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A clinical study on febrile non-convulsive seizures
Y. Fukuyama/Brain
& Decjelopment 1996: 18: 471-478
lated’ seizures, while severe myoclonic epilepsy in infancy is a syndrome which has the worst prognosis among these categories. We evaluated the clinical features and prognosis of epilepsy cases with ‘fever-related’ grand ma1 seizures. Subjects and Methods. From January 1981 to December 1985, 550 cases were diagnosed as having epilepsy, febrile convulsion or other situation-related seizures starting in the first year of life. We selected 128 cases in whom the seizure type was mainly grand ma1 and who were followed up until at least 6 years of age. Epilepsy cases were classified into four groups based on two criteria with or without the tendency to be provoked by fever (‘fever-related’), and control of fits for 2 or more years vs. less than 2 years. Febrile convulsions were divided into two groups: total fits exceeding 5 vs. 5 or less. In each case, age at seizure onset, family history of convulsion, etiology, seizure type, epilepsy classification and developmental prognosis were evaluated. Results. (1) Febrile convulsion with several fits (more than five) was associated with a family history of febrile convulsion at a very high rate as compared with cases with fewer fits (less than three) (81.3% vs. 42.8%). (2) Age at seizure onset was later in the cases with ‘fever-related’ seizures and a better prognosis than in cases whose seizures were not ‘fever-related’ (mean + SD.: 8.7 + 1.8 M vs. 6.2 k 3.3 MI. (3) The percentage of unknown etiology cases was higher among those with ‘fever-related’ seizures (93.5% vs. 66.7%). (4) The prognosis in cases whose seizures were not ‘fever-related’ and in whom the etiology was known, was poor (seizure control exceeding 2 years: 18.7%). (5) There were cases which showed a poor prognosis despite sharing some features of idiopathic epilepsy, such as unknown etiology and positive family history of febrile convulsion. Severe myoclonic epilepsy in infancy was in this category. Conclusions. (1) Being ‘fever-related’ was found to be an important factor influencing seizure and developmental prognosis in epilepsy cases with an onset in the first year of life. (2) Cases with ‘fever-related’ seizures formed a clinical spectrum, ranging from those with a good prognosis and certain features of febrile convulsion, to cases with intractable seizures and a poor developmental prognosis. Severe myoclonic epilepsy in infancy was included in the latter category. A clinical study on febrile non-convulsive Kiyoomi Sumi, Tetsuzo Tagawa. Fumitosho
Fujii (Dept. of Pediatrics,
seizures
Yusuke Itagaki,
Yuji Tanabe,
Osaka Kouseinenkin
Hospi-
tal, Osaka, Japan)
Object. Clinical features and the prognosis of febrile non-convulsive seizures (FNC) were studied prospectively. Patients and Methods. Of 478 patients with febrile seizures observed in our clinic during the last 15-year period from 1979 through 1993, there were 32 with FNC (7%). These FNC patients were compared with 418 who had febrile convulsive seizures, excluding 28 patients with bathing-induced seizures. Results. Family history was positive for febrile convulsions in 11 FNC patients and in 166 of those with febrile convulsive seizures. A positive family history of epilepsy was noted in two FNC patients and in 21 patients with febrile convulsive seizures.All FNC patients also had febrile convulsive seizures. While the majority of febrile convulsive seizures had occurred during the first 2 years after birth, 44% of FNC occurred after 4 years of age. The clinical manifestations of FNC include staring and/or generalized atonia. Epilepsy subsequently developed in
415
eight patients (25%) with FNC and 44 (11%) with convulsive febrile seizures. The type of subsequent epilepsy was partial in all FNC patients, while only 70% of patients with febrile convulsive seizures had subsequent partial epilepsy. Conclusion. These results suggest that subsequent epilepsy develops more frequently in patients with FNC than in those with febrile convulsive seizures, and that epilepsy in FNC patients is partial and therefore has a relatively benign prognosis. Grand ma1 seizures during follow-up of febrile convulsions Juko
Kitada,
Yoshiaki
mamoto (Department Hamamatsu,
Hirata,
of Pediatrics,
Satoru
Ohba,
Hamamatsu
Takaharu Medical
Ya-
Center.
