Significant changes in seizure frequency were seen between before LEV administration and both the first 6 mo (P < 0.01) and second 6 mo (P < 0.01) in responders, but not in non-responders. Mean effective dose of LEV was 27.51 mg/kg/d. Somnolence was the only reported individual adverse event (5.41%), and was mild in all cases, so LEV discontinuation was not needed. LEV appears useful as a first add-on treatment in children with localization-related epilepsy. Show more

Keywords: Levetiracetam, epilepsy, anti-epileptic drug, first add-on, children

DOI: 10.3233/PEP-14079

Citation: Journal of Pediatric Epilepsy, vol. 3, no. 2, pp. 77-83, 2014

Authors: Kanemura, Hideaki | Sano, Fumikazu | Sugita, Kanji | Aihara, Masao

Article Type: Research Article

Abstract: Reducing negative attitudes such as stigma for children with epilepsy is one of the most important goals of clinical management. However, it is not investigated how seizure frequency can affect perceived stigma in children with epilepsy. The purpose of this study was to identify a relationship between seizure frequency and perceived stigma in Japanese children with epilepsy. Inclusion criteria were: (1) age of 12–18 yr, inclusive; (2)≥6 mo since epilepsy onset; and (3) the ability to read and speak Japanese. As a control group, 15 healthy children were recruited. A questionnaire concerning measures of psychosocial functioning was divided into five …parts. Participants indicated whether they agreed or disagreed with each statement using a 5-point scale. In addition, participants were asked to rate how often they felt or acted in the ways described in the items on a 5-point scale using the child stigma scale. Participants comprised 33 Japanese patients (18 boys, 15 girls) with epilepsy. Children with frequent seizures showed significant impairment of psychosocial functioning compared to seizure-free children (P < 0.01). In addition, greater perceptions of stigma were associated with greater seizure frequency according to the child stigma scale. Children with frequent seizures perceived themselves as significantly more stigmatized compared to seizure-free children (P < 0.01). A relationship was seen between current seizure frequency and perceived impact of epilepsy and perceived stigma. Children with less seizure may have less internal contribution (perceived stigma). Although stigma is multivariable, better control of seizures may contribute to reduce perceived stigma and improve quality of life in children with epilepsy. Show more

Keywords: Epilepsy, stigma, psychosocial functioning, quality of life, seizure frequency, children

DOI: 10.3233/PEP-14080

Citation: Journal of Pediatric Epilepsy, vol. 3, no. 2, pp. 85-92, 2014

Authors: Moya-Vilches, Juan L. | Devilat, Marcelo

Article Type: Review Article

Abstract: Genetic epilepsies and their cognitive-behavioral traits have been described in various reviews. Nevertheless, it is difficult to find studies about generalized epilepsy and febrile seizures plus (GEFS+) displaying detailed descriptions of its neuropsychological comorbidities. We intend to describe the clinical picture of children with GEFS+, and its comorbidities, emphasizing cognitive-behavioral conditions, and also to find associations that may contribute to the development of these disorders. We reviewed clinical records from 22 patients diagnosed with GEFS+, based on clinical and family history (no genetic tests were conducted). Most of follow-up visits were with one of us (M. Devilat), over the period …1996–2011. Mean follow-up time was 5.3 yr (1–11 yr). Our investigation focused on the associated diagnoses: conduct disorder, attention deficit/hyperactivity disorder (ADHD), specific language impairment (SLI), specific learning disorders and intellectual disability (ID). Assessment for possible associations (i.e. age at onset, seizure-free period) was conducted. A total of 15 patients (68.18%) fulfilled the diagnostic criteria of these co-morbidities. The prevalence for each disorder was as follows: ADHD-six patients (27.27%); conduct disorder-five patients (22.73%); ID, SLI and specific learning disorders-four patients (18.18%) each. Among associated factors, long-lasting seizures and onset of seizures before 12 mo of life were statistically related to ID (P = 0.02 and P = 0.04, respectively). A normal electroencephalogram was predominant in patients with SLI (P = 0.01). We conclude that neuropsychological disorders are common among patients with GEFS+, ADHD being the most frequent diagnosis. Various factors including long-lasting epilepsy and early age of onset may be associated with cognitive disorders. Show more

Keywords: GEFS+, epilepsy, febrile seizures, cognitive, behavior, neuropsychological

DOI: 10.3233/PEP-14081

Citation: Journal of Pediatric Epilepsy, vol. 3, no. 2, pp. 93-106, 2014

Authors: Mahmoud, Adel A.H. | Al Ghamdi, Fouad A.S. | Soualmi, Lahbib | Sabbagh, Abdulrahman J.

