Infantile spasms: Ictal phenomena

King, Don W.; Dyken, Paul R.; Spinks, Ira L.; Murvin, Alice J.

doi:10.1016/s0887-8994(85)80002-3

Cited by 40 publications

(41 citation statements)

References 7 publications

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“…As the only inclusion requirement in our study was recorded spasms, we were able to study both interictal and ictal phenomena in the early stages of infantile spasms. Motor and subtle spasm behaviours and the association between asymmetrical and asynchronous spasms and the symptomatic aetiology observed in our study were similar to what has been reported before (Kellaway et al 1979, King et al 1985, Donat and Wright 1991, Haga et al 1995. Our observation that almost a quarter of the infants with symptomatic aetiology had only subtle spasms emphasizes the value of video-EEG in the investigation of infants with neurological impairments and epileptiform interictal EEG abnormalities.…”

Section: Methodssupporting

confidence: 91%

“…Dulac and coworkers (1993) and Fusco and Vigevano (1993) separated 'independent spasms', where hypsarrhythmia reappears between spasms, and 'clustering spasms' where no hypsarrhythmia is seen between spasms. The ictal EEG phenomena associated with infantile spasms include fast (or 'spindle-like') activity, high voltage spikes, spike-waves, slow waves, and attenuation (Jeavons and Bower 1964, Kellaway et al 1979, King et al 1985, Haga et al 1995.…”

mentioning

confidence: 99%

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Infantile spasms: diagnosis and assessment of treatment response by video‐EEG

Gaily

Liukkonen

Paetau

et al. 2001

Develop Med Child Neuro

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The purpose of this study was to investigate early electroclinical manifestations and evaluate treatment responses by video-EEG in infants with newly diagnosed spasms. Spasms were recorded in 44 infants (27 males, 17 females) before adequate treatment. Mean ages at onset of spasms and at first video-EEG were 5.3 months (range 0.9 to 9 months) and 5.9 months (range 2.4 to 11.5 months) respectively. Thirteen infants had cryptogenic and 31 had symptomatic aetiology. First treatment was vigabatrin in 36 infants. All infants were followed until 12 months of age or death. Treatment response in the first months of therapy was assessed by repeated video-EEG studies in 23 infants. On the first video-EEG, 34 infants had typical symmetric motor spasms, three infants showed asymmetric or asynchronous behaviour, and seven infants had only subtle spasms. Interictal EEG showed hypsarrhythmia in 27 infants and multifocal spikes with normal or nearly normal background in 17 infants. Subtle spasms, asymmetric or asynchronous spasms, and asymmetric ictal or interictal EEG abnormalities were associated with symptomatic aetiology and poor cognitive and seizure outcome at 12 months. Serial video-EEG recordings showed a transition from motor to subtle spasms during the first 2 weeks of vigabatrin therapy in four infants and only subtle spasms in two therapy-resistant infants at 12 months. Cessation of spasms usually preceded disappearance of hypsarrhythmia or multifocal spikes, but persistence of multifocal spikes over several weeks was always associated with existing spasms. Transition of hypsarrhythmia into multifocal spikes was observed during vigabatrin therapy even in infants with intractable spasms. Initial diagnosis of infantile spasms requires video-EEG studies especially in infants with symptomatic aetiology who may show only subtle spasms. Video-EEG is the only reliable method for assessing treatment response as spasms and interictal EEG abnormalities are modified by treatment and may become subtle.

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Section: Methodssupporting

confidence: 91%

mentioning

confidence: 99%

Infantile spasms: diagnosis and assessment of treatment response by video‐EEG

Gaily

Liukkonen

Paetau

et al. 2001

Develop Med Child Neuro

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“…Como salientado em outros estudos [5][6][7]14,15 , a história fornecida pelos pais sobre as manifestações clínicas dos eventos paroxísticos, nesta faixa etária, é confusa e pouco elucidativa. Neste contexto, o vídeo-EEG passa a desempenhar um importante papel na elucidação diagnóstica e conduta terapêutica dos eventos paroxísticos da infância.…”

