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The effect of prophylactic therapy for complex febrile convulsions
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Y. Fukuyama /Brain & Development 1995; 17: 383-9
(unchanged cases). In most of the contracted, contralateralized and unchanged cases, clinical seizures were frequently observed or uncontrolled, and EEG abnormalities were persistent. Conclusion. The present results suggest that repeated SPECT for observing time-course changes of regional CBF represents a useful technique which can be applied for evaluating the prognosis and for pathogenetic elucidation of the epileptic foci. Keywords: Febrile convulsion; Epilepsy; SPECT; Cerebral blood flow; Time-course change
A prospective clinical study on risk factors for febrile convulsions and subsequent afebrile seizures Kiyoomi Sumia, Tetsuzo Tagawa’, Yuusuke Itagakiq Toshisaburo Nagai’ (“Department of Pediatrics, Osaka Kouseinenkin Hospital, Osaka, Japan; bDepartment of Pediatrics, Osaka University Medical School, Osaka, Japan)
The risk factors for febrile convulsions (FC) and subsequent afebrile seizures were prospectively studied. Of 314 cases with antecedent FC who had been followed up for more than 2 yrs, 65 (21%) developed subsequent febrile seizures. These patients did not have non-specific diseases suggestive of brain damage with neurological abnormalities. The average age at the time of examination was 12 yrs. The mean follow-up period was 8 yrs. The 65 cases were divided into 2 groups. Thirty-nine (60%) cases comprised the controlled group (no seizures) (group A), while 26 cases (40%) comprised the uncontrolled group (some seizures) (group B). A family history of epilepsy was found in only 1 case in group A. In 25 cases (64%) in group A, a type of simple FC followed, while this occurred in 14 cases (54%) in group B. The first FC occurred most frequently at the age of 7 months to 1 yr in both groups. The perinatal abnormalities, febrile convulsive cluster and status were observed in both groups. At the time of the first FC, mental retardation was found in 1 case in group A, but in 4 cases (33%) in group B. On the first EEG examination, epileptic discharges were observed in 28 cases (72%) in group A, and 19 cases (73%) in group B. The age of onset of afebrile seizures was widely distributed between 1-12 yrs in both groups. Half of them occurred within 3 yrs after the last FC. Single afebrile seizure was observed in 18 cases (46%) in group A, but in 6 cases (23%) in group B. The main types of epilepsies and epileptic syndromes were localization-related epilepsies (21 cases in A and 14 in B), generalized epilepsies (10 in A and 5 in B), and undetermined epilepsies(8 in A and 7 in B). Bathing seizures were found in 1 case (3%) in group A, but in 6 cases (23%) in group B. The last EEG recordings were abnormal in 13 cases (33%) in group A but in 17 cases (65%) in group B. Mental deficiency was revealed in 13 cases (33%) in group A, but in 17 cases (65%) in group B. Seventeen cases (44%) in group A and 6 (23%) in group B still exhibit a type of simple FC. Frequent FC were not related with subsequent afebrile seizures. The present results suggested that the most important risk factors for FC in developing subsequent epilepsies are bathing seizures, frequent abnormal findings on follow-up EEG and mental retardation. The main etiology of afebrile seizures following FC may be closely related with an epileptic predisposition. Keywords: Febrile confulsion; Risk factor; Prognosis; Mental retardation; Afebrile seizure
The effect of prophylactic therapy for complex febrile convulsions Kiyotaka Murakami, Reiko Ishihara, Akitoshi Nakamura, Takao Aoki, Ryouji Ebina and Hiromitsu Nakano (Nakano Children’s Hospital, Osaka, Japan) Subjects and methods. We studied the effect of prophylactic therapy
for complex febrile convulsions (CFC). The subjects were 26 CFC patients (male:female = 16:lOl among 368 patients who came to our
hospital because of febrile convulsions in 1992. Their mean age was 4 years 2 months k 2 years 8 months. These patients were considered as of complex types, because of unusual onset age in 9 cases, too frequent seizures or clustering in 7, long duration of seizures in 7, etc. Anticonvulsant suppositories (diazepam or bromazepam) were used for 17 of 26 CFC patients (Group A) intermittently, and valproate (VPA) was administered by mouth to 9 patients (Group Bl. All of them were followed till December 1993. Results. 1. Group A: Three of 17 patients had a recurrence of FC. In one they recurred because of the non-compliance of the parents. In others they recurred due to delayed use of suppositories. Four of 17 patients dropped out. 2. Group B: Four of 9 patients had a recurrence of FC. In 3 of them they recurred most probably relating to an inadequate VPA serum concentration. Conclusion. The intermittent use of anticonvulsant suppositories was effective for the prevention of recurring CFC. But the education of the patients was thought to be the utmost importance for successful prophylactic therapy for CFC. Keywords: Complex febrile convulsion; Prophylactic therapy; VPA, DZP
