Clinical findings in children with occipital paroxysmal discharges.

Occipital paroxysmal discharges (OPDs) have been related to a variety of clinical problems. To evaluate associated symptoms and patient outcome, we studied 293 children with OPDs. Follow-up of more than 6 months was available in 141 children. Mental retardation, neurological symptoms, behavior problems, ocular symptoms, and convulsions of various types were present. Eight patients had ictal visual phenomena consistent with the diagnosis of benign epilepsy with occipital spike and wave (BEOSW). In the 141 children with at least 6 months follow-up, 58 had other types of convulsions. Clinical and EEG normalization was observed in 25 and clinical normalization only in 17. The use of antiepileptic drugs did not seem to influence the outcome although seizure control was obtained in 26 patients. In all the cases where follow-up was 9 or more years, clinical normalization was observed. Clinical symptoms in these patients were quite heterogeneous and frequently not ictal. The disappearance of OPDs with increasing age points to their being "not lesional" in origin.

Intractable epilepsy: etiology, risk factors and treatment.

The data emerging from our study are the following: the presence of an identifiable cause is important: complications like tuberous sclerosis or signs of marked cerebral damage represent an adverse risk factor for IE. The presence of epilepsy among relatives, evidence of pre- or perinatal cerebral damage, mental retardation, and early onset, long periods of uncontrolled seizures before starting an adequate therapy and frequency of seizures appear to be indicative of an adverse prognosis, since differences between the two groups of responsive or unresponsive patients are statistically significant. On the contrary, the occurrence of febrile convulsions in the past history does not seem to have an adverse prognosis. Temporal lobe epilepsy and IS bear the worst prognosis. ME, CPS, GTCS, SPS, LGS and PM have a progressively better outcome in responsiveness to AEDs. Concerning therapy in patients with IE, studies indicate the results of high dose monotherapy appear to be equal or better than with polypharmacy. Because of the gravity of the situation, trials with unconventional drugs have been performed, but it is too early to draw definite conclusions about the long-term usefulness of most of them. In conclusion, our data indicate that the appearance of an IE can be predicted utilizing the above mentioned criteria, considered either alone or in combination. The issue of IE remains undoubtedly an important one among the group of convulsive disorders. Further studies considering a greater number of patients and new therpeutic strategies are to be recommended.

Clinical experiences of petit mal.

Petit mal is a condition characterized by absences accompanied on EEG by discharges of 3/sec spike and waves lasting more than 3-4 seconds. In 145 patients with pure petit mal (PPM) these were the only findings. They were associated with other types of seizures (APM) in 52 subjects and with myoclonic jerks of the upper limbs. (MPM) in 8. Clinical and EEG normalization was obtained in 93/111 patients with PPM with adequate therapy (84%), while the same outcome was observed in 7/31 (22%) of the subjects without adequate therapy. In the group with APM, clinical and EEG normalization was obtained in 26/34 (76%), while it was observed in 3/18 (16%) of the patients who received inadequate therapy. Among the patients with MPM, clinical but not EEG normalization was obtained in 4/8. The personal history showed a high percentage of febrile convulsions. IPS was also frequently positive. The prognosis of PM seems to be mainly related to adequate therapy. The presence of other types of seizures does not significantly modify the prognosis provided that the therapy is adequate. It is, however, important to note that signs or symptoms of neurologic impairment were rare in this group of patients, probably due to the criteria chosen for the selection of patients.

Further observations on the treatment of infantile spasms with corticotropin.

The results of corticotropin treatment of 33 subjects with infantile spasms are reported. In 8 patients the disease was idiopathic and in 25 secondary. Among the idiopathic cases, full clinical and EEG normalization was obtained in 5. No anticonvulsants were given after the corticotropin treatment. All children have remained normal without therapy. Among the 25 secondary cases, complete normalization was obtained in one with meningioma and improvement in 15 others. The dosage of ACTH was usually 2 U/Kg/bw for 10 days and 10 U/Kg/bw on alternate days for a further 20 days. These findings indicate that therapeutic results quite similar to the most favourable reported in the literature can be obtained, with few side effects, with a low dosage and a short period of treatment with corticotropin.

Infantile spasms--long term results of ACTH treatment.

From a series of 230 subjects with infantile spasms (I.S.) observed from 1955 to 1982, 191 cases with sufficient data on follow-up and evaluation were selected. The period of follow-up in 100 subjects ranged from 3 months to 3 years and was more than 3 years in the remaining 91 patients. Disappearance of spasms and normal psychomotor development was observed in 34 of the 61 idiopathic and post-infectious cases. In 130 subjects with secondary forms normal psychomotor development was observed in only two patients; disappearance of spasms was noted in 54 and normalisation of the EEG in 13 subjects. Satisfactory long term results can be obtained with a relatively low dose of corticotropin in a considerable number of patients having idiopathic and post-infectious forms of I.S. To obtain the best results treatment should be started as soon as possible.

Electroencephalographic findings in pediatric cases of coma.

Electroencephalographic aspects of coma in 201 children are presented. The ages of the subjects ranged between 1 month and 14 years. The EEG picture was not specific. Diffuse slowing and convulsive activity were present in meningoencephalitis and postconvulsive coma. Diffuse slowing was also present in coma of metabolic origin. Mixed slow and fast activity was typical of coma due to benzodiazepines, barbiturates and alcohol. In patients with intracerebral hemorrhages, there was marked focal slowing associated with generalized delta and theta waves. In 12 patients with craniocerebral trauma, the EEG showed generalized slowing which was associated with focal reduction of voltage in 6 cases and with convulsive activity in 2. Extreme slowing or an isoelectric recording had a bad prognosis. The reappearance of sleep spindles was a favorable sign.