Article
Diagnosing idiopathic/cryptogenic epilepsy syndromes in infancy
N Sarisjulisa, B Gambonia, P Plouinb, A Kaminskaa, O Dulacc
a Service de
Neuropédiatrie, Hôpital Saint Vincent de Paul, 82 Avenue
Denfert-Rochereau, 75674 Paris Cedex, France, b Laboratoire
de Neurophysiologie Clinique, Hôpital Saint Vincent de Paul, c INSERM U29, Hôpital Saint Vincent de
Paul
Correspondence to: Dr Dulac
Accepted 28
September 1999
PURPOSE
To determine
the characteristics that permit diagnosis of the type of epilepsy
beginning in the 1st year of life, and to determine from what age such
characteristics are recognisable.
PATIENTSFrom 430 non-selected patients who began having seizures in the 1st year of life
and were referred to the neuropaediatric department of Saint Vincent de
Paul Hospital, those with epileptic spasms as the first seizure type,
those with recognisable aetiology, and those for whom early history was
not reliable were excluded.
METHODSFor the
remaining 140 patients, the age at which clinical and
electroencephalogram (EEG) characteristics met those of recognisable epilepsy syndromes according to the ILAE classification was studied.
RESULTSIn most
epilepsy syndromes, the diagnosis could be made within three months of
onset of the disorder. The most difficult was to distinguish
cryptogenic localisation related epilepsy from severe myoclonic
epilepsy in infancy. Repeat focal seizures and persisting spike focus
were the earliest and most reliable signs of localisation related
epilepsy, whereas alternating focal seizures, generalised myoclonus,
and/or spike waves appeared before the end of the 1st year in most
infants with severe myoclonic epilepsy. However, for 39 patients it was
not possible to reach the diagnosis of a precise syndrome.
CONCLUSIONFor over
three quarters of infants with cryptogenic/idiopathic epilepsy, it is
possible to reach a syndromic diagnosis within the first months of the
disease, based on clinical and EEG characteristics. However, for one
quarter, no diagnosis is possible based on the currently available classification.
Keywords: epilepsy; convulsions; diagnosis
© 2000 by Archives of Disease in Childhood
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