S236 Epilepsy

From December 1993 to January 1997 we conducted a prospective study on 364 randomly selected outpatients, who had been diagnosed epileptic based on clinical and EEG findings. We used a MR protocol that included images in sagittal, coronal and axial planes on Tl and T2-weighted sequences; coronal FFE 3D acquisition, inversion recovery and FLAIR, parallel and perpendicular to the long axis of the hyppocampus.

MR was normal in 159 cases (41.4%) and abnormal in 225 p. (58.6%). It showed tumors in 36 p, hippccampal sclerosis in 35 p. disorders of neuronal migration and organization in 29 p. vascular lesions in 22 p, arachnoid cysts in 16 p, hypoxic-ischemic in 11 p and there were miscellaneous findings in 74 p. Among the patients in the normal group, it showed partial seizures in 92 p and generalized seizures in 65 p. In the MR abnonal group 160 subjects showed partial seizures and 45 p generalized (p < 0.0001, risk relative 1.63).

MR, with optimizing protocols, should be part of routine work-up in epileptic patients since it is an essential tool for the diagnosis of symptomatic epilepsy, specially in our country, taking into account the relationship between benefit and cost.

4-l 7-l 6 Open 3 month add-on study of iamotrigine in treatment-resistant epileptic children

S. Papacostas, R. Koukkoulli. Cyprus tnsfitute of Neurology and Genetics, Cyprus

We evaluated Lamotrigine (LTG) efficacy and safety as add-on therapy in uncontrolled seizures.

Fifteen children ages 2-l 2 with treatment-resistant epilepsy participated in a twelve week LTG add-on protocol. 14 completed the study. Seizure frequency was compared before LTG treatment, and at three months. Seven patients (46.6%) became seizure-free. There was an overall 64% seizure frequency reduction. Greater than 50% reduction was seen in 53.3% of all patients; in 60% of patients with simple or complex partial seizures with secondary generalisation; in 75% of patients with complex partial seizures; and in 75% of patients with generalised seizures. Two patients (13.3%) showed moderate improvement (26-4996 reduction). Two patients showed no change (O-25% reduction). Two patients became worse. One patient was withdrawn because of severe rash. LTG was well tolerated. 26.6% of patients reported no side effects. Four reported headache; 3 reported decreased appetite, 2 reported nausea/emesis; 2 reported rash; one each complained of dizziness, chest pain, somnolence, and decreased concentration.

LTG is effective and safe in a broad spectrum of seizures in children. Both partial and generalised seizures respond. It is well tolerated and safe in the majority of patients.

I 4-l 7 17 P3 in patients with CPS before and during Carbamazepine treatment

M. Pashu, R. Naumovski. Clinic of Neurology; Medical Facula)! Ft. Macedonia

For evaluation of the effects of Carbamazepine (CBZ) over the cognitive pro- cessing with long-latency auditory event-related potentials (P3), a group of 15 patients was analyzed. Auditory oddball paradigm was used. Peak latency on P3 was measured at Fz, Cz. and Pz. For typical normal limit and median value of the P3 latency in our group, IFCN recommended standards were used. All 15 patients at the age of 23 f 4 had epilepsy, diagnosed for the first time, with complex partial seizures (CPS) negative CT and MRI found, and without any other disease. The research was conducted in four phases. Phase one, prior to beginning with the CBZ, phase two 10 days after the beginning of the CBZ therapy with steady-state already reached, phase three one month from the start of the treatment, and phase four, six months from the CBZ start. CBZ concentration was maintained in the lower half of the therapeutic range (4-19 @ml the therapeutic range for our laboratory). The results showed that in 3% of the analyzed group, there was a Z-score z 3 after six month CBZ treatment, without any kind of epilepsy manifestations, and 11% with Z-score > 3 after only a month of CBZ treatment. Our study proves that there is statistically significant prolongation of the P3 latency in more than l/3 of the patients after a six-month CBZ treatment, which could prove to be practical and relevant measurement of the patient’s individual response to chronic CBZ therapy.

I__/ 4 17 18 Outcome of pregnancy and postnatal follow-up in offspring of epileptic mothers: A prospective study

I. Perez L.-Fraile, R. Alarcia, A. Oliveros, A. L6pez. Department of Neurology. Miguel Servet Hospital, Zaragoza, Spain

Objectfve: To study the incidence and factors related to perinatal death and reduced anthropometric data in children of epileptic mothers.

