New ILAE Seizure Type Classification
The Commission on Classification and Terminology of the International League Against Epilepsy (ILAE) recently proposed to classify childhood epilepsy with occipital paroxysms (CEOP) into 2 syndromes with different predominant seizure types: early onset (Panayiotopoulos type) with eye deviation and ictal vomiting, and late onset (Gastaut type) with initial ictal visual symptoms.
Dr. S. Kivity and associates at the Pediatric Epilepsy Unit at Schneider Children's Medical Center (Petah Tikva, Israel) reviewed the records of all children with partial-onset seizures and interictal occipital spikes, referred to the unit during a recent 29-month period, to determine whether the recent ILAE proposal has a sound basis. Data for 134 children who satisfied the criteria for CEOP were classified according to the 2 ILAE systems: seizure classification and syndrome classification.
The researchers identified 3 groups according to predominant ictal manifestations. Group I (visual) included 24 (17.9%) children with ictal visual symptoms. Of these, 19 (14%) also had overlapping adversive manifestations, either as a separate seizure or as part of the same event. Group 2 (adversive) included 72 (53.7%) children with tonic eye deviation. Group 3 (nonvisual, nonadversive) consisted of 38 (28.4%) children with various seizure spread patterns.
Two syndromes were identified. The Gastaut type included all 24 children in the visual group (Group 1). Seizures were brief and infrequent; they were diurnal in 83% of the children. The Panayiotopoulos type included all 72 children in Group 2. Ictal eye deviation occurred in all in Group 2; ictal vomiting in 44%. Prolonged seizures were experienced in 35% and were nearly twice as likely in those who experiences ictal vomiting as in those who did not. Of the group, 24% experienced a single seizure; 58% had nocturnal seizures. Seizure onset occurred earlier than for the Gastaut type. The 38 children with nonoccipital manifestations did not meet the criteria for the complete form of either syndrome.
The authors conclude that the cluster of signs and symptoms which characterize the Panayiotopoulos type of CEOP - the more common type of CEOP - are sufficiently delineated to justify its classification as distinct from the Gastaut type.
More Information
Epilepsia 2000 December; 41(12):1522
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