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Convulsive Status Epilepticus in Children with Intractable Epilepsy is Frequently Focal in Origin

  • Mohammed M.S. Jan (a1), Brian G.R. Neville (a2), Timothy C. Cox (a3) and Rod C. Scott (a2)

Abstract

Background:

Convulsive status epilepticus (CSE) is a common neurological emergency. Our objectives were to study children with recurrent nonfebrile CSE to assess the evidence for focal origin.

Methods:

Series of 18 children with recurrent CSE and intractable epilepsy were identified by chart review. Clinical, radiological, and EEG data were reviewed. Focal structural abnormalities were identified on MRI and CT images by one neuroradiologist who was unaware of the clinical details.

Results:

The patient's ages ranged between 6-22 years (mean 15.3, SD 4), and 67% were males. Most children (89%) had a severe cognitive and / or behavioural disorder. Most patients (89%) had multiple seizure types and 95% of these were partial seizures. Twelve (67%) children had at least one episode of CSE with focal features identified clinically. Focal brain abnormalities were detected on 18% and 55% of CTand MRI films respectively. Overall, 53% had a focal abnormality on structural neuroimaging. Interictal EEG revealed focal or multifocal abnormalities on at least one occasion in 94% and 22% of patients respectively. Overall, 17 patients had focal features on at least one EEG. Thirteen ictal EEGs were recorded on 11 (61%) patients. Ten (91%) of these recordings revealed a focal onset.

Conclusions:

Many handicapped children with recurrent CSE have focal clinical, radiological, or electrographic features. This supports a focal origin for CSE in most children with intractable epilepsy.

RÉSUMÉ: Introduction:

Le status epilepticus convulsif (SEC) constitue une urgence neurologique fréquente. Nos objectifs étaient d'étudier les enfants qui présentent un SEC non fébrile récurrent et d'évaluer les données en faveur d'une origine focale.

Méthodes:

Un groupe de 18 enfants présentant un SEC récurrent et une épilepsie réfractaire au traitement ont été identifiés au moyen d'une revue de dossiers. Les observations cliniques, radiologiques et électroencéphalographiques ont été révisées. Des anomalies structurales focales ont été identifiées à la RMN et au CTscan par un neuroradiologiste qui ne connaissait pas les données cliniques pertinentes à chaque patient.

Résultats:

L'âge des patients variait de 6 à 22 ans (15,3 ± 4), et 67% étaient des garçons. La plupart des enfants (89%) avaient des troubles cognitifs et/ou comportementaux sévères. La plupart (89%) avaient plusieurs types de crises et 95% de ces crises étaient des crises partielles. Douze (67%) des enfants avaient eu au moins un épisode de SEC oùavait identifié des manifestations focales au point de vue clinique. Des anomalies focales ont été détectées sur 18% des images au CTet 55% à la RMN. Dans l'ensemble, 53% avaient une anomalie focale à la neuroimagerie structurale. L'ÉEG interictal a montré des anomalies focales ou multifocales à au moins une occasion chez 94% et 22% des patients respectivement. En tout, 17 patients avaient des anomalies focales sur au moins un tracé ÉEG. Treize ÉEG ictaux ont été enregistrés chez 11 patients (61%). Sur dix (91%) de ces enregistrements on a observé un début focal.

Conclusions:

Plusieurs enfants handicappés qui ont des SECs récurrents ont des manifestations focales en clinique, à l'imagerie ou à l'électroencéphalographie. Ceci appuie l'origine focale du SEC chez la plupart des enfants présentant une épilepsie réfractaire au traitement

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Convulsive Status Epilepticus in Children with Intractable Epilepsy is Frequently Focal in Origin

  • Mohammed M.S. Jan (a1), Brian G.R. Neville (a2), Timothy C. Cox (a3) and Rod C. Scott (a2)

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