CLINICAL CHARACTERISTICS, ETIOLOGY, EEG AND PROGNOSIS OF 12 PATIENTS WITH INFANTILE SPASMS AND PARTIAL SEIZURES

Objectives: to elucidate the characteristics of clinical, etiology, EEG and prognosis of patients with infantile spasms accompanying partial seizures.

Methods: study the time, clinical patterns, fluctuation, correlation between epileptic spasms and partial seizures, neuroimaging and etiology, EEG and prognosis of partial seizures occurred in 12 cases with infantile spasms by means of history analysis, clinical observation, cranial CT or MRI, video-EEG monitory and follow up.

Results: twelve younger (33.3%) with infantile spasms had partial seizures at some time during the course of the disease, and other characteristics of frequent attacks, asymmetric spasms, focal or poly-focal epileptic discharges, or asymmetric hypsarrhythmia, hemiparesis and poor prognosis. PS appeared only before ES in 2 cases (group A), concomitant with ES or continued to exist after ES in 6 cases (group B), and only after ES ceased in 4 cases (group C). The correlation occurred during one ictal event of ES and PS: PS? ES cases ES? PS? ES cases ES? PS cases Comparatively, PS appeared more frequent, atypical seizures (involving more often in ocular, facial, oral and systemic like models), migrating or alternating seizures, associated with epileptic discharges of posterior temporal-occipital and parietal-temporal-occipital origins in group A and early period of group B; whereas in the late period of B and group C, PS occurred less frequent and more stable, presenting complex partial seizures or secondarily generalized seizures originated mainly from frontal and surrounding area of lateralized or bilateral hemispheres. Neuroimaging showed focal or diffuse cortical abnormalities or underlying lesions.

Conclusion: In some of children with IS, some PS and ES were developed from focal cortical lesions; whereas others might be induced by diffuse abnormally increased excitability over the cortex. The result shows IS coincided with PS is an atypical IS or localization related epilepsy migrating or alternating epileptic discharges with corresponding clinical seizures does not ensure the definite lesions, while the stable epileptogenic zone triggering stereotyped manifestations highly indicates an underlying cortical lesion.