Article Type: Research Article

Abstract: Despite the expanding number of new generations of antiepileptic drugs, there continues to be a significant proportion of patients with epilepsy who are refractory to medical treatment. Other treatment options include the ketogenic diet, vagal nerve stimulation and other modalities including epilepsy surgery. The ideal patient for surgery could be the one with focal resectable lesion in an approachable area. This would be uncontroversial when the lesion is ipsilateral to the epilpetogenic discharges as per imaging and encephalogram studies. There has been growing evidence that with generalized or multifocal epileptiform discharges or even with those lesions on one side and …ictal/interictal epileptiform discharges on the opposite side, removal of the pathological lesion would help seizure control. Here we describe a patient with epileptiform discharges (ictal and interictal) contralateral to her actual encephalomalacic lesion, when antiepileptic drugs in good doses and for enough duration failed to control the seizures. Show more

Keywords: Epilepsy, lesion, focus, contralateral, epilepsy surgery

DOI: 10.3233/PEP-14082

Citation: Journal of Pediatric Epilepsy, vol. 3, no. 2, pp. 107-112, 2014

Authors: Cibils, Lucia | Cameto, Juan | Gonzalez, Gabriel

Article Type: Research Article

Abstract: Posterior reversible encephalopathy syndrome (PRES) can develop in association with a vast array of conditions including hypertensive encephalopathy and exposure to toxic agents. Clinical manifestations include seizures, headache, focal neurological deficits, visual disturbances and altered mental status and reversible radiological findings such as grey and white matter abnormalities on magnetic resonance imaging. Recurrent PRES in conjunction with periodic lateralized epileptiform discharges on electroencephalogram has been associated with new-onset epilepsy. Here, we report a pediatric case with systemic juvenile idiopathic arthritis with recurrent episodes of PRES and focal occipital epilepsy. The reason for presenting this case is to show an atypical …evolution of this disease, rarely described in children. Show more

Keywords: PRES, recurrent, epilepsy, prognosis, pediatric

DOI: 10.3233/PEP-14083

Citation: Journal of Pediatric Epilepsy, vol. 3, no. 2, pp. 113-116, 2014

Authors: Diaz-Negrillo, Antonio

Article Type: Research Article

Abstract: In the last 20 yr, the concept of ‘benign infantile epilepsy’ has received considerable attention. However, few cases of this condition have been reported. The purpose of this paper is to present a new case of benign infantile epilepsy and suggest new therapeutic options with favorable results. The patient was 11 mo of age who had complex partial seizures with secondary generalization since the age of 4 mo. The episodes were diagnosed as benign infantile seizures. Up to then there had been no optimal control of the seizures with valproic acid. By adding levetiracetam seizures disappeared completely. To our knowledge, …this is the first case reporting on the effectiveness of levetiracetam in benign infantile epilepsy. The use of levetiracetam can be a promising alternative when classical drugs do not show optimal results. Show more

Keywords: Benign infantile epilepsy, seizures, gastroenteritis, levetiracetam, epilepsy

DOI: 10.3233/PEP-14084

Citation: Journal of Pediatric Epilepsy, vol. 3, no. 2, pp. 117-119, 2014

Authors: Abid, Imen | Kamoun, Fatma | Boubaker, Chokri | Delague, Valérie | Triki, Chahnez

Article Type: Research Article

Abstract: While the involvement of the central nervous system in clinical phenotype of patients with Charcot Marie Tooth (CMT) disease has been reported in the past, the association with epilepsy has rarely been described. Only a few patients with CMT disease were reported in the literature to have epilepsy. We report the observation of a patient with CMT1A who also developed epileptic seizures. It is interesting to describe this case to show whether CMT and epilepsy are two different expressions of the same genetic abnormality or two different entities occurring together.

Keywords: CMT, epilepsy, central nervous system, child

DOI: 10.3233/PEP-14085

Citation: Journal of Pediatric Epilepsy, vol. 3, no. 2, pp. 121-125, 2014