The
  Infantile
Spasms
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Partial epilepsies  

 

 

 

These are epilepsies with a clearly defined focal area within the brain. As a result, they have highly characteristic symptoms, such as visual hallucinations, or motor difficulties on one side of the body.

Benign occipital epilepsy

(Benign focal epilepsy with occipital paroxysms)

  • occurs in the first decade of life
  • neurologically normal
  • simple visual hallucinations, temporary blindness
  • automatisms similar to psychomotor fits
  • focal motor fits
  • postictal headache in 25%
  • EEG: bi-occipital paroxysms in trains
  • EEG abnormalities disappear with eye opening
  • good prognosis, disappears by adolescence
  • 60% have fits controlled by medications
  • (link not working)   Benign rolandic epilepsy

    (Benign focal epilepsy with centrotemporal spikes)

    In benign rolandic epilepsy the focus of repetitive spike activity in the brain is predominantly within the mid-temporal or parietal areas, near the motor or rolandic strip.

    Fits usually occur infrequently, as generalized nocturnal fits characterized by a variety of minor tonic-clonic movements, often affecting only one side of the face. A fit begins with a sensation starting at the corner of the mouth, followed by jerking of that corner. The jerking may then spread to the rest of that side of the face, in turn causing a twisting motion. Excessive salivation occurs, along with possible speech arrest. The child usually does not lose consciousness, except in cases of secondarily generalized fits of this type. In rare cases, the fit may progress to encompass the entire side of the body, becoming a generalized tonic-clonic condition.

  • about 15-20 % of childhood epilepsy
  • onset 1 to 7 years, peak 3 to 5 years, fits stop around 15 years
  • nocturnal onset of fits
  • sensation of parasthesia in the lips gums and inner cheeks
  • focal motor fits: face, face and hand, rarely lower extremity
  • salivation, speech arrest
  • generalised tonic clonic fits
  • good response to treatment (which is often not required)
  • Frontal lobe epilepsy

  • stereotyped clusters of fits
  • short duration ( less than 30 seconds)
  • sudden onset and termination
  • rapid recovery of consciousness
  • prominent (and possibly violent) motor automatisms
  • increased risk for complex partial status epilepticus
  • Occipital lobe epilepsy

  • begin with 'occipital lobe features' in 90%
  • elementary visual hallucination
  • ictal blindness (partial field loss)
  • eye pulling or moving sensations (without actual movement)
  • bilateral rapid eyelid blinking
  • contra-lateral eye deviation with or without head turning
  • many then proceed to have 'temporal lobe epilepsy features' - 50%
  • some have features suggestive of frontal lobe epilepsy
  • Mesial temporal lobe epilepsy

  • strong association with febrile fits, particularly complex febrile fits
  • onset in childhood, 6-10 years
  • two thirds have complex partial fits from the onset
  • a third have generalised fits as presenting fits
  • there may be an interval between first febrile fit and recurrent fits
  • initial fits may be bland in comparison to later fits
  • uncertain if frequency of fits increases with age
  • auras are very common ( greater than 80%)
  • commonest aura is an abdominal aura (60%)
  • deja vu and psychic aura are less common (40%)
  • Parietal lobe epilepsy

  • poorly defined syndrome
  • clinical features may reflect spread to other areas
  • no clinically distinct manifestations
  • somatosensory aura is the commonest and this may be ipsi or contra-lateral to the epileptic focus
  • many fits have the characteristics of temporal lobe or mesial frontal epilepsy
  • neuroimaging is the most important test to define parietal location of the epileptogenic region
  • EEG may misleading (false localisation) or negative
  • return to   Types of epilepsy

     

     

    (checked: 15 November 2002)
    (update 1.1: 8 November 2002)
    (issue 1: 24 March 1998)