Benign focal epilepsy of childhood with centrotemporal spikes (BECTS): clinical characteristics of seizures according to age at first seizure

BECTS is characterized by the presence of simple partial motor seizures in the face and/or oropharynx, with or without sensory symptoms and often with secondary generalization. These seizures tend to occur more often during sleep or drowsiness. According to some authors, generalized seizures prevail over other types particularly among children aged five or less. The purpose of this study is to determine the characteristics of the first epileptic episode among children with BECTS, grouped by age as of their first epileptic seizure, as well as to analyze how such seizures change over the course of clinical evolution. A total of 61 children were examined, 16 of whom below the age of 5 and 45 above. With regard to the first and recurrent epileptic episodes, our final assessment showed that partial seizures occurred more frequently than generalized tonic-clonic seizures in both groups. Although no conclusive relation could be established between the type of partial seizure (i.e. simple versus complex) and the children's age as of their first epileptic episode, it was possible to correlate the type of epileptic seizure with their clinical evolution, in which case simple partial seizures proved to be more frequent than complex partial seizures. It should be noted that the number of children under the age of five was relatively small, which evinces the need for further studies. It should also be borne in mind that the reported frequency of generalized seizures in these children's first epileptic episode may be due to their parents' lack of attention and familiarity with this pathology and their attendant difficulty in characterizing its clinical symptoms

Treatment of febrile seizures with intermittent clobazam Tratamento de convuslsões febris com clobazam intermitente

Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m.) that experienced at least one febrile seizure (FS) entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, symptomatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified in 5. The mean follow-up period was 7.9 months (range=l to 23 m.), and the age at the first seizure varied from 5 to 42 months (mean=16.8 m.). Clobazam was administered orally during the febrile episode according to the child's weight: up to 5 kg, 5 mg/day; from 5 to 10 kg, 10 mg/day; from 11 to 15 kg, 15 mg/day, and over 15 kg, 20 mg/day. There were 219 febrile episodes, with temperature above 37.8 °C, in 40 children during the study period. Twelve children never received clobazam and 28 received the drug at least once. Drug efficacy was measured by comparing FS recurrence in the febrile episodes that were treated with clobazam with those in which only antipyretic measures were taken. Ten children (20%) experienced a FS during the study period. Of the 171 febrile episodes treated with clobazam there were only 3 recurrences (1.7%), while of the 48 episodes treated only with antipyretic measures there were 11 recurrences (22.9%), a difference highly significant (pAvaliamos prospectivamente o uso intermitente do clobazam na profilaxia de convulsão febril em 50 crianças, 24 do sexo feminino e 26 do masculino, com idades entre 6 e 72 meses (média = 23,7 meses) que haviam apresentado pelo menos um episódio de convulsão febril. Foram excluídas crianças com anormalidades neurológicas severas, doença neurológica progressiva, crises durante infecção do SNC e crises epilépticas sintomáticas outras. As convulsões febris foram classificadas como simples em 25 crianças, complicadas em 20 e em 5 crianças não foi possível a classificação. O tempo médio de seguimento foi 7,9 meses (1-23 meses) e a idade, na primeira crise, variou de 5 a 42 meses (média = 16,8 meses). O clobazam foi administrado por via oral, durante os episódios febris, na dose de 5 mg/dia, em crianças até 5 kg; 10 mg/dia, de 5-10 kg; 15 mg/dia, de 11 -15 kg, e 20 mg/dia, acima de 20 kg. Quarenta crianças apresentaram febre (T > 37,8 °C), num total de 219 episódios febris. Doze crianças não chegaram a receber clobazam e 28 receberam pelo menos uma vez. A eficácia do tratamento foi avaliada comparando a recorrência de convulsão febril entre os episódios febris tratados com clobazam e aqueles tratados apenas com medicação anti-pirética. Dez crianças (20%) apresentaram recorrência de convulsão febril, durante o período de estudo. Dos 171 episódios febris tratados com clobazam, houve apenas 3 (1,7%) recorrências, enquanto dos 48 episódios tratados apenas com anti-térmicos houve 11 (22,9%) recorrências, uma diferença altamente significativa (p < 0,0001) Efeitos colaterais foram observados em 10/28 (35,7%), principalmente vômito, sonolência e hiperatividade. A interrupção da medicação devido a efeitos colaterais foi necessária em um paciente, com vômitos recorrentes. Concluímos que o clobazam é droga eficaz e segura na prevenção de recorrência de convulsão febril na infância, podendo ser uma alternativa ao tratamento com diazepam intermitente

