Report of Eight Cases with Electrical Status Epilepticus During Sleep: Outcome with Conventional Versus New Antiepileptic Drugs
Abstract number :
3.036
Submission category :
Year :
2000
Submission ID :
2674
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Dilek Yalnizoglu, Guzide Turanli, Ozlem Herguner, Demet Genc-Acikgoz, Meral Topcu, Hacettepe Univ Medical Sch, Ankara, Turkey.
RATIONALE:Electrical status epilepticus during sleep (ESES) is defined as the presence of continuous diffuse spike-waves during slow wave sleep which persist for months to years but eventually disapear spontaneously or following therapy. The most serious feature of ESES is mental and/or behavioral deterioration, which is present in almost all cases. Treatment of ESES is currently based on ACTH and corticosteroids which have significant side effects. The continouos paroxysmal activity is resistant to conventional antiepileptic drugs (AEDs). We studied eight cases with ESES to evaluate the response to new AEDs. METHODS: Eight patients, between 3.5-14 years of age were studied. Serial EEGs with sleep recordings, psychometric evaluation, neuroimaging studies (MRI in all and interictal SPECT in one) were performed. AED treatment was adjusted according to seizure outcome, improvement on EEG and cognitive and/or behavioral issues. RESULTS: All patients had ESES pattern on EEG regardless of seizure control.All had cognitive and/or behavioral issues. Major features were hyperactivity, language problems and low school performance. MRI was normal in all patients; interictal SPECT was performed in one and was normal. Seven patients were maintained on combination therapy while one was seizure free with monotherapy. In four patients combination therapy included one or more of the new AEDS such as vigabatrin, lamotrigine and clobazam. Topiramate was added to treatment in two patients. One of them showed >50% decrease of discharges on sleep EEG. The other one had no discharges during sleep and his EEG showed extreme spindles during stage 2 sleep. Both patients on Topiramate showed remarkable improvement in school performance. CONCLUSIONS: Our initial results suggest that topiramate could be a promising option for patients with ESES, sparing the patient from side effects of steroids. Further studies on patients with ESES are necessary to determine the effects of new AEDs on seizure outcome, EEG, and cognitive/behavioural problems.