Section: Discussionunclassified

“…Uma das maiores indicações do vídeo-EEG é a classificação adequada da epilepsia para a melhor abordagem terapêutica. As crises generalizadas de início focal, freqüentes na infância 5,6,[17][18][19] , representam um dos maiores desafios para o diagnóstico em crianças com epilepsia e, em nosso estudo, foram uma das principais razões de reclassificação das crises epilépticas. Conseqüentemente, este método permitiu, indiretamente, um melhor ajuste das DAE e direcionou os exames de neuroimagem em pacientes previamente diagnosticados como criptogênicos.…”

Section: Discussionunclassified

“…Uma indicação importante deste tipo de procedimento inclui o diagnóstico diferencial entre eventos epilépticos e não epilépticos (sín-copes, arritmias cardíacas, distúrbios do sono e distúrbios psiquiátricos, entre outros). Outras condições nas quais o vídeo-EEG é recomendado são a classificação de síndro-mes e crises epilépticas, a determinação da zona epileptogênica na investigação pré-cirúrgica para epilepsia, a determinação da freqüência das crises, e a resposta às intervenções terapêuticas [1][2][3][4][5][6][7][8][9][10][11] .…”

Section: Introductionunclassified

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O vídeo-EEG dia no diagnóstico de eventos paroxísticos na infância

Freitas¹,

Fiore²,

Gronich³

et al. 2003

J. Pediatr. (Rio J.)

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ResumoObjetivo: este estudo tem como objetivo investigar o valor do vídeo-EEG dia numa população pediátrica, com queixas clínicas diversas, verificando os benefícios e as limitações deste método.Casuística e métodos: um protocolo prospectivo, desenvolvido na Universidade de São Paulo, analisou 38 pacientes consecutivos (quatro meses a 17 anos; média 6,9 anos). Todos os pacientes foram encaminhados para elucidação do seu quadro clínico. Estes foram classificados, segundo sua queixa clínica principal, em: dúvidas sobre a classificação das crises/ síndromes epilépticas em 22 pacientes (grupo I); diagnóstico diferencial entre eventos epilépticos e não epilépticos em 8 (grupo II); e diagnóstico diferencial entre declínio cognitivo e estado de mal epiléptico (EME) não convulsivo em 8 pacientes (grupo III).Resultados: episódios clínicos foram registrados em 36 pacientes (94,7%). No grupo I, as crises epilépticas foram reclassificadas em 11/22 (50%) pacientes e confirmadas em oito (36,4%). Deste grupo, um paciente apresentou distúrbio do sono, e dois não apresentaram eventos clínicos durante a monitorização. A classificação sindrômica foi modificada em nove pacientes (40,9%). No grupo II, quatro pacientes (50%) apresentaram eventos epilépticos. A deterioração cognitiva estava associada com EME em cinco crianças (62,5%) do grupo III. Mudanças na conduta terapêutica e diagnós-tica, como conseqüência da monitorização, ocorreram em 21/38 (55,3%) pacientes.Conclusão: em nossa série, o vídeo-EEG dia estabeleceu o diagnóstico na maioria dos pacientes, relacionando os dados clínicos com os eletrencefalográficos. Este procedimento foi bem tolerado pelas crianças, incluindo lactentes e aquelas com doenças psiquiátri-cas.J Pediatr (Rio J) 2003;79(3):259-64: epilepsia, monitorização, classificação. AbstractObjective: the objective of this study was to investigate the value of short-term video-EEG monitoring in a pediatric population with distinct clinical complaints in order to verify the benefits and limitations of this procedure.Patients and methods: a prospective protocol, developed in the University of São Paulo, analyzed 38 consecutive patients (age ranging from 4 months to 17 years; mean 6.9 years). All patients were referred in order to establish the diagnosis. The patients were divided in the following groups according to the main clinical complaint: doubts about seizure/syndromic classification (Group I, n = 22); differential diagnosis with non-epileptic events (Group II, n = 8) and differential diagnosis between cognitive decline and status epilepticus (Group III, n = 8).Results: clinical episodes were observed in 36 patients (94.7%). In group I, seizures were reclassified in 11/22 (50%) patients and confirmed in eight (36.4%). One patient presented a sleep disorder and two did not present clinical events during monitoring. Syndromic classification was modified in nine (40.9%). In group II, four patients (50%) presented epileptic seizures; two had movement disorders and two, non-epileptic events. The cognitive deteriorati...

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