Epilepsy with electrical status epilepticus during slow-wave sleep
~0.2% to 0.5% of all childhood epilepsies.
Age at onset
Seizures 2 months to 12 years; peak at 4 to 5 years. EEG continuous spikes and waves during slow-wave sleep (CSWS), usually 1 to 2 years from seizure onset.
Males (62%) show preponderance.
Neurological and mental state
Symptomatic, probably symptomatic and idiopathic.
Three stages of evolution:
Seizures are often nocturnal.
MRI is abnormal in more than half of patients. Unilateral or diffuse cortical atrophy, porencephaly, malformations of cortical development, and mainly polymicrogyria (18%).
Initially multifocal and bisynchronous sharp waves (mainly frontal). CSWS = continuous (85% to 100%) mainly bisynchronous 1.5 to 2 Hz (and 3 to 4 Hz) spikes and waves during non-REM sleep.
In all cases, seizures remit with global improvement of cognitive and behavioral abnormalities, but recovery is always slow and often partial; <1/4 resume acceptable social and professional levels; these are mainly of normal pre-morbid neuropsychological state and short CSWS life span.
(1) Landau-Kleffner syndrome; (2) benign childhood focal seizures with atypical evolutions; and (3) Lennox-Gastaut syndrome.
Seizures are not a major problem as their final prognosis is good. Valproate, lamotrigine, levetiracetam and sulthiame# may be the most appropriate treatments.
The treatment of CSWS, which is responsible for the neuropsychological impairment, is entirely empirical and usually of transient efficacy. The following schemes, alone or in combination, have been proposed.
In cases with severe linguistic impairment, subpial intracortical transections have been used with success.
*Expert opinion, please check FDA-approved indications and prescribing information
#Not approved by the FDA
This page was adapted from:
The educational kit on epilepsies
The epileptic syndromes
By C. P. Panayiotopoulos
Originally published by MEDICINAE
21 Cave Street, Oxford OX4 1BA
First published 2006 and reprinted in 2007
Reviewed and revised June 2008 by Steven C. Schachter, MD
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