Идиопатични детски фокални епилепсии

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Дата
2017-07-05
Автори
Александрова-Лазарова/Alexandrova-Lazarova, Илияна Антолиева/Iliyana Anatolyeva
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SUMMARY ***** Idiopathic focal epilepsies (IFE) are the most common form of childhood epilepsy. They are characterized by a variable course and some of the cases show an atypical evolution that can lead to cognitive decline. The aims of the study were to analyze the clinical course, the possibility of an atypical evolution and the risk factors for a complicated evolution and to summarize the therapeutic responses and determine the most effective drugs. Materials and methods: We have studied 343 children with rolandic epilepsy (66 with an atypical evolution), 51 children with idiopathic ESES, 20 children with symptomatic ESES, 40 children with Panayiotopoulos syndrome and 13 - with Gastaut syndrome. Results: Rolandic patients showed the typical for the disease clinical course: 56,3% had rare seizures (between 2 and 6 for the disease course), and 66,4% had only nocturnal seizures, permanent seizure remission was achieved in half of the patients with the first antiepileptic drug. The atypical rolandic cases showed more aggressive course: a higher percent of secondary generalized tonic-clonic seizures (82% vs. 69), earlier mean age of seizures' onset (5 vs. 7), a higher percent of cases with atypical clinical features (daytime seizures - 50% vs. 30%, postictal paresis - 33% vs. 10%), cognitive deficit or behavioral changes in 47%. The analysis of the clinical course of the rolandic patients showed that earlier age of seizure onset (below 5 years), the multiple and daytime seizures and the postictal paresis are risk factors for complicated course and atypical evolution. Analysis of the treatment responses in typical rolandic epilepsy (TRE) showed that Valproate (VPA) exceeds Carbamazepine (CBZ) in terms of its initial and long lasting effects concerning seizure remission. In the cases of an atypical evolution the most promising were the results with corticosteroids (CS), Levetiracetam (LEV), Ethosuximide (ESM), Benzodiazepines, but in general a significant therapeutic resistance was presented. The lack of an initial seizure remission or reduction with Oxcarbazepine (OXC), Lamotrigine (LTG) and CBZ and the lack of permanent seizure remission with VPA, LEV, OXC, CZP è LTG should be considered as factors for a selection of patients with a risk for an atypical course. The patients with rolandic epilepsy (n=32) had normal IQ but the results were lower than those of healthy controls. The statistical analysis found a correlation between the lower IQ scores and the earlier age of seizures' onset and the appearance of ESES. No connection between the cognitive deficit and the daytime distribution of seizures and the number of the seizures was established. Patients with rolandic epilepsy showed memory problems and attention deficit that correlated with the presence of ESES. The cases with ESES were characterized by a typical biphasic evolution and a significant therapeutic resistance. In the idiopathic cases the most promising were the results with CS, LEV, ESM. The symptomatic cases were more difficult to treat as seizures and ESES remission was rarely achieved. Panayiotopoulos syndrome was characterized by a typical course - mostly nocturnal (in 67,5% of the cases) and rare (72,5% of the children had below 6 seizures for the entire disease course) seizures with leading autonomic symptoms. Occipital epileptiform activity was registered in only 57% of the patients at the time of the diagnosis. The clinical course and the seizures' semiology were similar despite the localization of the epileptiform activity. The analysis of the clinical course showed that the number, the daytime distribution and the duration of the seizures did not affect the treatment responses. Patients with Gastaut syndrome had mostly daytime and multiple seizures, VPA and CBZ were the drugs of choice but the treatment was long lasting because of the significant risk of seizures' relapse. Conclusion: IFE are characterized by a favorable course but the possibility of an atypical evolution should be considered as those patients need close supervision with neuropsychological assessment and EEG monitoring and appropriate and prompt treatment.
Описание
Дисертационен труд за присъждане на образователна и научна степен "Доктор" /CD/ / Илияна Антолиева Александрова-Лазарова . - София, 2016 . - 181 с. + Автореферат /CD/
Ключови думи
Деца - дисертации; Нервна система - болести - деца - дисертации; Епилепсия, парциална - деца - дисертации , Child - dissertations; Nervous System Diseases - infancy and childhood - dissertations; Epilelepsies, Partial - child - dissertations
Цитирания