Predictive clinical factors for the differential diagnosis of childhood extratemporal seizures

A. Fogarasi, Ingrid Tuxhorn, Marta Hegyi, J. Janszky

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Purpose: To describe predictive clinical factors for the differentiation between childhood frontal lobe epilepsy (FLE) and posterior cortex epilepsy (PCE). Methods: Two independent, blinded investigators analyzed 177 seizures from 35 children (aged 11 months to 12 years) with extratemporal epilepsy selected by postoperative seizure-free outcome. Semiologic seizure components and different periictal signs were observed. Age at onset, auras, seizure frequency, and nocturnal dominance, as well as surgical and histopathologic data, were collected from medical charts. Results: Twenty patients had FLE, and 15 had PCE. Patients from both groups had daily seizures without significant differences in frequency but with higher nocturnal dominance in children with FLE (p <0.05). Visual aura, nystagmus, and versive seizure were observed exclusively in the PCE group, whereas somatosensory aura and hypermotor seizures appeared only in FLE. Tonic seizures were significantly more frequent in FLE (p <0.01), whereas the presence of clonic seizure (FLE; p = 0.07) and postictal nose-wiping (PCE; p = 0.05) showed only a trend to localize the seizure-onset zone. Myoclonic seizures, epileptic spasms, psychomotor seizures, atonic seizures, oral and manual automatisms, as well as vocalization and eye deviation appeared in both groups without significant differences in their frequency. Conclusions: Characteristic features described in adults' extratemporal epilepsies were frequently missing during childhood seizures, especially in infants and preschool children. Ictal features help only a little in differentiating childhood FLE from PCE. Nocturnal appearance and the type of aura have high localizing value; therefore an accurate history taking is still an essential element of pediatric presurgical evaluation.

Original languageEnglish
Pages (from-to)1280-1285
Number of pages6
JournalEpilepsia
Volume46
Issue number8
DOIs
Publication statusPublished - Aug 2005

Fingerprint

Frontal Lobe Epilepsy
Epilepsy
Seizures
Differential Diagnosis
Epilepsy, Partial, Motor
Automatism
Spasm
Preschool Children
Age of Onset
Nose
Stroke
Research Personnel
Pediatrics

Keywords

  • Children
  • Frontal lobe epilepsy
  • Occipital lobe epilepsy
  • Presurgical evaluation
  • Seizure semiology

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Predictive clinical factors for the differential diagnosis of childhood extratemporal seizures. / Fogarasi, A.; Tuxhorn, Ingrid; Hegyi, Marta; Janszky, J.

In: Epilepsia, Vol. 46, No. 8, 08.2005, p. 1280-1285.

Research output: Contribution to journalArticle

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AB - Purpose: To describe predictive clinical factors for the differentiation between childhood frontal lobe epilepsy (FLE) and posterior cortex epilepsy (PCE). Methods: Two independent, blinded investigators analyzed 177 seizures from 35 children (aged 11 months to 12 years) with extratemporal epilepsy selected by postoperative seizure-free outcome. Semiologic seizure components and different periictal signs were observed. Age at onset, auras, seizure frequency, and nocturnal dominance, as well as surgical and histopathologic data, were collected from medical charts. Results: Twenty patients had FLE, and 15 had PCE. Patients from both groups had daily seizures without significant differences in frequency but with higher nocturnal dominance in children with FLE (p <0.05). Visual aura, nystagmus, and versive seizure were observed exclusively in the PCE group, whereas somatosensory aura and hypermotor seizures appeared only in FLE. Tonic seizures were significantly more frequent in FLE (p <0.01), whereas the presence of clonic seizure (FLE; p = 0.07) and postictal nose-wiping (PCE; p = 0.05) showed only a trend to localize the seizure-onset zone. Myoclonic seizures, epileptic spasms, psychomotor seizures, atonic seizures, oral and manual automatisms, as well as vocalization and eye deviation appeared in both groups without significant differences in their frequency. Conclusions: Characteristic features described in adults' extratemporal epilepsies were frequently missing during childhood seizures, especially in infants and preschool children. Ictal features help only a little in differentiating childhood FLE from PCE. Nocturnal appearance and the type of aura have high localizing value; therefore an accurate history taking is still an essential element of pediatric presurgical evaluation.

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