Follow-up study on children with febrile convulsions having epileptiform EEG Se@ Kimura (Department of Pediatrics, Urafune Hospital of Yokohama City Unioersity, Yokohama, Japan) Introduction. The purpose of this study was to clarify the prognostic
importance of epileptiform electroencephalogram (EEG) in patients with febrile convulsions (FC). Material and methods. The epileptiform EEGs, defined as those having spikes, sharp, spike-waves, but excluding diffuse spike-waves in the drowsy state, in 173 children (66 female and 107 male) with FC who had been followed up for at least 10 years were evaluated. One hundred and three children had been given anticonvulsants for at least two years during the follow-up, and 70 had been followed without medication. The risk factors for developing epilepsy were studied in these patients. EEG was usually performed twice a year in these children. Results. The number of patients developing epilepsy before the age of 10 was 25/173 (14.4%). The numbers of children developing epilepsy among the 70 without medication and the 103 having anticonvulsants showed no significant difference. Twenty children had developed partial seizures (partial motor seizures or secondary generalization -18, complex partial seizures - 2), and 5 had generalized seizure (absence -2, tonic clonic convulsions -2, Lennox syndrome -1). Six of 11 (54.5%) children with mental retardation developed epilepsy in the follow-up period. Among the children developing epilepsy, the amount of epileptic discharges in the first EEGs was 84%; focal and diffuse epileptiform EEGs, 76% and 8%, respectively. On the other hand, in children with non-epilepsy, the amount of epileptiform EEGs was only 39.2%. Nineteen of 77 children (24.7%) having focal epileptiform EEGs at the first examination developed epilepsy before the age of 10. In contrast, only 2 of 59 children (3.6%) having diffuse epileptiform EEGs developed epilepsy. EEGs obtained from age 4 to 10 were analyzed. In children having focal epileptic discharges in every EEG during the follow-up period, 22 of 96 (22.9%) developed epilepsy. On the other hand, in children showing diffuse spike-waves only or in cases of transient focal epileptic discharge, 1 of 41 (3.4%) and 1 of 29 (3.4%) developed epilepsy during the follow-up period, respectively. Conclusion. Among 173 children with FC having epileptiform EEGs, 25 (14.4%) developed epilepsy before the age of 10. Focal epileptiform EEG obtained either at the first examination or constantly in the follow-up period seemed to be an important risk factor for developing epilepsy, next to the presence of mental retardation. Keywords: Febrile convulsion; Epileptiform EEG; Spike
Y. Fukuyama /Brain & Development 1995; 17: 383-9
(unchanged cases). In most of the contracted, contralateralized and unchanged cases, clinical seizures were frequently observed or uncontrolled, and EEG abnormalities were persistent. Conclusion. The present results suggest that repeated SPECT for observing time-course changes of regional CBF represents a useful technique which can be applied for evaluating the prognosis and for pathogenetic elucidation of the epileptic foci. Keywords: Febrile convulsion; Epilepsy; SPECT; Cerebral blood flow; Time-course change
A prospective clinical study on risk factors for febrile convulsions and subsequent afebrile seizures Kiyoomi Sumia, Tetsuzo Tagawa’, Yuusuke Itagakiq Toshisaburo Nagai’ (“Department of Pediatrics, Osaka Kouseinenkin Hospital, Osaka, Japan; bDepartment of Pediatrics, Osaka University Medical School, Osaka, Japan)
The risk factors for febrile convulsions (FC) and subsequent afebrile seizures were prospectively studied. Of 314 cases with antecedent FC who had been followed up for more than 2 yrs, 65 (21%) developed subsequent febrile seizures. These patients did not have non-specific diseases suggestive of brain damage with neurological abnormalities. The average age at the time of examination was 12 yrs. The mean follow-up period was 8 yrs. The 65 cases were divided into 2 groups. Thirty-nine (60%) cases comprised the controlled group (no seizures) (group A), while 26 cases (40%) comprised the uncontrolled group (some seizures) (group B). A family history of epilepsy was found in only 1 case in group A. In 25 cases (64%) in group A, a type of simple FC followed, while this occurred in 14 cases (54%) in group B. The first FC occurred most frequently at the age of 7 months to 1 yr in both groups. The perinatal abnormalities, febrile convulsive cluster and status were observed in both groups. At the time of the first FC, mental retardation was found in 1 case in group A, but in 4 cases (33%) in group B. On the first EEG examination, epileptic discharges were observed in 28 cases (72%) in group A, and 19 cases (73%) in group B. The age of onset of afebrile seizures was widely distributed between 1-12 yrs in both groups. Half of them occurred within 3 yrs after the last FC. Single afebrile seizure was observed in 18 cases (46%) in group A, but in 6 cases (23%) in group B. The main types of epilepsies and epileptic syndromes were localization-related epilepsies (21 cases in A and 14 in B), generalized epilepsies (10 in