Prevalence of Epilepsy in Children From a Brazilian Area of High Deprivation

This study assessed the prevalence rate of epilepsy and its causes in children and adolescents in one area of high deprivation in Sao Paulo, Sao Paulo, in Southeast Brazil. Between July 2005 and June 2006, 4947 families from a population of 22,013 inhabitants (including 10,405 children and adolescents between the ages of 0 and 16 years) living in the shantytown of Paraisopolis, were interviewed. In the first phase, a validated questionnaire was administered, to identify the occurrence of seizures. In the second phase, clinical history, neurologic examination, electroencephalography, and structural neuroimaging were performed. The diagnosis of epilepsy, including etiology, seizure types, and epileptic syndrome classification, was according to criteria of the International League Against Epilepsy. The screening phase identified 353 presumptive cases. In the second phase, 101 of these cases (33.8%) received the diagnosis of epilepsy. Crude prevalence of epilepsy was 9.7/1000 and prevalence of active epilepsy was 8.7/1000. Partial seizures were the most frequent seizure type (62/101). Symptomatic focal epilepsy was the most common form, and hypoxic-ischemic encephalopathy the most common etiology, reflecting the socioeconomic conditions of this specific population. Adequate public policies regarding perinatal assistance could help reduce the prevalence of epilepsy. (C) 2010 by Elsevier Inc. All rights reserved

A pilot study of topiramate in children with Lennox-Gastaut syndrome Estudo piloto com topiramato em crianças com síndrome de Lennox-Gastaut

We conducted an open, add-on study with topiramate (TPM) as adjunctive therapy in Lennox-Gastaut syndrome (LGS), to assess the long-term efficacy and safety and to evaluate quality of life (QL) measurements in the chronic use of TPM. We studied 19 patients (11 male; age ranging from 4 to 14 years) with uncontrolled seizures receiving 2-3 anti-epileptic drugs. Patients were followed up to 36 months of treatment. A questionnaire was used to query parents about QL. Seven patients completed the study at 36 months and seizure frequency was reduced > 75% in 4, and < 50% in 3 patients. Two children became seizure free for more than 24 months. Most side effects were CNS related, with the most frequent being somnolence and anorexia. These were generally transient. One patient dropped-out due to powder in the urine. None of the patients required hospitalization. At 36 months, patients' alertness (2/7), interaction with environment (5/7), ability to perform daily activities (5/7), and verbal performance (6/7) improved on TPM. We conclude that TPM may be useful as adjunctive therapy in the treatment of LGS. The efficacy of TPM was maintained in long-term treatment in more than 40% of patients, long term safety was confirmed and QL improved on TPM.<br>Realizamos estudo aberto, de adição do topiramato (TPM) como medicação adjuvante no tratamento da síndrome de Lennox-Gastaut (SLG), com a finalidade de verificar a eficácia e a segurança de avaliar a qualidade de vida (QV) no uso crônico do TPM. Estudamos 19 pacientes (11 do sexo masculino; idade entre 4 e 14 anos) com epilepsia de difícil controle e em uso de 2 a 3 drogas anti-epilépticas. Os pacientes foram seguidos por 36 meses. Um questionário foi aplicado aos pais para se avaliar QV. Sete crianças completaram o estudo. A frequência de crises foi reduzida em mais de 75% em 4 e em menos de 50% em 3 delas. Dois pacientes ficaram sem crises. A maioria dos efeitos colaterais relacionou-se ao sistema nervoso central, sendo sonolência e anorexia os mais frequentes e transitórios. Um paciente foi excluído do estudo por apresentar pó na urina. Nenhuma criança necessitou de hospitalização. Aos 36 meses, os pacientes encontravam-se mais alertas (2/7), e houve melhora na interação com o meio ambiente (5/7), na habilidade em realizar tarefas diárias (5/7) e na performance verbal (6/7). Concluímos que o TPM pode ser útil como terapia adjuvante na SLG. A eficácia manteve-se no tratamento a longo prazo em mais de 40% dos pacientes, a segurança foi confirmada e a QV melhorou com o uso do TPM