CCT IN DIFFERENT EPILEPSIES WITH GRAND MAL AND FOCAL SEIZURES IN 309 CHILDREN: RELATION TO CLINICAL AND ELECTROENCEPHALOGRAPHIC DATA

Abstract

309 children with different types of grand mal and focal epilepsies were examined by cranial computerized transverse axial tomography (CCT). The results are reported in correlation to clinical and EEG data. 35 children (38 %) with primary generalized epilepsies had pathologic CCT changes: 22 of slight, 10 of medium-degree, and 3 of severe degree. Mostly symmetrical, cortical and/or subcortical atrophies (N = 24) were found.
In 43 out of 51 children with secondary generalized epilepsy we found pathologic results: all 16 patients with West syndrome and 80% of children with Lennox syndrome (N = 35). There were mostly medium-degree to severe changes and cortical and/or subcortical atrophies (N = 24).
In 165 patients with focal epilepsy we found slight (16 %) or medium-degree (19 %) changes in 39 % (64 patients). Out of these 29 had symmetric atrophies and 22 one-sided or focal atrophies.
The following differences could be statistically secured: (1) patients with centrencephalic myoclonic-astatic petit mal had more pathologic results than those with other primary generalized epilepsies with grand mal seizures, on the other hand they had less and less severe changes than children with Lennox syndrome, (2) patients with West syndrome had more and more severe CCT changes than patients with Lennox syndrome, (3) there were no differences as far as frequency and severity of CCT changes were concerned between patients with primary generalized and focal epilepsies, (4) there are severe differences between patients with focal epilepsies and secondary generalized epilepsies.
Patients with the following symptoms had significantly more pathologic changes in the CCT
-retardation of motor development in focal epilepsies,
-delay of mental development (all subgroups),
-disturbance during neurologic examination, with the exception in secondary generalized epilepsies,
-frequency of grand mal seizures, exception Lennox syndrome,
-constant slow wave focus and missing additional centrencephalic pattern in the EEG in focal epilepsies.
There was no correlation as to severity or frequency of CCT changes in patients with following symptoms
-pre- and perinatal risk factors increased,
-microcephalus,
-positive family history with respect to seizure disorders, exception in Lennox syndrome with less and less severe CCT changes,
-complicated or not complicated febrile convulsions at onset of seizure disorder, exception focal epilepsies, who had less severe CCT changes than in children without febrile convulsions,
-grand mal status,
-focal sign during seizures in primary generalized epilepsies,
-inconstant slow wave focus or focal sharp wave in primary generalized epilepsies,
-generalized sharp wave groups in focal epilepsies,
-favourable or non favourable course of epilepsy.

Key words

Computerized tomography in epilepsy - grand mal epilepsy and computerized tomography - focal epilepsy and computerized tomography - clinical findings and computerized tomography - Lennox syndrome - absende epilepsy - myoclonic-astatic petit mal - propulsive petit mal - infantile spasms