Absence epilepsy is associated with bursts of generalized 3 Hz spike-and-wave activity. Even very brief bursts may cause an alteration in the level of consciousness and impaired reaction time. We studied 15 patients, ages 5-16 years, with absence epilepsy using 8 channel ambulatory cassette electroencephalography. All patients demonstrated multiple paroxysms of generalized spike-and-wave discharges, most of which were asymptomatic. Because patients with absence epilepsy may not accurately report seizure frequency, periodic long-term monitoring may be required which is accomplished easily on an outpatient basis with ambulatory cassette electroencephalography.

Adolescent↗

PubMedDate not supplied

Neurologic findings in neonates with intrauterine cocaine exposure.

To determine the effects of prenatal cocaine exposure on intrauterine growth and neurologic function, 30 term infants were evaluated prospectively: 14 cocaine-exposed and 16 unexposed. Cocaine-exposed infants had significantly lower mean birth weights, birth lengths, and head circumferences than urine-negative controls. Neurologic abnormalities among cocaine-exposed newborns included hypertonia of any type (86% vs 33%), axial hypertonia (79% vs 19%), plantar extension (46% vs 19%), and coarse tremor (57% vs 12%). The degree of hypertonia was sufficiently severe to warrant a diagnosis of "hypertonic tetraparesis" in 64% of cocaine-exposed and 12% of unexposed infants (P = .007). This diagnosis was highly correlated to small head size (r = 0.48; P = .01). Persistent tonic downward gaze was evident in two neurologically abnormal cocaine-exposed newborns. Gaze abnormalities improved slightly over the next 3 weeks of observation. One such infant re-evaluated at 6 months of age revealed resolution of tonic downward gaze and neurologic findings. We conclude that prenatal cocaine exposure is associated with tone and movement abnormalities in newborn infants.

Cephalometry↗

PubMedDate not supplied

Risk of recurrence after an initial unprovoked seizure.

A cohort of 424 patients was followed to determine the patterns of risk for recurrence after an initial unprovoked seizure. Overall, the risk of recurrence was 36% by 1 year, 48% by 3 years, and 56% by 5 years. The risk of subsequent seizures was lower for patients with idiopathic seizures than for those whose seizures had a presumed etiology. Among cases for which initial seizure was classified as idiopathic, EEG abnormalities, abnormal neurologic examination findings, and initial partial seizures were identified as significant independent predictors of higher recurrence risks.

Adolescent↗

PubMedDate not supplied

Fertility in persons with epilepsy: 1935-1974.

Data from the Rochester-Olmsted County Medical Records Linkage Project were utilized to assess fertility in persons with epilepsy. Population age-specific reproduction rates for Rochester residents for the years 1935-1974 were estimated using the number of live births from the Minnesota Department of Health Statistics and Vital Statistics of the U.S. for comparison with rates in affected persons. Overall, fertility rates were significantly reduced to 80% of expected for affected males and 85% for affected females. Individuals with partial seizures (simple and complex) were disadvantaged, whereas those with generalized onset were not. During the last 20 years of the study period, males were more disadvantaged than females. The male-female difference was greatest during the time of low population fertility (after 1965). Male deficits were more marked after diagnosis; female deficits were more marked before diagnosis. Differences in the proportion of ever-married person-years between the sexes only partially explain the observed differences.

Adolescent↗

PubMedDate not supplied

Epilepsy, antiepileptic drugs, and the risk of spontaneous abortion.

The possible effect of in utero antiepileptic drug (AED) exposure on the incidence of spontaneous abortion was evaluated among pregnancies of women with epilepsy and the wives of men with epilepsy. The proportion of pregnancy outcomes terminating in spontaneous abortion, the gestational age-specific rates of spontaneous abortion, and the cumulative risks of spontaneous abortion were determined. The gestational age-adjusted rate ratio for spontaneous abortion of 0.80 (95% confidence interval 0.45-1.40) was not increased for the pregnancies of women with epilepsy compared with those of the wives of men with epilepsy. Among women with epilepsy the rate ratio for in utero exposure to AED exposure was 1.14 (0.52-1.47) and was consistent with no effect of AED on fetal loss. The cumulative risk of spontaneous abortion of 18% for AED exposed pregnancies was also similar to risks reported in nonepilepsy populations. Thus, neither epilepsy nor in utero AED exposure was found to be associated with recognized fetal loss.

Abortion, Spontaneous↗

PubMedDate not supplied

EEG and other early predictors of epilepsy remission: a community study.

The course of seizures was reviewed in all 306 residents of Rochester, Minnesota who had epilepsy diagnosed between 1935 and 1978, lived in the region greater than or equal to 5 years after diagnosis, and had an electroencephalogram (EEG). The life-table probability of having achieved 5 years seizure-free (FYSF) by 20 years after diagnosis was 75%. In a multivariable proportional hazards model, these three variables predicted a significantly higher rate of achieving FYSF: no early-life brain damage (remission rate ratio = 2.27, p less than 0.01), no generalized epileptiform activity (rate ratio = 1.58, p less than 0.05), and never having had a generalized tonic-clonic seizure (rate ratio = 1.4, p less than 0.05). The same three variables, plus age at diagnosis, were descriptors of the rate of reaching FYSF off medication. Gender, family history, type of seizure, and EEG findings other than generalized epileptiform activity were not significantly related to either end point. The predictor set did 15% better than prior probabilities in forecasting FYSF. Although informative about group experience, these predictors are weak clinical discriminators, singly or in a set. FYSF occurred in high proportion of even those persons whose history, clinical examination, or EEG findings placed them in a less favorable stratum of one or more predictors.