Shizuoka, Japan)
Grand ma1 seizures, which are afebrile, are not uncommon during follow-up of febrile convulsions. Some patients do, however, have a good outcome. We conducted a comparison between a single afebrile grand ma1 seizure and multiple afebrile seizures following febrile convulsions to clarify the risk factors for developing subsequent afebrile seizures. Methods. During the follow-up of febrile seizures, a single afebrile grand ma1 seizure occured in 37 cases (S group) while 26 cases (M group) had two or more afebrile seizures. The patients were followed for more than 2 years after the initial afebrile grand ma1 seizure and risk factors associated with the second afebrile seizure were evaluated. Results. Of 692 cases with febrile convulsions, afebrile grand ma1 seizures appeared in 63 (9.1 %I. Of these 63 cases, 26 (3.8%) had repeated afebrile seizures and 37 (5.3%) had a single afebrile seizure during the course. The sex ratio, family history of febrile convulsions, hemiconvulsions, prolonged seizures lasting more than 30 min, clustered febrile convulsions and frequent febrile convulsions did not differ between two groups. The onset of febrile convulsions in both groups was same as that of regular febrile convulsions. The interval between the final febrile convulsion and the initial afebrile grand ma1 seizure was nearly the same in the two groups, i.e., 75.7% in the S group and 77.0% in the M group had an interval of less than 2 years. The AED was administered for febrile convulsions in 43.2% of the S group and 69.2% of the M group. PB or/and VPA were given continuously in 24.3% of the S group and in 38.5% of the M group. This difference was not statistically significant as 14 S-group cases were followed uneventfully without AED. In 23 (63.2%) S-group cases and 20 (77.0%) of M-group cases, AED was administered after the initial afebrile grand ma1 seizure. Eventually discharges on the first visit for febrile convulsions were compared in the two groups. Eighteen S-group cases and 12 M-group cases had epileptic discharges. The focal spikes were more predominant in the S group. In particular, a central focal spike was revealed in six S-group cases, while there were none in the M group. Furthermore, the epileptic discharges seen concomitantly with the initial afebrile grand ma1 seizure revealed similar findings. Twenty-five (67.6%) S-group cases and 17 (65.4%) M-group cases had epileptic discharges. Focal spikes were identified in 15 (40.5%) S-group cases and five (19.2%) M-group cases. A central focal spike was present in seven S-group cases but none of the M-group cases. Conclusion. Risk factors for recurrence of the initial afebrile grand ma1 seizure during follow-up of febrile convulsions have been thought to be a family history of epilepsy, and an association with mental retardation. Central focal spikes may be indicative of a good prognosis.
& Decjelopment 1996: 18: 471-478
lated’ seizures, while severe myoclonic epilepsy in infancy is a syndrome which has the worst prognosis among these categories. We evaluated the clinical features and prognosis of epilepsy cases with ‘fever-related’ grand ma1 seizures. Subjects and Methods. From January 1981 to December 1985, 550 cases were diagnosed as having epilepsy, febrile convulsion or other situation-related seizures starting in the first year of life. We selected 128 cases in whom the seizure type was mainly grand ma1 and who were followed up until at least 6 years of age. Epilepsy cases were classified into four groups based on two criteria with or without the tendency to be provoked by fever (‘fever-related’), and control of fits for 2 or more years vs. less than 2 years. Febrile convulsions were divided into two groups: total fits exceeding 5 vs. 5 or less. In each case, age at seizure onset, family history of convulsion, etiology, seizure type, epilepsy classification and developmental prognosis were evaluated. Results. (1) Febrile convulsion with several fits (more than five) was associated with a family history of febrile convulsion at a very high rate as compared with cases with fewer fits (less than three) (81.3% vs. 42.8%). (2) Age at seizure onset was later in the cases with ‘fever-related’ seizures and a better prognosis than in cases whose seizures were not ‘fever-related’ (mean + SD.: 8.7 + 1.8 M vs. 6.2 k 3.3 MI. (3) The percentage of unknown etiology cases was higher among those with ‘fever-related’ seizures (93.5% vs. 66.7%). (4) The prognosis in cases whose seizures were not ‘fever-related’ and in whom the etiology was known, was poor (seizure control exceeding 2 years: 18.7%). (5) There were cases which showed a poor prognosis despite sharing some features of idiopathic epilepsy, such as unknown etiology and positive family history of febrile convulsion. Severe myoclonic epilepsy in infancy was in this category. Conclusions. (1) Being ‘fever-related’ was found to be an important factor influencing seizure and developmental prognosis in epilepsy cases with an onset in the first year of life. (2) Cases with ‘fever-related’ seizures formed a clinical spectrum, ranging from those with a good prognosis and certain features of febrile convulsion, to cases with intractable seizures and a poor developmental prognosis. Severe myoclonic epilepsy in infancy was included in the latter category. A clinical study on febrile non-convulsive Kiyoomi Sumi, Tetsuzo Tagawa. Fumitosho