A and 5 in B), and undetermined epilepsies(8 in A and 7 in B). Bathing seizures were found in 1 case (3%) in group A, but in 6 cases (23%) in group B. The last EEG recordings were abnormal in 13 cases (33%) in group A but in 17 cases (65%) in group B. Mental deficiency was revealed in 13 cases (33%) in group A, but in 17 cases (65%) in group B. Seventeen cases (44%) in group A and 6 (23%) in group B still exhibit a type of simple FC. Frequent FC were not related with subsequent afebrile seizures. The present results suggested that the most important risk factors for FC in developing subsequent epilepsies are bathing seizures, frequent abnormal findings on follow-up EEG and mental retardation. The main etiology of afebrile seizures following FC may be closely related with an epileptic predisposition. Keywords: Febrile confulsion; Risk factor; Prognosis; Mental retardation; Afebrile seizure
The effect of prophylactic therapy for complex febrile convulsions Kiyotaka Murakami, Reiko Ishihara, Akitoshi Nakamura, Takao Aoki, Ryouji Ebina and Hiromitsu Nakano (Nakano Children’s Hospital, Osaka, Japan) Subjects and methods. We studied the effect of prophylactic therapy
for complex febrile convulsions (CFC). The subjects were 26 CFC patients (male:female = 16:lOl among 368 patients who came to our
hospital because of febrile convulsions in 1992. Their mean age was 4 years 2 months k 2 years 8 months. These patients were considered as of complex types, because of unusual onset age in 9 cases, too frequent seizures or clustering in 7, long duration of seizures in 7, etc. Anticonvulsant suppositories (diazepam or bromazepam) were used for 17 of 26 CFC patients (Group A) intermittently, and valproate (VPA) was administered by mouth to 9 patients (Group Bl. All of them were followed till December 1993. Results. 1. Group A: Three of 17 patients had a recurrence of FC. In one they recurred because of the non-compliance of the parents. In others they recurred due to delayed use of suppositories. Four of 17 patients dropped out. 2. Group B: Four of 9 patients had a recurrence of FC. In 3 of them they recurred most probably relating to an inadequate VPA serum concentration. Conclusion. The intermittent use of anticonvulsant suppositories was effective for the prevention of recurring CFC. But the education of the patients was thought to be the utmost importance for successful prophylactic therapy for CFC. Keywords: Complex febrile convulsion; Prophylactic therapy; VPA, DZP
Follow-up study on children with febrile convulsions having epileptiform EEG Se@ Kimura (Department of Pediatrics, Urafune Hospital of Yokohama City Unioersity, Yokohama, Japan) Introduction. The purpose of this study was to clarify the prognostic
importance of epileptiform electroencephalogram (EEG) in patients with febrile convulsions (FC). Material and methods. The epileptiform EEGs, defined as those having spikes, sharp, spike-waves, but excluding diffuse spike-waves in the drowsy state, in 173 children (66 female and 107 male) with FC who had been followed up for at least 10 years were evaluated. One hundred and three children had been given anticonvulsants for at least two years during the follow-up, and 70 had been followed without medication. The risk factors for developing epilepsy were studied in these patients. EEG was usually performed twice a year in these children. Results. The number of patients developing epilepsy before the age of 10 was 25/173 (14.4%). The numbers of children developing epilepsy among the 70 without medication and the 103 having anticonvulsants showed no significant difference. Twenty children had developed partial seizures (partial motor seizures or secondary generalization -18, complex partial seizures - 2), and 5 had generalized seizure (absence -2, tonic clonic convulsions -2, Lennox syndrome -1). Six of 11 (54.5%) children with mental retardation developed epilepsy in the follow-up period. Among the children developing epilepsy, the amount of epileptic discharges in the first EEGs was 84%; focal and diffuse epileptiform EEGs, 76% and 8%, respectively. On the other hand, in children with non-epilepsy, the amount of epileptiform EEGs was only 39.2%. Nineteen of 77 children (24.7%) having focal epileptiform EEGs at the first examination developed epilepsy before the age of 10. In contrast, only 2 of 59 children (3.6%) having diffuse epileptiform EEGs developed epilepsy. EEGs obtained from age 4 to 10 were analyzed. In children having focal epileptic discharges in every EEG during the follow-up period, 22 of 96 (22.9%) developed epilepsy. On the other hand, in children showing diffuse spike-waves only or in cases of transient focal epileptic discharge, 1 of 41 (3.4%) and 1 of 29 (3.4%) developed epilepsy during the follow-up period, respectively. Conclusion. Among 173 children with FC having epileptiform EEGs, 25 (14.4%) developed epilepsy before the age of 10. Focal epileptiform EEG obtained either at the first examination or constantly in the follow-up period seemed to be an important risk factor for developing epilepsy, next to the presence of mental retardation. Keywords: Febrile convulsion; Epileptiform EEG; Spike