The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 2, 1992
42 1
Specific Problems of Benign Epilepsy of Children with Centro-Temporal EEG Foci: Prognostic Assessment and Reconsideration of Medical Treatment
ical characteristics and prognoses were studied. Remission of epilepsy was defined as a seizure free period of three years.
Mariko Maezawa, M.D., Tohru Seki, M.D.,* Hidenori Yamawaki, M.D.,* Nobuyuki Suzuki, M.D.,* Satoshi Kimiya, M.D.,** Tetsuya Yamada, M.D.,* Yasuo Tachibana, M.D., * Mitsuhiro Hara, M.D.,* Rintaro Hashimoto, M.D.* and Noboru Kumagai, M.D. *
From a group of BECCT patients (60 boys and 37 girls: age of onset; 3-10, mean 7 years, 2 months), 34 boys and 15 girls were followed up for more than five years for prognostic evaluation. All these patients were aged over 11. Their clinical characteristics are summarized in Table 1. Seventeen patients (12 boys and 5 girls) had a history of febrile seizures. Of the 49 patients followed up, 98% were seizure free at the last visit. Although there was no significant difference in the age of cessation of seizures and the normalization of EEG between the
Saiseikai Central Hospital, Tokyo *Department of Pediatrics, Keio University School of Medicine, Tokyo * * Kawakita General Hospital, Tokyo A review of the literature shows that the seizure prognosis for BECCT (Benign epilepsy of children with centro-temporal EEG foci) has been established as remission before 15-16 years of age. Some have proposed that anticonvulsant therapy is not necessary for these children.' There is no general agreement as to whether medical treatment should be given or not. Some of the patients with BECCT have problems such as the arrest of speech during seizures, postictal paralysis, and choking sensatiom2 Memories of these seizures may affect patients emotionally. The psychiatric aspects of epilepsy are still widely i g n ~ r e d . ~ It is important to identify the complaints of BECCT, because the results of the patient's prognosis must be judged not only by thinking about the seizure prognosis but by considering the other aspects of the disease (i.e., quality of life). This paper reports the results of the factors associated with considering medical management of BECCT in 97 children. Subjects and Methods The children were referred to Keio University Hospital between 1976 and 1991, and diagnosed as having BECCT on the basis of the 1989 ILAE criteria. Their clin-
Results
Table 1: Clinical Characteristics of BECCT Boys (34) Girls (15) Mean age of onset (years) PH of febrile seizures Cessation of seizures (%) Mean age of cessation of seizures (years) Normalization of EEG (%) Mean age of normalization of EEO (years)
7.2k1.9 12 34 (100%)
7.2k2.2 14 (93%)
8.7k2.2 27 (79%)
8.9k2.0 13 (87%)
5
13.5k1.8 13.1k2.9
PH: Past History
Girls 0
.,Y.
Y.W.
th dvlln ol th sum (m) 0 p.WndIhhdWd&bvuvr
Fig. 1: BECCT: Seizure frequency and the duration of the seizures.
422
Selected Papers: Course and Prognosis
10
1
2
3
4
5
Duntion of oburvalion ( y e r s )
Fig. 2: BECCT: Cumulative ratio of seizure cessation (49 patients).