Fujii (Dept. of Pediatrics,
seizures
Yusuke Itagaki,
Yuji Tanabe,
Osaka Kouseinenkin
Hospi-
tal, Osaka, Japan)
Object. Clinical features and the prognosis of febrile non-convulsive seizures (FNC) were studied prospectively. Patients and Methods. Of 478 patients with febrile seizures observed in our clinic during the last 15-year period from 1979 through 1993, there were 32 with FNC (7%). These FNC patients were compared with 418 who had febrile convulsive seizures, excluding 28 patients with bathing-induced seizures. Results. Family history was positive for febrile convulsions in 11 FNC patients and in 166 of those with febrile convulsive seizures. A positive family history of epilepsy was noted in two FNC patients and in 21 patients with febrile convulsive seizures.All FNC patients also had febrile convulsive seizures. While the majority of febrile convulsive seizures had occurred during the first 2 years after birth, 44% of FNC occurred after 4 years of age. The clinical manifestations of FNC include staring and/or generalized atonia. Epilepsy subsequently developed in
415
eight patients (25%) with FNC and 44 (11%) with convulsive febrile seizures. The type of subsequent epilepsy was partial in all FNC patients, while only 70% of patients with febrile convulsive seizures had subsequent partial epilepsy. Conclusion. These results suggest that subsequent epilepsy develops more frequently in patients with FNC than in those with febrile convulsive seizures, and that epilepsy in FNC patients is partial and therefore has a relatively benign prognosis. Grand ma1 seizures during follow-up of febrile convulsions Juko
Kitada,
Yoshiaki
mamoto (Department Hamamatsu,
Hirata,
of Pediatrics,
Satoru
Ohba,
Hamamatsu
Takaharu Medical
Ya-
Center.
Shizuoka, Japan)
Grand ma1 seizures, which are afebrile, are not uncommon during follow-up of febrile convulsions. Some patients do, however, have a good outcome. We conducted a comparison between a single afebrile grand ma1 seizure and multiple afebrile seizures following febrile convulsions to clarify the risk factors for developing subsequent afebrile seizures. Methods. During the follow-up of febrile seizures, a single afebrile grand ma1 seizure occured in 37 cases (S group) while 26 cases (M group) had two or more afebrile seizures. The patients were followed for more than 2 years after the initial afebrile grand ma1 seizure and risk factors associated with the second afebrile seizure were evaluated. Results. Of 692 cases with febrile convulsions, afebrile grand ma1 seizures appeared in 63 (9.1 %I. Of these 63 cases, 26 (3.8%) had repeated afebrile seizures and 37 (5.3%) had a single afebrile seizure during the course. The sex ratio, family history of febrile convulsions, hemiconvulsions, prolonged seizures lasting more than 30 min, clustered febrile convulsions and frequent febrile convulsions did not differ between two groups. The onset of febrile convulsions in both groups was same as that of regular febrile convulsions. The interval between the final febrile convulsion and the initial afebrile grand ma1 seizure was nearly the same in the two groups, i.e., 75.7% in the S group and 77.0% in the M group had an interval of less than 2 years. The AED was administered for febrile convulsions in 43.2% of the S group and 69.2% of the M group. PB or/and VPA were given continuously in 24.3% of the S group and in 38.5% of the M group. This difference was not statistically significant as 14 S-group cases were followed uneventfully without AED. In 23 (63.2%) S-group cases and 20 (77.0%) of M-group cases, AED was administered after the initial afebrile grand ma1 seizure. Eventually discharges on the first visit for febrile convulsions were compared in the two groups. Eighteen S-group cases and 12 M-group cases had epileptic discharges. The focal spikes were more predominant in the S group. In particular, a central focal spike was revealed in six S-group cases, while there were none in the M group. Furthermore, the epileptic discharges seen concomitantly with the initial afebrile grand ma1 seizure revealed similar findings. Twenty-five (67.6%) S-group cases and 17 (65.4%) M-group cases had epileptic discharges. Focal spikes were identified in 15 (40.5%) S-group cases and five (19.2%) M-group cases. A central focal spike was present in seven S-group cases but none of the M-group cases. Conclusion. Risk factors for recurrence of the initial afebrile grand ma1 seizure during follow-up of febrile convulsions have been thought to be a family history of epilepsy, and an association with mental retardation. Central focal spikes may be indicative of a good prognosis.