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Convulsive status epilepticus in children with intractable epilepsy is frequently focal in origin
Mohammed Jan1, Brian G R Neville, Timothy C Cox
1Department of Pediatrics, King Abdulaziz University Hospital and College of Medicine and Allied Health Sciences, Jeddah, Saudi Arabia.
Insights
Recurrent convulsive status epilepticus (CSE) in children often originates from a focal brain issue, indicated by clinical, imaging, and EEG findings. This suggests targeted treatment approaches for intractable epilepsy cases.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neuroimaging
Background:
- Convulsive status epilepticus (CSE) is a frequent neurological emergency in children.
- Recurrent nonfebrile CSE presents a diagnostic challenge.
- Understanding the origin of CSE is crucial for effective management.
Purpose of the Study:
- To investigate the evidence for a focal origin in children experiencing recurrent nonfebrile CSE.
- To correlate clinical, radiological, and electroencephalographic (EEG) data in these patients.
Main Methods:
- Chart review of 18 children with recurrent CSE and intractable epilepsy.
- Analysis of clinical, radiological (CT and MRI), and EEG data.
- Neuroradiologist assessment of neuroimaging for focal structural abnormalities, blinded to clinical details.
Main Results:
- Most patients (89%) had severe cognitive/behavioral disorders and multiple seizure types (95% partial).
- Focal features were clinically observed in 67% of CSE episodes.
- Focal abnormalities detected on MRI (55%) and CT (18%), with overall 53% showing focal neuroimaging findings.
- EEG revealed focal abnormalities in 94% (interictal) and 91% (ictal) of patients, supporting a focal onset.
Conclusions:
- A significant proportion of children with recurrent CSE and intractable epilepsy exhibit focal clinical, radiological, or electrographic features.
- These findings strongly support a focal origin for CSE in this pediatric population.
- Identifying focal origins can guide treatment strategies for intractable epilepsy.
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 CT and 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.