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Differentiation of nonepileptic patients by long-term video-EEG monitoring
290. V O L U M E T R I C A N A L Y S I S OF C E R E B R A L STRUCTURES IN DOWN SYNDROME USING SEQUENTIAL MRI Nobuaki Iwasaki, Kenzo Hamano, Toshiki Takeya, Natsuki Imoto, Yae Shimakura, and Hitoshi Takita, Tsukuba, Ibaraki, Japan Details of cerebral development are not well analyzed in Down syndrome (DS). We studied the 3-dimensional development of cerebral structures in children with DS using a method we devised utilizing sequential MRI. Subjects were 12 children with DS and 40 normal controls without neurologic or neuroradiologic abnormalities. The DS group ranged in age from 8 months to 10 years, and the control group from 4 months to 27 years. Five of the DS group had epilepsy. Tj- and T2-weighted MRI were obtained using a spin-echo technique with a slice thickness of 10 mm. The object contours of the cerebral hemisphere (CH), myelinated white matter (MW), and basal ganglia and thalamus (BT) were traced and calculated using the image analyzing system (Olympus SP-500). The total areas of each part obtained were multiplied by the slice thickness to estimate the volume. The volume ratios of CH, MW, and BT of DS versus those of the control group were 72 - 8%, 88 -+ 17%, and 68 - 12%, respectively. The volume ratio of BT/CH did not differ between the DS and control groups. The volume ratio of MW/CH was reduced in the DS group with epilepsy (82 +- 12%). These data indicated that cerebral volume in DS decreased for all ages, and that myelinizationof the cerebral white matter was delayed in DS with epilepsy. 291. O U T C O M E OF C A L L O S O T O M Y ON MEDICALLY INTRACTABLE SEIZURES IN TAIWAN Kai-Ping Chang, Tai-Tong Wong, Shang-Yeong Kwan, and Tsui-Fen Yang, Taipei, Taiwan From September, 1989 to December, 1993, partial callosotomy (anterior two-thirds) was performed on 26 patients with medically intractable seizures in our hospital. Eighteen patients followed-up regularly for more than 6 months after callosotomy are included in this survey. Among them there are 16 patients with Lennox-Gastaut syndrome, 1 with infantile spasms, and 1 with secondary generalized tonic-clonic seizures. Although 3 patients did not get any benefit from the callosotomy, the remaining 15 obtained significant improvement which is judged by the parents if there is more than 50% reduction in seizure occurrence after callosotomy. Excluding 2 patients with transient mutism, no short-term or long-term sequelae of callosotomy were found in these patients. From this retrospective survey, we conclude that callosotomy is a safe, effective procedure for the treatment of children with medically intractable seizures. 292. DIFFERENTIATION OF NONEPILEPTIC PATIENTS BY LONG-TERM VIDEO-EEG MONITORING Y. Renda, G. Turanli, M. Top,u, and A. Gtilya§ar, Ankara, Turkey Long-term EEG and video monitoring techniques were applied on 224 patients who were diagnosed as having epilepsy or nonepileptic seizures in order for better diagnosis and prospective epileptic surgery from February, 1992 to February, 1994. Prior to long-term monitoring, 203 patients (90.6%) were diagnosed
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as epileptic and 21 (9.4%) as nonepileptic. After long-term video-EEG monitoring, 176 of 203 patients (86.7%) were rediagnosed as true epileptics, and 27 (13.3%) were rediagnosed as nonepileptic. The diagnoses of 21 patients did not change. EEGs of the 27 patients that were obtained in the last 3 months prior to monitoring were retrospectively analyzed; 3 had active paroxysmal anomaly, 4 had background dysrhythmia, 6 had latent paroxysmal anomaly, and 14 had normal EEG findings. All patients had been treated as epileptics prior to the long-term video-EEG monitoring. It was concluded that among our epileptic patients, 13.3% were shown to be nonepileptic after the application of this technique. This rate was found to be important.
293. INTRAVENOUS GAMMA GLOBULIN TREATMENT IN INTRACTABLE EPILEPSY E. 0zdirim, S. Aysun, M. Topqu, G. Turanli, and Y. Renda, Ankara, Turkey A group of 14 patients with intractable epilepsy, 7-12 years of age, was studied. They were followed up for 3-11 years. Frequency of seizures varied among the patients and they did not respond to multiple antiepileptic drug (AED) therapy for at least a minimum period of 3 years. A dose of 400 mg/kg intravenous gamma globulin was administered every 3 weeks over a 3-month period in addition to AED therapy. An appreciable reduction in the number of seizures was observed in 3 patients during gamma globulin administration and 1 patient had no seizures for 4 weeks. However, seizure frequency gradually increased after the initial response of the first 2-3 weeks. In 11 patients, no reduction in seizure frequency was observed. Clinical characteristics of patients will be discussed in view of the literature.
