ObjectiveMalformations of cortical development (MCDs) are increasingly identified as important etiology for refractory epilepsy. Little is known about the spectrum, distribution and clinical features of MCDs, especially in a resource-limited region. This study investigated the distribution and compared the clinical features and long-term prognosis between simple and multiple forms. MethodsConsecutive 150 epilepsy patients with pathologically or radiologically confirmed MCDs were included from a tertiary epilepsy center in western China. Patients were divided into three subtypes according to the scheme of Barkovich, also Simple and Multiple forms based on whether single type of MCDs or other brain developmental abnormalities co-existed. ResultsThe most common type of MCDs is focal cortical dysplasia, and China is still in the early phase of implementing surgical treatments. We found perinatal insults more common in sub-group III patients. Furthermore, 'Multiple' form was identified in 36/150 patients. Patients with heterotopias were more commonly associated with other abnormalities. ConclusionMCDs are critical causes for epilepsy, also a big challenge for resource-limited countries. Imaging techniques are crucial in diagnosing and classifying cortical deformities. Multiple malformations lead to more severe clinical features and worsen the prognosis, helping physicians to seek the best therapeutic option, also assists in classifying MCDs.
ObjectiveThe aim of this study is to identify clinical and electroencephalographic features associated with refractoriness to the initial antiepileptic drug in typical benign childhood epilepsy with centrotemporal spikes (BECTS). MethodsA total of 87 children with typical BECTS were retrospectively reviewed in the analyses.The patients were subdivided into two groups:patients whose seizures were controlled with monotherapy, and those requiring two medications. 63 childrenachieved seizure-freedom with monotherapy, while 24 received two medications for seizure control. ResultsDiffusing foci at the follow-up EEG and delayed treatment (duration > 1 year) are two main risk factors associated with more refractory cases (P < 0.001). Delayed diagnosis (37.1%) and non-adherence to treatment (57.2%) contributed to delayed treatment. ConclusionsOur findings suggested that diffusing foci on EEG and delayed treatment are associated with more frequent seizures and refractoriness in BECTS. Diagnostic delays and non-adherence hindered timely care, which may represent opportunities for improved intervention.
ObjectiveTo investigate the video-electroencephalography (VEEG) characteristics of old patients with epilepsy (OPWE). MethodsBetween June 2013 and July 2014, 57 OPWE at an age over 60 years were assigned to research group and 65 adults between 16 and 60 years old with epilepsy were regarded as controls. All the subjects underwent VEEG for 24 hours covering awake state and sleep with hyperventilation test being applied. Chi square was used to compare occurrence rate of epileptic wave and abnormal response rate after hyperventilation between the two groups of patients. Additionally, ictal elcetroencephalograph (EEG) was analyzed. ResultsCommon features of waves on EEG for patients in both the two groups during the ictal period included widespread low amplitude fast wave (2 cases in the research group, 7.4%; 4 cases in the control group, 12.5%), focal low amplitude fast wave (5 cases in the research group, 18.5%; 6 cases in the control group, 18.8%), widespread spike or spike slowing complex (3 cases in the research group, 11.1%; 7 case in the control group, 21.8%), focal spike or spike slowing complex (5 cases in the research group, 14.9%; 8 cases in the control group, 25.0%), and focal rhythmic slow wave (6 cases in the research group, 18.5%; 6 cases in the control group, 18.8%). In the research group, there were two following cases:single abnormal background activity in 5 cases (18.5%), and neither abnormal background activity nor epileptic discharge in 1 case (3.7%). Ictal focal epileptic discharges were found in 16 cases in the research group and 8 in the control group (59.3% vs 25.0%), with statistical difference (P<0.05). Inter-ictal epilepsy discharges were found in 57 patients of the research group (awake, 15.8%; sleep, 52.6%), which was less than that in the control group (awake, 46.2%; sleep, 83.1%) with statistical difference (P<0.05), accompanied by focal slow wave (temporal intermittent rhythmic delta activity, TIRDA) in 9 cases. In natural sleep period, epilepsy discharge occurrences increased (65.3%). Abnormal response rate in the research group (14.0%) was lower than that in the control group (64.6%) with statistical difference (P<0.05). ConclusionEarly onset EEG of the old and the adult are similar except those with single abnormal background activity and those with neither abnormal background activity nor epileptic discharge. Focal onset on EEG is more frequently seen in OPWE than in APWE. In natural sleep, epileptic discharge increases among OPWE, and abnormal response during hyperventilation is less likely to happen in OPWE.
ObjectiveThe purpose of this study was to better delineate the clinical spectrum of periventricular nodular heterotopia (PNH) in a large patient population to better understand social support in people with PNH and epilepsy in west China. Specifically, this study aimed to relate PNH subtypes to clinical or epileptic outcomes and epileptic discharges by analyzing anatomical features. MethodsThe study included 70 patients with radiologically confirmed nodular heterotopias and epilepsy. We also recruited healthy controls from nearby urban and rural areas. People with PNH and epilepsy and healthy controls were gender-and age-matched. Two-sided Chi-square test and Fisher's exact t-test were used to assess associations between the distribution of PNHs and specific clinical features. ResultsBased on imaging data, patients were subdivided into three groups: (a) classical (bilateral frontal and body, n=25), (b) bilateral asymmetrical or posterior (n=9) and (c) unilateral heterotopia (n=36). Most patients with classical heterotopia were females, but were mostly seizure-free. Patients with unilateral heterotopia were prone to develop refractory epilepsy. ConclusionsEach group's distinctive genetic mutations, epileptic discharge patterns and overall clinical outcomes confirm that the proposed classification system is reliable. These findings could not only be an indicator of a more severe morphological and clinical phenotype, but could also have clinical implications with respect to the epilepsy management and optimization of therapeutic options.