RESUMO
In the study of 887 new born infants with prenatal and perinatal risk factors for brain damage, 11 children with West syndrome that progressed into Lennox-Gastaut syndrome and another 4 children with Lennox-Gastaut syndrome that had not been preceded by West syndrome were found. In this study we present the main findings of these 15 subjects. In all infants multifactor antecedents were detected. The most frequent risk factors were prematurity and severe asphyxia; however placenta disorders, sepsis, and hyperbilirubinemia were also frequent. In all infants MRI direct or secondary features of periventricular leukomalacia were observed. Followup of all infants showed moderate to severe neurodevelopmental delay as well as cerebral palsy. It is concluded that prenatal and perinatal risk factors for brain damage are very important antecedents that should be taken into account to follow up those infants from an early age in order to detect and treat as early as possible an epileptic encephalopathy.
RESUMO
Previous studies have investigated whether routine use of antiepileptic drugs is adequate to improve cognitive abilities in children who are learning disabled not otherwise specified (LD NOS) and who display interictal paroxysmal patterns in the electroencephalogram (EEG) but do not have epilepsy, and the findings of these studies have been controversial. In the current study, 112 LD children without epilepsy were assessed; however, only 18 met the strict inclusion/exclusion criteria in order to obtain a homogeneous sample. These children showed interictal paroxysmal patterns in the EEG, and a randomized, double-blind trial was carried out on them. The children were treated with either magnesium valproate (MgV; 20mg/kg/day) or a placebo for six months, and differences in WISC subtests, in a computerized reading skills battery (BTL) and EEG recordings were evaluated between groups before and after the treatment period. Performance IQ score and several items of the BTL (rhymes and ordering of words) improved in children who received MgV, whereas no changes were observed in the placebo group. No changes in the number of interictal paroxysmal patterns were observed in any group; however increased EEG currents at 10.92 and 12.87Hz (alpha band) in posterior regions and decreased currents in frequencies within the theta band (3.90, 4.29 and 5.07Hz) in frontal regions and at 4.68 and 5.46Hz in the parietal cortex were observed, suggesting an improvement in EEG maturation.
Assuntos
Mapeamento Encefálico , Inibidores Enzimáticos/uso terapêutico , Deficiências da Aprendizagem/tratamento farmacológico , Deficiências da Aprendizagem/fisiopatologia , Ácido Valproico/uso terapêutico , Criança , Eletroencefalografia/métodos , Inibidores Enzimáticos/farmacologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estimulação Luminosa , Psicofísica , Ácido Valproico/farmacologiaRESUMO
PURPOSE: To evaluate the number of seizures and interictal epileptiform discharges (IEDs) in patients with focal neocortical epilepsy before, during and after rTMS. METHODS: Twelve patients (seven men and five women, mean age 29.3+/-15.8 years) were studied. An open-label study with baseline (4 weeks), intervention (2 weeks) and follow-up (8 weeks) periods was carried out. Repetitive transcranial magnetic stimulation (rTMS) with 900 pulses, intensity of 120% motor resting threshold and 0.5Hz frequency was used. A 120 channel EEG was recorded; an electrical source analysis of IEDs with Variable Resolution Electromagnetic Tomography (VARETA) was performed. The number of seizures per week and IEDs per minute were measured and compared in the three periods. RESULTS: During the basal period the mean seizure frequency was 2.25 per week; in the intervention period it decreased to 0.66 per week (F=2.825; p=0.0036) which corresponds to a 71% reduction. In the follow-up period the mean frequency was 1.14 seizures per week, that is, a 50% reduction in the number of seizures. In the visual EEG analysis, the baseline IED frequency was 11.9+/-8.3events/min; it decreased to 9.3+/-7.9 during 2 weeks of rTMS with a further reduction to 8.2+/-6.6 in the follow-up period. These differences however were not significant (p=0.190). CONCLUSION: We conclude that 2 weeks of rTMS at 0.5Hz with a figure-of-eight coil placed over the epileptic focus, determined with VARETA, decreases the number of seizures in patients with focal epilepsy, without reduction in IEDs.