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Head injuries may result from impact or shaking or a combination of these mechanisms, which act through translational or rotational forces. The classic presentation of non-accidental brain injury (NABI) in infants is the shaken baby syndrome (SBS), which is characterized by widespread parenchymal damage, diffuse axonal injury, subdural and/or subarachnoid hemorrhages, and retinal hemorrhages. Seizures occur more frequently in children with inflicted versus non-inflicted traumatic brain injury. Radiological imaging plays a crucial role in investigating NABI, in order to assess intracranial complications, guide clinical management, and provide documentary evidence for forensic investigation. Magnetic resonance imaging (MRI) detects hemorrhage in the sub acute stage (3-14 days) and demonstrates with high sensitivity early ischemic changes and diffuse axonal injury. Phenytoin has been considered the drug of choice for preventive treatment of early and late seizures while carbamazepine and valproate would be more suitable for the treatment of late seizures.
To report on five patients with temporal lobe epilepsy (TLE) as the unique manifestation of multiple sclerosis (MS).
Among 350 consecutive MS patients, we identified 16/350 (4.6%) who also had epileptic seizures. Here, we review their electrophysiological and clinical features.
Five of these 16 patients (four female, one male; mean age 34.2 years; range 31 to 38) with MS and epileptic seizures had an extremely homogeneous clinical picture characterized by TLE as the unique manifestation of MS, even at long follow-up (mean: five years; range 4 to 10). In all patients, seizures started in the second or third decade. Brain MRI revealed at least one juxta-cortical lesion within the temporal region. Antiepileptic medication was always effective.
The present study provides the first evidence of a peculiar form of MS characterized by TLE as the unique manifestation of the disease with no disability or MS relapses at long-term follow-up.
To compare mild vs. severe non-lesional temporal lobe epilepsy (TLE).
Data from 104 consecutive patients with non-lesional TLE were reviewed. Seventy-three of the 104 fulfilled the criteria for inclusion in this study of a follow-up period longer than three years at our Institute. Patients were considered to have a mild TLE if they were seizure free for at least three years after appropriate antiepileptic medication, or had rare (≤ 2/year) complex partial or secondarily generalized seizures for at least three years with or without appropriate antiepileptic therapy. Clinical, EEG and MRI data of mild vs. severe non-lesional TLE patients were compared on the basis of a cross-sectional study design.
Of the 73 patients with non-lesional TLE included in the study, 43 (59%) had mild TLE, and 30 (41%) had severe TLE. Duration of epilepsy was significantly shorter (mean 15.2 ± 10.5 years vs. 26.4 ± 13.2 years) and age at onset was significantly higher (mean 34.3 ± 15.3 years vs. 7.8 ± 6.8 years) in mild than in severe TLE group. Patients with mild TLE had also a significantly higher prevalence of positive family history of epilepsy (37.2% vs. 10%), and a significantly lower occurrence rate of febrile convulsions (FC) (4.7% vs. 33.3%), mesial temporal sclerosis (MTS) (6.9% vs. 36.7%), and intelligence deficiency (0% vs. 20%). In mild TLE there was also a significantly high rate (58.1% vs. 0%) of delayed diagnosis (from 1 to 28 years), because of misdiagnosis (39.5%) or no medical counseling (18.6%).
Mild non-lesional TLE is a common, unrecognized disorder mainly characterized by both onset in adulthood and high prevalence of familial history of epilepsy. The present findings suggest that mild non-lesional TLE may represent a clinical entity different from severe non-lesional TLE.
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