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This type of focal motor epilepsy is unique among the partial epilepsies of childhood in that it tends to be a self-limited disorder, transmitted in families as an autosomal dominant trait The convulsive disorder begins between 5 and 9 years of age and usually announces itself by a nocturnal tonic-clonic seizure with focal onset Thereafter, the seizures take the form of clonic contractions of one side of the face, less often of one arm or leg, and the interictal EEG shows high-voltage spikes in the contralateral lower rolandic or centrotemporal area The seizures are readily controlled by a single anticonvulsant drug and gradually disappear during adolescence The relation of this syndrome to acquired aphasia with convulsive disorder in children, described by Landau and Kleffner, is unsettled A similar type of epilepsy, usually benign in the sense that there is no intellectual deterioration and a cessation of seizures in adolescence, has been associated with spike activity over the oc-

cipital lobes, as identi ed by Panayiotopoulos As described in the review by Taylor and colleagues, visual hallucinations, while not invariable, are the most common clinical feature; sensations of movements of the eyes, tinnitus, or vertigo are also reported in cases of occipital epilepsy These authors point out symptomatic causes of the syndrome, such as cortical heterotopias In both of these types of childhood epilepsy, the observation that spikes are greatly accentuated by sleep is a useful diagnostic aid

be the bar chart, in which comparisons between individual elements are shown in a bar chart Categories are arranged vertically and values are arranged horizontally The emphasis is on the comparison of values and not on displaying a change during a period of time An example bar chart is shown in the next illustration In cases such as this example, you will need to make some additional changes to the chart Here, the data points for Sales are probably not sufficiently detailed Therefore, going into the Chart Type and identifying the types of values would be required For example, in this case we have a comparison between Yearly Sales of 2007 and 2008 and we would need to identify the types of values rather than just showing the title of Sales As in a 3D column chart, in a 3D bar chart you can depict the bars as cylinders, cones, or pyramids In a 2D bar chart, you can depict the bars as triangles (2D pyramids) To do this, choose Bars | BlockStyle If you are using a 2D bar chart, there is no difference between the Pyramid and Cone settings

Infantile Spasms (West Syndrome)

This is the term applied to a particular form of epilepsy of infancy and early childhood West, in the mid-nineteenth century, described the condition in his son in exquisite detail This seizure disorder, which in most cases appears during the rst year of life, is characterized by recurrent, single or brief episodes of gross exion movements of the trunk and limbs and, less frequently, by extension movements (hence the alternative terms infantile spasms or salaam or jackknife seizures) Most but not all patients with this disorder show severe EEG abnormalities, consisting of continuous multifocal spikes and slow waves of large amplitude However, this pattern, referred to originally by Gibbs and Gibbs as hypsarrhythmia ( mountainous dysrhythmia), is not speci c for infantile spasms, being frequently associated with other developmental or acquired abnormalities of the brain As the child matures, the seizures diminish; they usually disappear by the fourth to fth year If MRI and computed tomography (CT) scans are more or less normal, the usual pathologic ndings according to Jellinger are cortical dysgeneses Both the seizures and the EEG abnormalities may respond dramatically to treatment with adrenocorticotropic hormone (ACTH), corticosteroids, or the benzodiazepine drugs, of which clonazepam is probably the most widely used However, most patients, even those who were apparently normal when the seizures appeared, are left mentally impaired Infantile spasms may also be part of the Lennox-Gastaut syndrome, a seizure disorder of early childhood of grave prognosis (see page 274)

the same or different illnesses (complicated febrile seizures) These seizures may recur not only with infections but also at other times When patients with both types are lumped together under the rubric of febrile convulsions, it is not surprising that a high percentage are complicated by atypical petit mal, atonic, and astatic spells followed by tonic seizures, mental retardation, and partial complex epilepsy Falconer, who studied psychomotor seizures in adults, noted retrospectively a high incidence of febrile seizures during the infancy and childhood in his cohort of surgical subjects The present authors believe that he was referring to complicated febrile seizures, ie, fever and convulsions with structural brain disease, which should be kept separate from the common benign febrile seizures In a later study of 67 patients with proven medial temporal lobe epilepsy (French et al), 70 percent had a history of complicated febrile seizures during the rst 5 years of life, although many did not develop temporal lobe epilepsy until their teens Bacterial meningitis was another important risk factor; head and birth trauma were less common factors All of the patients had complex partial seizures and half of them, in addition, had secondarily generalized tonic-clonic seizures Epidemiologic studies have substantiated this clinical point of view Annegers and colleagues observed a cohort of 687 children for an average of 18 years after their initial febrile convulsion Overall, these children had a vefold excess of unprovoked seizures in later life Among the children with simple febrile convulsions, the risk was only 24 percent By contrast, children with what Annegers et al called complex febrile convulsions (focal, prolonged, or repeated episodes of febrile seizures) had a greatly increased risk 8, 17, or 49 percent, depending on the association of one, two, or three of the complicating features

Doughnut Chart In a doughnut chart, the relationship between parts of a whole are displayed in a doughnut This is similar to a pie chart, discussed a bit later in this section In contrast to the pie chart, however, the doughnut can represent more than one data series, where each ring corresponds to a data series, as shown here I do not favor this chart type, but in the correct situation it can work well You can change the width of the rings by setting the size of the hole To do so, choose Doughnut | Hole Size | <value as percentage of ring size>