TREATMENT OF EPILEPTOGENIC ACTIVITY ON EEG PREVENTS EPILEPSY AND PSYCHOMOTOR DELAY IN CHILDREN WITH TUBEROUS SCLEROSIS
Abstract number :
2.091
Submission category :
4. Clinical Epilepsy
Year :
2009
Submission ID :
9808
Source :
www.aesnet.org
Presentation date :
12/4/2009 12:00:00 AM
Published date :
Aug 26, 2009, 08:12 AM
Authors :
Sergiusz Jozwiak, K. Kotulska, D. Domanska-Pakiela, D. Chmielewski, D. Dunin-Wasowicz, J. Borkowska, D. Kuczynski, B. Lojszczyk, M. Respondek-Liberska and J. Dangel
Rationale: Epilepsy develops in up to 85% of tuberous sclerosis (TSC) patients. Up to 70% of them present with psychomotor delay followed by persisting intellectual disability. Intellectual disability is observed almost exclusively in patients with epilepsy, especially if epilepsy develops in infancy. It is established that epileptogenic activity on EEG precedes clinical seizures. It is also known that epileptogenic activity deteriorates mental outcome in children. The aim of this work was to examine the hypothesis that antiepileptic treatment introduced in TSC infants with epileptic EEG changes before seizure onset prevents epilepsy and intellectual disability. Methods: Thirty four infants with prenatal or perinatal diagnosis of TSC were included in the study. In all of them the diagnosis was established prior to seizures development. Twenty children were thoroughly observed during the first two years of life and antiepileptic treatment was introduced only after first clinical seizures appeared (group A). In the other group the antiepileptic treatment with vigabatrin was introduced when EEG recording begun to be epileptogenic (group B). In both groups, psychomotor development was assessed every three months using appropriate scales. Results: Mean follow-up of the patients was 21 months, median 19 months. In both groups, 25% patients did not require antiepileptic treatment. In these children the mental status remained normal. Among treated patients, in group A, psychomotor delay was observed in 10/15 patients (67%). In group B, delay was observed in only 1/14 patients (7%). Clinical seizures occurred in 4/14 patients (29%) in this group. Drug- resistant epilepsy was more frequently seen in group A. Conclusions: Treatment of epileptiform EEG changes prevents epilepsy and psychomotor delay in children with TSC. Therefore, every child with early diagnosis of TSC should undergo thorough EEG monitoring during the first 2 years of life. If epileptic changes appear, we recommend preventive antiepileptic treatment.
Clinical Epilepsy