CHRONIC PERIODIC LATERALIZED EPILEPTIFORM DISCHARGES (PLEDS) IN CHILDREN UNDER THE AGE OF 18 YEARS
Abstract number :
1.153
Submission category :
Year :
2003
Submission ID :
3786
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Ajay Gupta, Elaine Wyllie, Kahterine D. Holland Deapartment of Neurology, Cleveland Clinic Foundation, Cleveland, OH
In adult series PLEDs have usually been reported transiently during acute stroke, infection, or hypoxic encephalopathy. Few data concerning PLEDs are available in children.
: To assess the clinical setting in which PLEDs occur in pediatric patients. To study children who had persistent PLEDs without any acute clinical deterioration (chronic PLEDs).
89 EEGs on 51 children (6 days to 18 years, median 6.5 years) with PLEDs were identified from the EEG database from 1990 to 2000. Medical records and neuroimaging were reviewed. In 21, PLEDs occurred during an acute neurological event, while in 23 children PLEDs were seen in the absence of any acute condition (chronic PLEDs).
Of 23 children with chronic PLEDs, 7 had remote epilepsy surgery with PLEDs after but not before hemispherectomy (5, for hemimegalencephaly or Sturge-Weber syndrome) or cortical resection (2, for tumor or lobar MCD), 9 had PLEDs due to focal, hemispheric or diffuse malformation of cortical development (MCD), 3 had remote head trauma with encephalomalacia, 2 had remote infarction, and 2 had metabolic disease. All children with Chronic PLEDs (n=23) had mental retardation and neurological deficits. Children with remote epilepsy surgery (n=7) had no seizures, while 16 children without previous surgery had chronic seizures. Of 23 with chronic PLEDs, 22 children had an EEG and clinical follow-up at 5 months to 9 years. 2 with metabolic disease died, 4 had hemispherectomy (3) or fronto-parietal resection (1) with disappearance of PLEDs after surgery with resolution (3) or significant improvement (1) in seizures, 7 with remote epilepsy surgery were seizure free, and 9 with inoperable MCD, remote head trauma and infarcts continued to have PLEDs and chronic seizures.
In children, an acute CNS insult is not necessary for generation of PLEDs, which may be seen in a variety of chronic conditions. Pathogenesis of PLEDs may include brain immaturity, uncontrolled epilepsy with neurologic impairment, and certain characteristics of differential grey or white matter involvement due to congenital malformation, injury or surgical resection.