Idiopathic Epileptic Seizures and Syndromes in Infancy
An is a that is only epilepsy, with no underlying structural brain lesion or other neurological signs or symptoms. Idiopathic epilepsy syndromes are presumed to be genetic and are usually age dependent.
Idiopathic comes from the Greek words idios (meaning self, own, and personal) and pathic (suffer, see also pathology and pathological). Idiopathic is not synonymous with . There are idiopathic epilepsies with bad prognoses or lifelong duration and, conversely, there are epilepsies with a few seizures that may not even need treatment.
The infantile period is defined as between 4 weeks and 1.5 years. Idiopathic epileptic seizures, are situation-related, isolated, or age-related benign epileptic seizures that do not require a diagnosis of epilepsy. Idiopathic epileptic seizures starting in the infantile and early childhood age include:
Idiopathic epileptic syndromes starting in the infantile and early childhood age are:
The epileptic syndromes and their significance
A major advance in recent epileptology is the recognition of epileptic syndromes that allows an accurate diagnosis and management of seizure disorders.[1-3]
Medical diagnosis is the identification of a disease by investigation of its symptoms and history, which provides a solid basis for the treatment and prognosis of the individual patient. An accurate diagnosis is the golden rule in medicine, and epilepsies should not be an exception to this. Like in any other disease, the recognition of non-fortuitous clustering of symptoms and signs in epilepsies requires the study of detailed clinical and laboratory data.[1-3] However, often in current practice, the diagnosis is limited to either epilepsy or seizures, which is unsatisfactory because this cannot provide guidance on important items such as severity of the disease, prognosis, short- and long-term therapeutic decisions, and genetics (research and counselling), which are all factors that crucially affect personal, family, and social life; education; and career choices of patients. Defining the type of epilepsy should now be considered mandatory as it offers the best guide to both management and prognosis. Most epileptic syndromes and diseases are well defined and easy to diagnose. The benefits of syndromic diagnosis over seizure/symptom diagnosis or an inclusive diagnosis such as epilepsy far outweigh any morbidity from incorrect categorization that may arise in difficult cases.
Important clinical features of a syndrome include the type of seizures, their localization, frequency, sequence of events, circadian distribution, precipitating factors, age at onset, mode of inheritance, physical or mental symptoms and signs, prognosis, and response to treatment.
Epilepsies or epilepsy?
The clinical and practical significance of the syndromic diagnosis of epilepsies is well illustrated by 3 common epileptic disorders. Benign childhood focal epilepsies, (), and hippocampal epilepsy have nothing in common other than the fact that they may all be complicated by generalized tonic clonic seizures (GTCS), which are primarily GTCS in JME and secondarily GTCS in benign childhood focal epilepsies and hippocampal epilepsy.
Furthermore, the short-and long-term treatment strategies are entirely different for each disorder: benign childhood focal epilepsies may or may not require medication for a few years, appropriate anti-epileptic drug (AED) treatment is lifelong in JME while neurosurgery may be life-saving for patients with hippocampal epilepsy. What may be a life-saving drug such as carbamazepine for hippocampal epilepsy may be ill-advised for JME.
It should not be difficult to distinguish an intelligent child with benign focal seizures or childhood absence epilepsy from a child with Kozhevnikov-Rasmussen, Lennox-Gastaut, Down, or or a child with severe post-traumatic cerebral damage, brain anoxia, or catastrophic progressive myoclonic epilepsy. Describing all these children as simply having epilepsy just because they have seizures offers no more benefit than a diagnosis of febrile illness irrespective of cause, which may be a mild viral illness, a life-threatening acute bacterial , or a malignancy. Inappropriate generalizations with regard to terminology, diagnosis, and treatment are the single most important factor of mismanagement in epilepsies.
C. P. Panayiotopoulos, MD, PhD, FRCP
For details and bibliography for these syndromes see the reference book: Panayiotopoulos CP. A clinical guide to epileptic syndromes and their treatment. Second edition. London:Springer; 2007.
This section was adapted from:
The educational kit on epilepsies
The Educational Kit on Epilepsies was produced through an unrestricted educational grant from UCB Pharma SA.
Originally published by MEDICINAE
Reviewed and revised June 2008 by Steven C. Schachter, MD
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