Table 2 : Problems Associated with BECCT Number of Patients Enuresis
7
Headache Seizures other than during night sleep
6
Vomiting during or after seizures Anxiety or complaints by the patients Status epileptics Behavior or personality problems
3
Comments Patients: 6, 7, 8, 9, 12, 12, 13 years of age
TV monitor (4), train ( 2 ) , kotatsu (Japanese style foot warmer with a quilt over it) (3)
8 2 7
Memory of seizures, numbness of the extremities, fear 20 minutes, 40 minutes Restless, irritability
boys and girls, there was a significant difference in the duration of seizures between the patients who had “sparse” and those who had “frequent” seizures (Fig. 1). Overall, in boys, the seizures tended to disappear earlier than in girls. All the girls who had a past history of febrile seizures had more than three attacks and the seizures took longer to disappear compared with the boys who had one or two attacks. The cumulative remission rate clearly showed the earlier seizure cessation for boys (Fig. 2). Three years after the initiation of seizures, the cumulative seizure ces-
sation rate was 70.6% for boys and 46.7% for girls. Table 2 summarizes complaints about the 97 children from their family members. We depicted only complaints volunteered by the patient’s family rather than using a questionnaire. Therefore, we suggest that the actual number of complaints is higher. Seven patients had enuresis, six had headaches, nine experienced daytime seizures while on the train, or watching television, three patients vomited during seizures, and eight patients complained about terrible memories of the seizures. They remembered sore throats and numbness of the extremities after the seizure. One patient wanted to call her mother during her seizure, but she found she was unable to speak. This “arrest of speech” status made her fearful of the attacks. Complaints of behavior and personality disturbance must be carefully analyzed, because the majority of patients were of primary school age. Discussion This study was designed to reconsider the treatment of BECCT. The data indicated that the factors associated with the consideration of medical treatment were 1) girls, 2) status epilepticus, and vomiting, 3) seizure occurring outdoors; i.e., social factors, 4) psychiatric effects, and 5 ) daily life affected by lack of sleep from seizures. We agree that oligoepileptic BECCT patients do not require anticonvulsants immediately after the diagnosis. Some of our patients were, however, disadvantaged by seizures such as enuresis in a 12-year-old girl or seizures while traveling. Some patients may lose their self-esteem and social confidence. When we only consider the outcome of the last seizure, such disadvantages may be overlooked. We have to discuss the necessity of treatment of BECCT, in the light of these unfavorable factors for the patients. We propose a medical approach, to those who were present with these factors, without adhering to routine prescriptions of
The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 2, 1992
423
anticonvulsants.
Epilepsia 31: 802-805, 1990. 2. Loiseau, P. and Beaussart, M.: The seizures
Acknowledgment
of benign childhood epilepsy with rolandic paroxysmal discharges. Epilepsia 14 38 1-
We are grateful for the guidance provided by Professor Mitsuru Osano. References 1. Ambrosetto, G. and Tassinari, C.A.: Anti-
epileptic drug treatment of benign childhood epilepsy with rolandic spikes: Is it necessary?
389, 1973. 3. Blumer, D.: Diagnosis and treatment of psy-
chiatric problems associated with epilepsy. In: Smith, D.B. (Ed.), Epilepsy: Current approaches to diagnosis and treatment. Raven Press, New York, pp 193-209, 1990.
42 1
Specific Problems of Benign Epilepsy of Children with Centro-Temporal EEG Foci: Prognostic Assessment and Reconsideration of Medical Treatment
ical characteristics and prognoses were studied. Remission of epilepsy was defined as a seizure free period of three years.
Mariko Maezawa, M.D., Tohru Seki, M.D.,* Hidenori Yamawaki, M.D.,* Nobuyuki Suzuki, M.D.,* Satoshi Kimiya, M.D.,** Tetsuya Yamada, M.D.,* Yasuo Tachibana, M.D., * Mitsuhiro Hara, M.D.,* Rintaro Hashimoto, M.D.* and Noboru Kumagai, M.D. *
From a group of BECCT patients (60 boys and 37 girls: age of onset; 3-10, mean 7 years, 2 months), 34 boys and 15 girls were followed up for more than five years for prognostic evaluation. All these patients were aged over 11. Their clinical characteristics are summarized in Table 1. Seventeen patients (12 boys and 5 girls) had a history of febrile seizures. Of the 49 patients followed up, 98% were seizure free at the last visit. Although there was no significant difference in the age of cessation of seizures and the normalization of EEG between the
Saiseikai Central Hospital, Tokyo *Department of Pediatrics, Keio University School of Medicine, Tokyo * * Kawakita General Hospital, Tokyo A review of the literature shows that the seizure prognosis for BECCT (Benign epilepsy of children with centro-temporal EEG foci) has been established as remission before 15-16 years of age. Some have proposed that anticonvulsant therapy is not necessary for these children.' There is no general agreement as to whether medical treatment should be given or not. Some of the patients with BECCT have problems such as the arrest of speech during seizures, postictal paralysis, and choking sensatiom2 Memories of these seizures may affect patients emotionally. The psychiatric aspects of epilepsy are still widely i g n ~ r e d . ~ It is important to identify the complaints of BECCT, because the results of the patient's prognosis must be judged not only by thinking about the seizure prognosis but by considering the other aspects of the disease (i.e., quality of life). This paper reports the results of the factors associated with considering medical management of BECCT in 97 children. Subjects and Methods The children were referred to Keio University Hospital between 1976 and 1991, and diagnosed as having BECCT on the basis of the 1989 ILAE criteria. Their clin-
Results
Table 1: Clinical Characteristics of BECCT Boys (34) Girls (15) Mean age of onset (years) PH of febrile seizures Cessation of seizures (%) Mean age of cessation of seizures (years) Normalization of EEG (%) Mean age of normalization of EEO (years)
7.2k1.9 12 34 (100%)
7.2k2.2 14 (93%)
8.7k2.2 27 (79%)
8.9k2.0 13 (87%)
5
13.5k1.8 13.1k2.9
PH: Past History
Girls 0
.,Y.