Brain↗

PubMedDate not supplied

Risk of age-related fractures in patients with unprovoked seizures.

The incidence of age-related fractures was determined in a cohort of 467 Rochester, Minnesota residents with unprovoked seizures. The 30 initial hip fractures observed were significantly more than the 13.19 expected [standardized morbidity ratio (SMR) = 2.3; 95% confidence interval (CI) 1.5-3.3]. The overall incidence of distal forearm (Colles) fractures was not significantly increased (SMR = 1.6; 95% CI 0.9-2.5), based on 17 cases. Hip fracture incidence was increased during the first 10 years after seizure diagnosis but was not related to anti-epileptic drug (AED) use. In contrast, the increase in Colles' fracture incidence was associated with duration of therapy, as the SMR for greater than or equal to 10 years of AED use was 2.4 (95% CI 1.0-5.0). The incidence of vertebral fractures was slightly higher among treated patients but was not associated with duration of AED use. Thus, there was no consistent pattern to support the contention that fracture incidence is greatly increased by long-term AED use.

Aging↗

PubMedDate not supplied

Prevalence of epilepsy and seizure disorders in an urban minority population: a feasibility study.

Information on the frequency of epilepsy/seizure disorders and factors associated with development of epilepsy in an underprivileged urban ghetto population is urgently needed. A feasibility study was undertaken, and a questionnaire to collect information on seizure activity and behavior in the community was administered to a series of households with known seizure disorders, a series of households with chronic diseases, and a series of households chosen at random. Sensitivity and specificity of the seizure questions were estimated to be 0.93 and 0.89 respectively. The community was receptive to a survey of this type, and the overall refusal/nonresponse rate was 7.2%. Factors that would contribute to the success of an urban minority community survey are considered.

Epilepsy↗

PubMedDate not supplied

Seizure risk in offspring of parents with generalized versus partial epilepsy.

Genetic factors are commonly assumed to play a more important role in generalized than in partial epilepsy. This study tested this hypothesis by comparing risks of unprovoked seizures in offspring of individuals with generalized versus partial epilepsy. Overall, seizure incidence was no higher in offspring of persons with generalized epilepsy than in offspring of those with partial epilepsy. The number of affected offspring was about three times that expected from population incidence rates, regardless of whether the parent had partial or generalized epilepsy. For the subgroup of generalized cases with absence seizures, however, seizure incidence in offspring was about three times as high as for partial cases. The higher incidence in offspring of absence cases was only partly explained by a higher proportion of absence than partial cases with two factors associated with high risk in relatives, namely early age at onset and idiopathic epilepsy. Offspring of absence cases had higher risk than offspring of other cases not only for absence seizures, but for other seizure types as well, suggesting that absence epilepsy is not genetically distinct from other seizure types of epilepsy. These results suggest that the higher incidence sometimes observed in relatives of patients with generalized epilepsy is due to a small proportion of generalized cases with extremely high familial risks--most generalized epilepsies are no more likely than partial epilepsies to have a genetic basis.

Epilepsies, Partial↗

PubMedDate not supplied

Semistructured interview for seizure classification: agreement with physicians' diagnoses.

A semi-structured interview was developed for classification of seizures in accordance with the 1981 International League Against Epilepsy (ILAE) criteria. The interview was administered over the telephone by trained lay interviewers. Interview-based diagnoses for 50 patients were compared with independent diagnoses by neurologists who also use the ILAE system for seizure classification. Interview diagnoses agreed with those of physicians for broad seizure-type classifications (i.e., partial vs. generalized onset) in 88% of patients and for detailed combinations of seizure type in 64% of patients. Nonchance agreement between the two sources, assessed by the kappa statistic, was excellent for any partial onset (kappa = 0.83), secondarily generalized (kappa = 0.81), and primary generalized tonic-clonic (kappa = 0.76) seizures. Agreement was fair to good for any generalized onset (kappa = 0.70), simple partial (kappa = 0.56), complex partial (kappa = 0.54), and generalized nonconvulsive (kappa = 0.56) seizures. Sensitivity ranged from 0.60 to 1.0 for partial onset seizures, and from 0.43 to 0.67 for generalized onset seizures. Specificity ranged from 0.60 to 0.87 for partial onset seizures, and was 1.0 for generalized onset seizures. Positive predictive value was 0.95 for any partial onset and 1.0 for any generalized onset seizure. These results suggest that this interview can produce accurate diagnoses of major seizure categories. Use of this instrument for clinical epilepsy research should facilitate conduct of large studies at a significant saving of both time and money.

Humans↗