Method: 61 epileptic and 47 matched pregnant women and theirs babies were followed from early pregnancy, as we have previously described.

Results: There was 1 spontaneous abortion in the wntrol group and eleven ones in epileptic group, eight with phenobarbital treatment. One had abruptio placentae and two fetus had trisomies, 6 and 16. One stillbirth owned by status epilepticus at term, precipitated by patient noncompliance.

There were 7 preterm labors, in both groups. The two premature labors in epileptic women were induced: one by maternal status epilepticus and other one by child meningocele. Both were exposed to valproate.

Ten newborns of epileptics mothers (20.4%) had birth weight and head circumference 5 25th percentile. These data in control group were 15.2% and 13% respectively.

Comments: The fetal loss appears in this study as a major problem in epileptic pregnancies, mainly related to obstetric o genetic factors.

The differences in birth weight and head circumference do not reach statis- tical significance. We find no correlation between low anthropometric birth data and seizure incidence during pregnancy or exposure to a specific antiepileptic drug.

4-l 7-l 9 Vigabantrin versus Lamotrigine in intractable edieosv secondarv to cerebral oaisv: Our eiperieke -

. .

M. Perlni, M.R. Lischetti, V. Buganza, M. Sala. Sacra Famiglia Institute, Milan, Italy

Several new antiepileptic drugs (AED) are proposed in last years to reduce seizures in intractable epilepsy. We studied therapeutical effects, electroen- cephalogram (EEG) modifications, side effects of two AED, Vigabantrin and Lamotrigine, on a cohort of 9 patients affected by cerebral palsy, with severe mental deterioration and epilepsy (several generalized atonic or tonic seizures in a week).

We began to introduce Vigabantrin to previous therapy. After 3 months we noted in 4 cases an initial good response to Vigabantrin, with 50% seizures reduction and EEG improvement. Behaviour abnormalities were reported in one patient. However, after one year treatment, in all cases we noted an increase seizures number and EEG abnormalities.

Gradually Vigabantrin was substituted by Lamotrigine. After 3 months ther- apy we noted in 6 cases a good response to Lamotrigine, with 50% seizures reduction and EEG improvement. Vomiting due to increase plasma valproate sodium concentrations was reported in one patient. With Lamotrigine, this good response was still present after one year treatment.

Conclusions: in our cohort of 9 patients after initial good therapeutical response, Vigabantrin partially loosed its effects in a year even if seizures frequency was still reduced in front of the number of attacks before this therapy. Substitution of Vigabantrin with Lamotrigine was useful, in our patients, to obtain a better control of seizures number and EEG abnormalities in the first year. We are monitoring these data, in order to wntrol Lamotrigine efficacy in next years.

I__I 4 17 20 Difficulties for classification of epileptic seizures (ILAE) in epidemiologic study

M.-C. Picot’, A. Crespel 2, J.-P. Daures 3, M. Baldy-Moulinier 2. ’ Epidemiology unit, Medicat Information Department, Lapeyronie Hospital, Montpelier, France, 2 Epilepsy Unit, G. de Chauliac Hospital, Montpelier, France, 3 Medical Information Department, G. Doumergue Hospital, iWme.s, France

Rationale: An epidemiologic study done in an adult defined population, (Beziers 71,040 inhabitants) to estimate prevalence of Epilepsy and distri- bution of seizure has shown difficulties by using International League Against Epilepsy (ILAE) classification of epileptic seizures.

Methods: Established definitions for epilepsy were used. Special emphasis was given to case ascertainment and classification: All suspected cases were identified in from several sources (files of general practitioners and neurologist, hospital files, mental and old people’s home,...), data were examined by experts in epileptology to classify by epilepsy type and patients were reexamined using french adaptation of Semistructured Interview for Seizure Classification (Dttman, 1969).

Resultsi Age-adjusted prevalence ratios of epilepsy 6.5 per 1000 persons over 15 years of age.

In the initial distribution of epilepsies with retrospective crude data, the most frequently identified seizure type was generalized: 73%. Partial was 27% and undetermined: 16%.

After reexamination of files by an epileptologist the results were: general- ized: 53%. partial 36% and undetermined 9%.

Furthermore, reexamination of a part of patients permitted to classify epilepsy types as following: 30%, partial 51% and undetermined 19%.

Hence we can say that a proportion of seizures with focal onset secondarily generalized was misclassified as generalized seizures. In addition, myoclonic jerks were often not identified, and if they were, they tended to be misclassified as partial seizures.