294. IMPACT OF INFORMATION COURSE OF EPILEPSY FOR PARENTS Matti J. Koivikko and Piia Puolakka, Tampere, Finland An information course concerning epilepsy is arranged yearly for all parents whose child has started antiepileptic drug (AED) therapy during the previous year. We studied the effect of this course by a questionnaire. From 1989 to 1992, AEDs were given to 103 children. One or both parents from 68 families took part in the course. We received 57 questionnaire answers from families who had been in the course and 22 from families who had not. The social background or education of the parents did not differ between the 2 groups. The extent of knowledge about epilepsy was measured by asking the correctness of 56 statements about epilepsy. The parents who had been in the course gave correct answers more often (t = - 3 . 5 , P < .001) and "don't know" answers less often than the others (t = 3.2, P < .004). The course had thus increased and strengthened the parents' knowledge about epilepsy, despite the rather systematic information given to all parents during the initiation of medication (always 1-2 days in hospital ward) and at the outpatient visits.
295. BRAIN ABSCESS Boonsom Ratnasiri and Narong Dejchaiwatana, Bangkok, Thailand Brain abscess frequently occurred in children especially in congenital heart disease and chronic otitis media. Fifty-four patients
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as epileptic and 21 (9.4%) as nonepileptic. After long-term video-EEG monitoring, 176 of 203 patients (86.7%) were rediagnosed as true epileptics, and 27 (13.3%) were rediagnosed as nonepileptic. The diagnoses of 21 patients did not change. EEGs of the 27 patients that were obtained in the last 3 months prior to monitoring were retrospectively analyzed; 3 had active paroxysmal anomaly, 4 had background dysrhythmia, 6 had latent paroxysmal anomaly, and 14 had normal EEG findings. All patients had been treated as epileptics prior to the long-term video-EEG monitoring. It was concluded that among our epileptic patients, 13.3% were shown to be nonepileptic after the application of this technique. This rate was found to be important.
293. INTRAVENOUS GAMMA GLOBULIN TREATMENT IN INTRACTABLE EPILEPSY E. 0zdirim, S. Aysun, M. Topqu, G. Turanli, and Y. Renda, Ankara, Turkey A group of 14 patients with intractable epilepsy, 7-12 years of age, was studied. They were followed up for 3-11 years. Frequency of seizures varied among the patients and they did not respond to multiple antiepileptic drug (AED) therapy for at least a minimum period of 3 years. A dose of 400 mg/kg intravenous gamma globulin was administered every 3 weeks over a 3-month period in addition to AED therapy. An appreciable reduction in the number of seizures was observed in 3 patients during gamma globulin administration and 1 patient had no seizures for 4 weeks. However, seizure frequency gradually increased after the initial response of the first 2-3 weeks. In 11 patients, no reduction in seizure frequency was observed. Clinical characteristics of patients will be discussed in view of the literature.
294. IMPACT OF INFORMATION COURSE OF EPILEPSY FOR PARENTS Matti J. Koivikko and Piia Puolakka, Tampere, Finland An information course concerning epilepsy is arranged yearly for all parents whose child has started antiepileptic drug (AED) therapy during the previous year. We studied the effect of this course by a questionnaire. From 1989 to 1992, AEDs were given to 103 children. One or both parents from 68 families took part in the course. We received 57 questionnaire answers from families who had been in the course and 22 from families who had not. The social background or education of the parents did not differ between the 2 groups. The extent of knowledge about epilepsy was measured by asking the correctness of 56 statements about epilepsy. The parents who had been in the course gave correct answers more often (t = - 3 . 5 , P < .001) and "don't know" answers less often than the others (t = 3.2, P < .004). The course had thus increased and strengthened the parents' knowledge about epilepsy, despite the rather systematic information given to all parents during the initiation of medication (always 1-2 days in hospital ward) and at the outpatient visits.
295. BRAIN ABSCESS Boonsom Ratnasiri and Narong Dejchaiwatana, Bangkok, Thailand Brain abscess frequently occurred in children especially in congenital heart disease and chronic otitis media. Fifty-four patients