Abstracts

Seizures occur extensively during sleep or on awakening in a substantial proportion of patients with epilepsy. The seizure threshold is often affected by changes in the level of arousal and many interictal EEG abnormalities are activated by sleep as well. This study aimed at identifying childhood epileptic syndromes with seizures during, shortly before falling or shortly after awakening from sleep and also analysing the clinical, electrophysiological, intellectual and neuroimaging characteristics of affected children.
One hundred and fifteen children (84 males and 31 females) with sleep related seizures were recruited from the Neuropediatric Clinics [ndash] Cairo and Ain Shams University Children Hospitals. All the study patients were subjected to full seizure analysis, thorough clinical and neurological examination, interictal sleep, sleep deprived and awake EEG records and I.Q assessment. Some patients had brain CT or MRI as well. Diagnosis of the epileptic syndrome was done according to the criteria set by the ILAE.
Results showed that the patients[rsquo] mean age was 10.2 [plusmn] 3.95 years and their seizures started at a mean age 8.1 [plusmn] 2.56 years. The most common seizure types were GTCS (31.3%), hemifacial spasms with speech arrest (21.7%) and myoclonic jerks (20%). Eighty-five patients (73.9%) had abnormal EEG records mainly in the form of unifocal or bifocal spikes or slow wave involving mainly the centrotemporal area (35.4%) and generalized polyspikes and slow wave 4-6 Hz discharge (31.3%). Five epileptic syndromes were identified in 96/115 patients (83.5%): benign childhood epilepsy with centrotemporal spikes (BCECT) in 42.7%, juvenile myoclonic epilepsy (JME) in 21.9%, grand mal on awakening epilepsy (GMAE) in 17.4%, nocturnal frontal lobe epilepsy (NFLE) in 15.6% and continuous spike and wave during slow sleep (CSWSS) in only 2 patients. I.Q was affected in only 6/96 patients (6.3%): 4/15 cases with NFLE and the 2 cases with CSWS.
In conclusion, knowledge of the circadian pattern of certain seizure types and their precipitants helps to instruct epileptic patients concerning sleep hygiene, which might improve the efficacy of antiepileptic drug (AED) treatment, even if no change is made in dosage. Nocturnal seizures in a child or adolescent are usually linked to benign childhood epilepsies and syndromes. When frontal lobe semiology exists, an elaborate work up is mandatory to identify cortical dysplasias. Most children with nocturnal seizures have normal cognitive functions. However, in CSWSS and NFLE, psychometric tests are recommended.
[Supported by: Tha National Research Center, Medical Division
Cairo, Egypt]