Relationship between benign epilepsy of children with centro-temporal EEG foci and febrile convulsions

Summary:Purpose: Our aim is to outline the clinical and electroencephalographic (EEG) features of patients with hot water epilepsy (HWE), a rare and unique form of reflex epilepsy.Methods: Twenty-one patients with HWE, seen in our clinic until 1999, were studied. Male outnumbered female subjects in a ratio of 3:1. The age at the onset of seizures ranged from 19 months to 27 years (mean age at onset, 12 years).Results: The main factors precipitating seizures were bathing with hot water and/or pouring water over the head. Six patients reported self-induction, either by increasing the heat or the amount of water and/or recalling earlier bathing experiences. Nine patients expressed feeling pleasure during the seizures. Twenty patients had partial seizures, eight of whom also had secondarily generalized seizures. One patient had apparent generalized seizures only. Spontaneous seizures were present in 62% of the cases. Interictal epileptogenic abnormalities were documented in the EEGs of eight patients; the other eight had normal EEGs. The major sites of epileptogenic activity were over the unilateral temporal regions (in 40% of patients). Neuroimaging studies available for 12 patients (four cranial computed tomography and eight cranial magnetic resonance imaging scans) revealed normal findings. Seizure control in patients who were followed up was achieved by reducing the temperature or the duration of the bath or shower; several of the patients required medication.Conclusions: The major findings of this study are that HWE has a male preponderance, can be self-induced, is often done for pleasure, has complex triggering factors, and shows temporally located abnormalities in the EEGs. Although HWE is generally known to be self-limited, antiepileptic drug treatment may sometimes be necessary to control seizures. Hot water epilepsy should be classified separately among the epileptic syndromes.

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“…Rather, the association might reflect a genetic predisposition. These percentages are almost the same in all idiopathic partial epilepsies (20).…”

Section: Discussionmentioning

confidence: 68%

Hot Water Epilepsy: Clinical and Electrophysiologic Findings Based on 21 Cases

et al. 2001

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“…On the other hand, hippocampal cytotoxic edema may have caused slowing and spiking activities on EEG. Most of the reported epileptiform discharges in patients with nonprolonged febrile seizures were bursts of generalized spike‐wave discharges or centrotemporal spikes . These epileptiform discharges are generally considered to represent genetic susceptibility to seizures in common febrile seizures and are also not useful to predict subsequent epilepsy .…”

Section: Discussionmentioning

confidence: 99%

“…Most of the reported epileptiform discharges in patients with nonprolonged febrile seizures were bursts of generalized spike-wave discharges or centrotemporal spikes. 28,29 These epileptiform discharges are generally considered to represent genetic susceptibility to seizures in common febrile seizures 28,29 and are also not useful to predict subsequent epilepsy. 30,31 The characteristics of the EEG abnormalities in the present study are different from those in common febrile seizures.…”

Section: Subsequent Epilepsy After Fsementioning

confidence: 99%

Hippocampal diffusion abnormality after febrile status epilepticus is related to subsequent epilepsy

et al. 2019

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Objective To assess hippocampal signal changes on diffusion‐weighted imaging (DWI) during the acute period after febrile status epilepticus (FSE) and to examine the relationship between DWI and subsequent epilepsy. Methods A prospective, multicenter study of children with a first episode of FSE was performed. The patients underwent magnetic resonance imaging (MRI) within 3 days of FSE, and signal intensity was evaluated on DWI. Electroencephalography studies within 3 days of FSE were also assessed. Nine to 13 years after FSE, information on subsequent epilepsy was obtained. Results Twenty‐two children with FSE were evaluated. DWI showed unilateral hippocampal hyperintensity in six patients (27%). Three of six patients with hippocampal hyperintensity had ipsilateral thalamic hyperintensity. On EEG within 3 days of FSE, five of six patients with hippocampal hyperintensity had ipsilateral focal slowing, spikes, or attenuation. Nine to 13 years later, the outcomes could be determined in five patients with hippocampal hyperintensity and in 10 without. All 5 patients with hippocampal hyperintensity had hippocampal atrophy and developed focal epilepsy, whereas only 1 of 10 patients without hippocampal hyperintensity developed epilepsy (P = 0.002). Ictal semiology was concordant with temporal lobe seizures in all patients. Ipsilateral temporal epileptiform abnormalities were seen on EEG in four of five at last follow‐up. Significance Acute DWI hippocampal hyperintensity was seen in 27% of patients with FSE. Acute DWI hyperintensity suggests cytotoxic edema caused by prolonged seizure activity. Hippocampal DWI hyperintensity is related to mesial temporal lobe epilepsy and can be a target of neuroprotective treatments to prevent the onset of epilepsy.

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“…In particular, we noted no aggregation of sharp-wave foci in siblings of children with typical rolandic epilepsy. In addition, siblings of patients with FC had a high incidence of focal sharp waves (20%), a further argument for the affiliation of this form of FC with the group of diseases we have categorized as "hereditary impairment of brain maturation" (HIBM) (14,15,41).…”

Section: Family Findingsmentioning

confidence: 97%

Children with Focal Sharp Waves: Clinical and Genetic Aspects

Doose¹,

Brigger-Heuer

Neubauer

1997

Epilepsia

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Summary:Purpose: To investigate the spectrum of clinical manifestations in children with benign focal sharp waves in the EEG to gain further insight into the genetic background of clinical and EEG symptomatology in a family study.Methods: All 147 children (134 with seizures, 13 without) met the following inclusion criteria: (a) at least one EEG with focal sharp waves characteristic of benign partial epilepsies, and (b) at least 1 sibling investigated by EEG. The families were questioned orally or in writing regarding the occurrence of seizures. Patients' records were evaluated by a standardized scheme.Results: The following types of seizures occurred: febrile convulsions (FC), afebrile generalized tonic-clonic seizures (GTCS), simple and (rarely) complex partial seizures; and rolandic seizures in the strict sense. Neonatal seizures were overrepresented (6%); there were no indications of lesional causes. FC occurred in 38 children (26%). As compared with unselected cases of FC, complex symptoms were overrepresented. Family data suggested a maternal preponderance in the transmission of FC liability. Affected relatives of FC probands manifested FC more often than did relatives of probands without FC. Families of 32 patients with typical rolandic seizures (24% of the 134 probands with seizures) showed no aggregation of rolandic epilepsy, but did show variable seizure types. In the entire sample, .EEG investigations showed focal sharp waves in 11% of siblings aged 2-10 years. No relation existed between clinical symptomatology and sharp wave findings in siblings. In 66% of probands, the EEG disclosed generalized genetic patterns. Siblings with generalized spike-waves (sw) and/or theta rhythm had focal sharp waves more often than those without sw andor theta rhythm.Conclusions: The phenotypic expression of the genetic anomaly underlying focal sharp waves shows considerable variability. The clinical and EEG findings are in agreement with a multifactorial pathogenesis of epilepsies with "benign" focal epileptiform sharp waves.

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Relationship between benign epilepsy of children with centro-temporal EEG foci and febrile convulsions

Cited by 20 publications

References 10 publications

Hot Water Epilepsy: Clinical and Electrophysiologic Findings Based on 21 Cases

Hot Water Epilepsy: Clinical and Electrophysiologic Findings Based on 21 Cases

Hippocampal diffusion abnormality after febrile status epilepticus is related to subsequent epilepsy

Children with Focal Sharp Waves: Clinical and Genetic Aspects

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