Epileptic Spasms and Partial Seizures as a Single Ictal Event

Pachatz, Christa; Fusco, Lucia; Vigevano, Federico

doi:10.1046/j.1528-1157.2003.25102.x

Cited by 24 publications

(15 citation statements)

References 15 publications

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“…Their persistence in the following years is typical of a frontal location, as already stressed [6,10] . In one late-onset case, we observed a cluster of spasms inside an hypermotor seizure, confi rming the possibility of epileptic spasms and partial seizures to present as single ictal event [23] . All cases of epileptic spasms in our series could belong to the heterogeneous category of epileptic spasms outside West syndrome [14] .…”

Section: Discussionmentioning

confidence: 65%

Seizure Semiology of Lesional Frontal Lobe Epilepsies in Children

Battaglia¹,

Lettori²,

Contaldo³

et al. 2007

Neuropediatrics

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The aim of the study was to analyse the semiology of seizures in children with frontal lobe epilepsy (FLE) and to compare them with other paediatric cohorts described in the literature as well as with adult counterparts. We analysed 174 registered seizures of 18 cases under 12 years with lesional epilepsy whose frontal origin was defined by the concordance of neuroimaging and ictal electrographic findings, and confirmed by surgery in the six cases operated on. Seizures were generally short, with a high daily frequency and usually related to sleep. The most characteristic semiological pattern consisted of complex motor seizures, particularly hypermotor. Often seizures corresponded to a mixture of different semiological patterns (tonic, gelastic, automotor, hypermotor, versive) presenting in the same seizure, often as a unique type in the same patient. With regard to several aspects the semiology of FLE in our cohort looks like that reported in adult series, in particular as to the frequency of complex motor seizures. However, our cohort was also characterised by a more protean array of seizure semiology, stressing the occurrence of seizures typically present in adults (versive and complex motor) and of some seizure patterns more characteristic in children such as epileptic spasms; moreover, the rare occurrence of secondarily generalised tonic clonic seizures (SGTCS) was confirmed.

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Section: Discussionmentioning

confidence: 65%

Seizure Semiology of Lesional Frontal Lobe Epilepsies in Children

Battaglia¹,

Lettori²,

Contaldo³

et al. 2007

Neuropediatrics

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“…West syndrome is characterized by the triad of epileptic spasms, hypsarrhythmic EEG pattern, and arrest in psychomotor development, but not all children with epileptic spasms show hypsarrhythmia on interictal EEG or developmental delays (1,5,6). In addition, subsets of patients with epileptic spasms have other types of epileptic seizures, such as partial seizures (1,2,7–10).…”

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confidence: 99%

Origin and Propagation of Epileptic Spasms Delineated on Electrocorticography

et al. 2005

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Summary:Purpose: Ictal electrographic changes were analyzed on intracranial electrocorticography (ECoG) in children with medically refractory epileptic spasms to assess the dynamic changes of ictal discharges associated with spasms and their relation to interictal epileptiform activity and neuroimaging findings.Methods: We studied a consecutive series of 15 children (age 0.4 to 13 years; nine girls) with clusters of epileptic spasms recorded on prolonged intracranial subdural ECoG recordings, which were being performed for subsequent cortical resection, and in total, 62 spasms were analyzed by using quantitative methods.Results: Spasms were associated with either a "leading" spike followed by fast-wave bursts (type I: 42 events analyzed quantitatively) or fast-wave bursts without a "leading" spike (type II: 20 events analyzed quantitatively). Twenty-three of the 42 type I spasms but none of the 20 type II spasms were preceded by a focal seizure. A "leading" spike had a focal origin in all 42 type I spasms and involved the pre-or postcentral gyrus within 0.1 s in 37 of these spasms. A leading spike was associated with interictal spike activity >1/min in 40 of 42 type I spasms and originated within 2 cm from a positron emission tomography glucose hypometabolic region in all but two type I spasms. Failure to resect the cortex showing a leading spike was associated with poor surgical outcome (p = 0.01; Fisher's exact probability test). Fast-wave bursts associated with spasms involved neocortical regions extensively at least in two lobes within 1.28 s in all 62 spasms and involved the pre-or postcentral gyrus in 53 of 62 spasms.Conclusions: Epileptic spasms may be triggered by a focal neocortical impulse in a subset of patients, and a leading spike, if present, might be used as a marker of the trigger zone for epileptic spasms. Rapidly emerging widespread fast-wave bursts might explain the clinical semiology of epileptic spasms.

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“…Earliest studies suggested brainstem dysfunction as a trigger for both spasms and the hypsarrhythmic EEG . Based on PET studies showing focal cortical hypometabolism and electroclinical demonstrations of co‐occurring partial seizures and spasms, abnormal functional interactions between brainstem and a focal or diffuse cortical abnormality were hypothesized . A predominant role of either the cortical abnormality or the subcortical structures has always been a divisive argument.…”

Section: Discussionmentioning

confidence: 99%

Unilobar surgery for symptomatic epileptic spasms

Barba

Mai²,

Grisotto

et al. 2016

Ann Clin Transl Neurol

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ObjectiveTo assess factors associated with favorable seizure outcome after surgery for symptomatic epileptic spasms and improve knowledge on pathophysiology of this seizure type.MethodsInclusion criteria were: (1) age between 6 months and 15 years at surgery; (2) active epileptic spasms; (3) follow‐up after surgery >1 year.ResultsWe retrospectively studied 80 children (aged 1.3 ± 2 years at seizure onset; 5.8 ± 4 years at surgery, 11.7 ± 5.7 years at last follow up). Magnetic resonance imaging (MRI) revealed structural abnormalities in 77/80 patients (96.3%; unilateral in 69: 89.6%). We performed invasive recordings in 24 patients (30%). In 21 patients in whom MRI or histopathology detected a lesion, electrodes exploring it constantly captured initial ictal activity at spasm onset. Fifty‐eight patients (72.5%) underwent unilobar and 22 (27.5%) multilobar or hemispheric procedures. At last follow‐up, 49 patients (61.3%) were in Engel class I. Multivariate logistic models showed completeness of resection of the seizure onset zone (OR = 0.016, 95%CI: 0.002, 0.122) and of the MRI visible lesion (OR = 0.179, 95% CI: 0.032, 0.999) to be significantly associated with Engel class IA outcome. Unfavorable outcome was associated with an older age at surgery, when it reflected a longer duration of epilepsy (OR = 1.383, 95% CI: 0.994,1.926).InterpretationData emerging from invasive recordings and the good seizure outcome following removal of discrete epileptogenic lesions support a focal cortical origin of spasms. In patients with discrete epileptogenic lesions, the pragmatic approach to surgery should follow the same principles applied to focal epilepsy favoring, whenever possible, unilobar, one‐stage resections.

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Epileptic Spasms and Partial Seizures as a Single Ictal Event

Cited by 24 publications

References 15 publications

Seizure Semiology of Lesional Frontal Lobe Epilepsies in Children

Seizure Semiology of Lesional Frontal Lobe Epilepsies in Children

Origin and Propagation of Epileptic Spasms Delineated on Electrocorticography

Unilobar surgery for symptomatic epileptic spasms

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