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Cause of seizure ring three-per-second spike-and-wave 70 EEG abnormality, also begins in this age period (rarely before 4 years) and 60 Cogenital carries a good prognosis This seizure 50 Trauma disorder responds well to medications, 40 Infection as indicated further on Its features are 30 Cerebrovascular fully described on page 274 Tumor 20 A number of partial epilepsies Degenerative 10 may appear for the rst time during this 0 age period and carry a good prognosis, 0 14 15 34 36 64 >65 ie, the neurologic and intellectual caYears pacities remain relatively unimpaired Figure 16-3 Distribution of the main causes of seizures at different ages Evident is the prevalence of and seizures may cease in adolescence congenital causes in childhood and the emergence of cerebrovascular disease in older patients (Adapted These disorders begin between 3 and from several sources including Hauser and Annegers and the texts of Engel and of Pedley) 13 years of age, and there is often a familial predisposition Most are all antiepileptic drugs The use of full doses of corticosteroids, if marked by distinctive focal spike activity that is greatly accentuated started within the rst year of the disease, proved bene cial in 5 by sleep (see above, in reference to benign childhood epilepsy with of the 8 patients treated by Chinchilla and colleagues Repeated centrotemporal or occipital spikes) In one form, unilateral tonic or plasma exchanges and immune globulin have been tried, but the clonic contractions of the face and limbs recur repeatedly with or results are dif cult to interpret When the disease is extensive and without paresthesias; anarthria follows the seizure There are cenunilateral, neurosurgeons have in the past resorted to partial hemitral and temporal spikes in the EEG interictally According to Gasspherectomy The authors have cared for a number of such patients taut, the focus may involve an occipital lobe with EEG spiking on with the same discouraging results eye closure An acquired aphasia was noted by Landau and Kleffner to mark the beginning of an illness in which there are partial or Seizures in Later Childhood and Adolescence These represent generalized motor seizures and multifocal spike or spike-and-wave the most common epileptic problem in general practice Here, we discharges in the EEG Tumor and arteriovenous malformation are face two different issues: one relates to the nature and management rare causes in this age group of the rst seizure in an otherwise normal young person and the Rasmussen Encephalitis In other rare cases, a lesion, usually other to the management of a patient who has had one or more identi ed by biopsy, takes the form of a chronic focal encephalitis seizures at some time in the past With respect to the rst, a search In 1958, Rasmussen described three children in each of whom the for a cause by CT, MRI, CSF examination, and EEG rarely disclinical problem consisted of intractable focal epilepsy in associcloses a tumor or a vascular malformation and the epilepsy is then ation with a progressive hemiparesis The cerebral cortex disclosed classed as idiopathic The type of seizure that rst brings the child a mild meningeal in ltration of in ammatory cells and an encephor adolescent to medical attention is most likely to be a generalized alitic process marked by neuronal destruction, gliosis, neuronotonic-clonic convulsion and often marks the beginning of a juvenile phagia, some degree of tissue necrosis, and perivascular cuf ng myoclonic epilepsy, as described on page 275 In the second type Many additional cases were soon uncovered, and by 1991, in a of case, in which there had been some type of seizure at an earlier publication devoted to this subject (edited by Andermann), Rasperiod, one should suspect a developmental disorder, parturitional mussen was able to summarize the natural history of 48 personally hypoxic-ischemic encephalopathy (birth injury), or one of the heobserved patients reditary metabolic diseases The expanded view of the syndrome has added several interSeveral groups of patients fall between these two distinct esting features All the patients were children aged 3 to 15 years, types Development may have been slightly delayed, but reportedly more girls than boys Half of them had epilepsia partialis continua no seizures had occurred earlier in life Closer investigation may The progression of the disease led to hemiplegia or other de cits disclose absence seizures, not always recognized as such by parents and brain atrophy in most cases The CSF has shown pleocytosis or teachers, and a typical absence EEG, which points more directly and sometimes oligoclonal bands Focal cortical and subcortical to a genetic factor and to a more favorable prognosis lesions have been well visualized by MRI and are bilateral in some When the seizures are an expression of a long-standing epicases The neuropathology of ve fully autopsied cases revealed leptic focus or foci that had been associated with mental backextensive destruction of the cortex and white matter with intense wardness, scholastic failure, and inadequacy of social adjustment, gliosis but with lingering in ammatory reactions The nding of the diagnostic and therapeutic problem becomes much more dif antibodies to glutamate receptors in a proportion of patients has cult and demanding Poor observations by the family, muddled raised interest in an immune causation (see review by Antel and thinking, and bizarre ideation on the part of the patient as well as Rasmussen) An autoimmune hypothesis has been supported by the poor compliance with therapy may pose problems as dif cult as ndings of Twyman and colleagues that these antibodies cause the seizures themselves Some patients of this latter group will seizures in rabbits and lead to the release of the neurotoxin kainate eventually fall into the category of epilepsy with complex partial in cell cultures However, Wiendl s group and others have found seizures In adulthood, the seizures may continue to interfere with these antibodies in many types of focal epilepsy and question their work, marriage, and family relationships In the interictal periods, speci city for the Rasmussen type of encephalitis the patients may exhibit bursts of bad temper, and they commonly The unrelenting course of the disease has de ed medical therhave wide mood swings of sadness and anger or elation As indiapy In some patients the process has eventually burned out, but in cated earlier, paranoid ideation or a frank hallucinatory-delusional those with continuous focal epilepsy the seizures continued despite Percent of incident cases.

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