Y.W.
th dvlln ol th sum (m) 0 p.WndIhhdWd&bvuvr
Fig. 1: BECCT: Seizure frequency and the duration of the seizures.
422
Selected Papers: Course and Prognosis
10
1
2
3
4
5
Duntion of oburvalion ( y e r s )
Fig. 2: BECCT: Cumulative ratio of seizure cessation (49 patients).
Table 2 : Problems Associated with BECCT Number of Patients Enuresis
7
Headache Seizures other than during night sleep
6
Vomiting during or after seizures Anxiety or complaints by the patients Status epileptics Behavior or personality problems
3
Comments Patients: 6, 7, 8, 9, 12, 12, 13 years of age
TV monitor (4), train ( 2 ) , kotatsu (Japanese style foot warmer with a quilt over it) (3)
8 2 7
Memory of seizures, numbness of the extremities, fear 20 minutes, 40 minutes Restless, irritability
boys and girls, there was a significant difference in the duration of seizures between the patients who had “sparse” and those who had “frequent” seizures (Fig. 1). Overall, in boys, the seizures tended to disappear earlier than in girls. All the girls who had a past history of febrile seizures had more than three attacks and the seizures took longer to disappear compared with the boys who had one or two attacks. The cumulative remission rate clearly showed the earlier seizure cessation for boys (Fig. 2). Three years after the initiation of seizures, the cumulative seizure ces-
sation rate was 70.6% for boys and 46.7% for girls. Table 2 summarizes complaints about the 97 children from their family members. We depicted only complaints volunteered by the patient’s family rather than using a questionnaire. Therefore, we suggest that the actual number of complaints is higher. Seven patients had enuresis, six had headaches, nine experienced daytime seizures while on the train, or watching television, three patients vomited during seizures, and eight patients complained about terrible memories of the seizures. They remembered sore throats and numbness of the extremities after the seizure. One patient wanted to call her mother during her seizure, but she found she was unable to speak. This “arrest of speech” status made her fearful of the attacks. Complaints of behavior and personality disturbance must be carefully analyzed, because the majority of patients were of primary school age. Discussion This study was designed to reconsider the treatment of BECCT. The data indicated that the factors associated with the consideration of medical treatment were 1) girls, 2) status epilepticus, and vomiting, 3) seizure occurring outdoors; i.e., social factors, 4) psychiatric effects, and 5 ) daily life affected by lack of sleep from seizures. We agree that oligoepileptic BECCT patients do not require anticonvulsants immediately after the diagnosis. Some of our patients were, however, disadvantaged by seizures such as enuresis in a 12-year-old girl or seizures while traveling. Some patients may lose their self-esteem and social confidence. When we only consider the outcome of the last seizure, such disadvantages may be overlooked. We have to discuss the necessity of treatment of BECCT, in the light of these unfavorable factors for the patients. We propose a medical approach, to those who were present with these factors, without adhering to routine prescriptions of
The Japanese Journal of Psychiatry and Neurology, Vol. 46, No. 2, 1992
423
anticonvulsants.
Epilepsia 31: 802-805, 1990. 2. Loiseau, P. and Beaussart, M.: The seizures
Acknowledgment
of benign childhood epilepsy with rolandic paroxysmal discharges. Epilepsia 14 38 1-
We are grateful for the guidance provided by Professor Mitsuru Osano. References 1. Ambrosetto, G. and Tassinari, C.A.: Anti-
epileptic drug treatment of benign childhood epilepsy with rolandic spikes: Is it necessary?
389, 1973. 3. Blumer, D.: Diagnosis and treatment of psy-
chiatric problems associated with epilepsy. In: Smith, D.B. (Ed.), Epilepsy: Current approaches to diagnosis and treatment. Raven Press, New York, pp 193-209, 1990.
