Ictal characteristics of cryptogenic partial epilepsies in infancy
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1Service de Neuro-Pédiatrie, Hôpital St. Vincent de Paul, INSERM, Paris, France.
Insights
Early-onset partial seizures (PS) in infants present unique semiologic features and potential diagnostic challenges. While seizure persistence is a concern, neurological outcomes may be more favorable than other early-onset epilepsies.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Infancy-onset epilepsies pose diagnostic and therapeutic challenges.
- Partial seizures (PS) in early childhood require detailed ictal event analysis.
- Understanding seizure semiology is crucial for accurate diagnosis and management.
Purpose of the Study:
- To analyze the ictal semiology and clinical characteristics of partial seizures (PS) in infants.
- To investigate the diagnostic difficulties and prognostic factors in early-onset PS.
- To evaluate the neurological outcome in children with PS starting in the first two years of life.
Main Methods:
- Retrospective analysis of 23 patients with infantile-onset partial seizures (PS).
- Detailed review of ictal semiology, including seizure types and associated phenomena.
- Assessment of initial neurological examinations, etiological investigations, and follow-up data.
Main Results:
- Three main seizure types were identified: simple PS, complex partial seizures (CPS) with impaired consciousness, and CPS with motor onset.
- Frequent association of versive phenomena, oroalimentary automatisms, and vegetative signs.
- Suggested temporal lobe and somatomotor area involvement based on ictal discharge topography.
Conclusions:
- Diagnosis of PS in the first year of life can be challenging, with potential evolution from generalized to partial seizures.
- Prognosis for seizure control is guarded, but overall neurological outcomes appear better than other infancy-onset epilepsies.
- Early identification and characterization of ictal events are vital for managing pediatric partial seizures.
Abstract:
Twenty-three patients with onset of partial seizures (PS) during the first 2 years of life were collected in a single neuropediatric center and ictal events were analyzed. All patients initially had normal developmental and neurologic examinations, negative etiologic investigations, and at least two nonfebrile PS of a single type. Mean follow-up from first seizure to the last contact with the patient was 51 months (SEM 8.17 months). Ictal semiology was characterized by three types of seizures: simple PS with motor signs, complex partial seizures (CPS) with impairment of consciousness at onset followed by motor manifestations, and CPS with motor activity at onset. Versive phenomena, oroalimentary automatisms, and vegetative manifestations were frequently associated. The topography of the ictal discharges and the elementary ictal events, suggested involvement of the temporal lobe and somatomotor area. The diagnosis of PS can be difficult during the first year of life since some patients beginning with generalized seizures may evolve into partial seizures. The prognosis is guarded with regard to seizure persistence, but the neurologic outcome is better as a whole than is reported for infancy-onset epilepsies.