Epileptic disorders : international epilepsy journal with videotape
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Treatment of severe, incapacitating action myoclonus is difficult. Piracetam has been shown to be a very potent antimyoclonic agent, but only at very high, impractical doses, ranging from 24 to 40 g/d. ⋯ LEV produced a clear abatement of myoclonus, which is demonstrated on video for the patient with post-anoxic myoclonus, without any unwanted side-effects. These preliminary findings suggest that LEV may have interesting antimyoclonic properties that deserve further investigation.
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The selection of terminology, though seemingly unimportant, can have profound effects on our thinking. A seizure classification system based exclusively on seizure semiology emphasizes the wide diversity and richness of seizure expression. ⋯ This proves to be particularly true in pediatric epilepsy, because seizure semiology is more subtle and difficult to characterize. The following article describes a semiological seizure classification and its relevance to both pediatric epilepsy surgery and status epilepticus.
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The purpose of this report is to describe the full clinical and electroencephalograpic spectrum of atypical benign partial epilepsy (ABPE) or pseudo-Lennox syndrome (PLS). We retrospectively analyzed the clinical and EEG data of 43 children with ABPE/PLS seen in our department during the last 25 years. Criteria for diagnosis of ABPE/PLS were the occurrence of generalized minor seizures as previously described for ABPE/PLS and the detection of focal sharp waves indistinguishable from those of rolandic epilepsy (RE) with generalization during slow sleep. ⋯ ABPE/PLS overlaps broadly with RE, but also with electrical status epilepticus during sleep and Landau-Kleffner syndrome. Therefore, ABPE/PLS can be ranked alongside RE and other idiopathic partial epilepsies. The high incidence of sharp waves in siblings suggests that ABPE/PLS and RE have a common underlying genetic etiology.
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This is a systematic-prospective study of occipital seizures with elementary visual hallucinations in 18 patients with symptomatic occipital epilepsy. Qualitative and chronological analysis showed that visual seizures usually lasted for seconds to 1-3 minutes. Three patients also had longer visual seizures of 20-150 minutes. ⋯ Progress to temporal lobe structures is different and consistent with symptomatic occipital lobe epilepsy. The clinical diagnosis of visual seizures is easy if individual elements of duration, colour, shape, size, location, movement, speed of development and progress are identified. They are markedly different from visual aura of migraine, although they often trigger migrainous headache, probably by activating trigeminovascular or brain stem mechanisms.
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In order to help clarify the mechanism of tonic convulsion, which is commonly seen in supplementary motor area (SMA) seizures, we investigated the temporal relationship between ictal discharges arising from the SMA and the associated EMG discharges in the foot, in a patient with SMA seizures, prior to surgical treatment. The patient's intractable seizures consisted of tonic followed by clonic convulsion of the left foot also involving at times, the left hand. Ictal EEGs were investigated by subdural electrodes placed on the SMA-proper and pre-SMA, which were defined by cortical stimulation and by recording cortical-evoked potentials. ⋯ It had a duration of 300 to 500 msec, and on each occasion a positive cortical activity at the pre-SMA preceded the EMG onset by 110 msec, and a negative spike at the SMA-proper preceded the EMG onset by 50 to 60 msec. Epileptic discharges originating from the pre-SMA spread to the SMA-proper and possibly also to the primary motor cortex (MI) in this patient. Since both SMA-proper and MI could elicit EMG discharges through the independent corticospinal tracts having different conduction velocities, even a single spike arising from the SMA could give rise to a long EMG burst, which may play some role in the tonic convulsion which characterizes SMA seizures.