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[Epilepsies during the first year of life]
R Caraballo1, R Cersósimo, S Galicchio
1Servicio de Neurología, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina.
Insights
West syndrome is the most common epilepsy in infants, particularly symptomatic West syndrome. Symptomatic partial epilepsies are the second most frequent, highlighting the prevalence of symptomatic epilepsy in early childhood.
Area of Science:
- Neurology
- Pediatrics
- Epileptology
Context:
- Epileptic seizures in the first year of life present classification challenges.
- A 1989 classification of epilepsy and epileptic syndromes exists.
- Neonatal seizures and febrile convulsions were excluded from this study.
Purpose:
- To classify epilepsies and epileptic seizures beginning in the first year of life.
- To apply the 1989 international classification criteria.
- To analyze the frequency of different epilepsy types in infants.
Summary:
- The study analyzed 471 infants with seizures in their first year, excluding neonatal seizures and febrile convulsions.
- West syndrome (symptomatic and cryptogenic) was the most frequent epilepsy type (47%).
- Symptomatic partial epilepsies were the second most common (28%), followed by undetermined epilepsies (6.6%).
Impact:
- Identifies West syndrome as the predominant infantile epilepsy.
- Highlights the significant proportion of symptomatic epilepsies (partial and generalized).
- Reveals a notable percentage of infantile epilepsies not clearly defined by the 1989 classification.
Objective:
An important number of epileptic patients who began with epileptic seizures during the first year of life have not just been well classified. The objective is to identify the different types of epilepsies and epileptic seizures which begin during the first year of life, according to the last classification of epilepsy and epileptic syndromes of 1989.
Material And Methods:
We have studied 471 patients who consulted to our service in the last 5 years, with epileptic seizures during the first year of life. We excluded neonatal seizures and febrile convulsions.
Results:
1. Partial epilepsy: a) idiopathic: 12 (2.5%); b) symptomatic: 130 (28%); c) cryptogenic: 25 (5%). 2. Generalized epilepsy: a) idiopathic: benign myoclonic epilepsy in infancy, 6 (1%); b) cryptogenic-symptomatic: symptomatic West syndrome, 155 (33%); cryptogenic West syndrome, 65 (14%); cryptogenic myoclonic epilepsy, 6 (1%); early infantile epileptic encephalopathy, 8 (1.6%); early myoclonic encephalopathy, 4 (0.8%); other symptomatic generalized epilepsies without specific aetiology, 14 (3%). 3. Epilepsies and syndromes undetermined as to whether they are focal or generalized: a) severe myoclonic epilepsy in infancy, 15 (3%); symptomatic epilepsy with multifocal and independent spikes, 3 (0.6%); other undetermined epilepsies not defined above, 3 (0.6%). 4. Special syndromes: occasional convulsions, 15 (3%).
Conclusions:
West syndrome is the commonest type of epilepsy during the first year of life, particularly symptomatic West syndrome. Symptomatic partial epilepsies are in the second place in frequency. We identified 12 patients with idiopathic partial epilepsy, who full-filled clinical and EEG characteristics of a recently described epilepsy: benign infantile familial convulsions. The study showed the predominance of symptomatic epilepsy, generalized (represented by West syndrome) and partials. Finally 6% of the patients have a generalized epilepsy, cryptogenic or symptomatic, not defined in the classification.