Diario de epilepsia

Background: There is a wide variation in epidemiology and clinical profile of children with seizures following a head injury. Head injury can result from a variety of trauma to the head and remains a worldwide public health problem. Purpose: To determine the prevalence and characteristics of posttraumatic epilepsy among epileptic children seen in a pediatric neurology clinic in Enugu, Nigeria. Method: Records of epileptic patients who presented from January 2009 to January 2013 were reviewed. Data of those with history of head injury prior to onset of the seizure were documented. Statistical analysis was done using SPSS. Frequency and contingency table were derived and Chi2 test was used for associations. Result: Out of 1400 patients, who presented to the clinic, six hundred and eighty-two (48.7%) patients had epilepsy and fifty-nine of the epileptics (8.65%) had history of significant head injury before the onset of seizure. The peak incidence was in the preschool age (13-60 months). Falls from heights were the commonest mechanism of head injury. Mild, moderate and severe trauma was documented in 32, 19 and 8 patients respectively. Majority of patients with severe trauma fell from heights. There was however no statistically significant difference between the mechanism of head injury and degree of severity of trauma (p = 0.73). Complex partial seizure was the most common type. Seizure control was documented in 35 patients who were followed up for 18 months or more. Eighteen patients (51.43%) had good control. Conclusion: Head injury is a significant cause of epilepsy in this environment. Home injuries may have farreaching public health concern in our environment.

Valproic acid is the most used antiepileptic drug in children. Thrombocytopenia is one of known adverse effects of valproic acid. Acute respiratory infections are the most frequent acute infections in children. We present eleven cases of resistant thrombocytopenia in children on valproic acid therapy within therapeutic levels. Thrombocytopenia (without clinical signs) appeared after a short febrile episodes and signs and symptoms of acute respiratory infection, presenting with only few petehial skin spots. It does not respond to intravenous immunoglobulin’s, nether to corticosteroids. Thrombocytopenia responded dramatically to withdrawing of valproic acid. Complete platelet normalization after valproic acid withdrawal proved known adverse drug reaction between valproic acid and the thrombocytopenia this association.

For epilepsy patients who are not responding to anticonvulsant medications, surgery is an alternative treatment. A key issue in epilepsy surgery is the accurate localization of the “epileptogenic zone”. To date, pre-surgical evaluation of the epileptogenic network can be carried out by Electroencephalogram (EEG), video-EEG, magnetic resonance imaging, magneto-encephalography, single-photon emission computed tomography (SPECT) and positron emission tomography (PET). The interictal FDG-PET reveals hypometaboism at the epileptic focus, and it has been demonstrated to be much more sensitive than the interictal SPECT, and similarly sensitive to the ictal SPECT for the accurate localization of epileptogenic foci prior to surgical therapy. Visual assessment of 18F-FDG-PET is associated with interobserver and intraobserver variability. We have studied the issues of rigorous quantitation of FDG-PET brain studies and developed self-normalization technique. In addition to FDG-PET imaging, PET receptor imaging has also been demonstrated to provide significant insight into the mechanisms of neurotransmitters in epileptogenesis. In conclusion, we believe that nuclear medicine imaging can facilitate the identification of epileptic foci and investigate novel treatment for epilepsy.

Patients with medically refractory epilepsy should be evaluated for potentially curative epilepsy surgery when feasible. However, if seizure foci occur in eloquent brain regions—regions where damage causes overt neurological deficits—alternative treatments must be considered. This review will discuss what defines eloquent cortex, and the various treatments of seizure foci in eloquent regions, including resective surgery, multiple subpial transections, electrical brain stimulation of the anterior nucleus of the thalamus, closed-loop responsive neurostimulation, and vagus nerve stimulation.