Long term prognosis of symptomatic occipital lobe epilepsy ... - sepeap

Longitudinal clinical course 99
The posterior cerebral predilection of neonatal hypoglycemic
encephalopathy has been demonstrated by
computed tomography and magnetic resonance imaging
(Chiu, 1998; Traill et al., 1998; Kinnala et al., 1999). The
possible reasons for the pattern of damage may relate to the
high degree of axonal migration and synaptogenesis occurring
within the occipital lobe during the neonatal period and
the development of receptors for excitatory amino acids
which can be stimulated by elevated levels of aspartate.
This last mechanism could result in the selective death of
the postsynaptic neurons. It has also been hypothesized that
high metabolic turnover during early life predisposes this
area to injury as occurs in mitochondrial diseases (Dvorkin
et al., 1987).
A few limitations of this study can now be examined.
First, the small number of patients may affect the accuracy
of the results. Further studies with larger numbers
are needed. Second, occipital lobe epilepsy was based on
seizure semiology and interictal EEG. The possibility of
frontal or temporal lobe epilepsy cannot be completely
denied in patients with extra-occipital lobe abnormality.
Third, occipital lobe injuries could not be identified on MRI
in 2 patients. Brain injuries could be subtle, while nevertheless
we cannot deny the possibility of minor focal cortical
dysplasia.
In occipital lobe epilepsy in infancy and early childhood,
neonatal hypoglycemia should be considered as an important
possible etiology. Seizures are liable to be pharmacoresistant
and develop status epileptics in infancy and early
childhood, while they mostly decrease and are shortened in
late childhood and adolescence.
References
Alkalay, A.l., Flares-Sarnat, L., Sarnat, H.B., Moser, F.G., Simmons,
C.F., 2005. Brain imaging findincs in neonatal hypoglycemia: case
report and review of 23 cases. Clin. Pediatr. (Phila) 44, 783—
790.
Caraballo, R.H., Sakr, D., Mozzi, M., Guerrero, A., Adi, J.N., Cersósimo,
R.O., Fejerman, N., 2004. Symptomatic occipital lobe
epilepsy following neonatal hypoglycemia. Pediatr. Neurol. 31,
24—29.
Chiu, N.T., 1998. Technetium-99m-HMPAO brain SPECT in
neonates with hypoglycemic encephalopathy. J. Nucl. Med. 39,
1711—1713.
Dvorkin, G.S., Andermann, F., Carpenter, S., Melanson, S., Verret,
S., Jacob, C., Sherwin, A., Bekhor, S., Lugaresi, E., Sackellares,
C., Willoughby, J., MacGregor, D., 1987. Classical migraine,
intractable epilepsy and multiple strokes: a syndrome related to
mitochondrial encephalomyopathy. In: Andermann, F., Lugaresi,
E. (Eds.), Migraine and Epilepsy. Butterworths, London, pp.
203—232.
Filan, P.M., Inder, T.E., Cameron, F.J., Kean, M.J., Hunt, R.W., 2006.
Neonatal hypoglycemia and occipital cerebral injury. J. Pediatr.
148, 552—555.
Gil-Nagel, A., García Morales, I., Jiménez Huete, A., Alvarez Linera,
J., del Barrio, A., Ruiz Ocaña, C., Muñoz, D.G., 2005. Occipital
lobe epilepsy secondary to ulegyria. J. Neurol. 252, 1178—1185.
Kinnala, A., Rikalainen, H., Lapinleimu, H., Parkkola, R., Kormano,
M., Kero, P., 1999. Cerebral magnetic resonance imaging
and ultrasonography findings after neonatal hypoglycemia. Pediatrics
103, 724—729.
Montassir, H., Maegaki, Y., Ogura, K., Kurozawa, Y., Nagata, I.,
Kanzaki, S., Ohno, K., 2009. Associated factors in neonatal hypoglycemic
brain injury. Brain Dev. 31, 649—656.
Murakmi, Y., Yamashita, Y., Matsuishi, T., Utsunomiya, T., Okudera,
T., Hashimoto, T., 1999. Cranial MRI of neurologically impaired
children suffering from neonatal hypoglycemia. Pediatr. Radiol.
29, 23—27.
Norden, A.D., 2001. A novel epilepsy syndrome secondary to neonatal
hypoglycemia. Epilepsia 42 (Suppl. 7), S50.
Oguni, H., Sugama, M., Osawa, M., 2008. Symptomatic parietooccipital
epilepsy as sequel of perinatal asphyxia. Pediatr.
Neurol. 38, 345—352.
Okanishi, T., Maegaki, Y., Ohno, K., Togari, H., 2008. Underlying
neurologic disorders and recurrence rates of status epilepticus
in childhood. Brain Dev. 30, 624—628.
Pisani, F., Orsini, M., Braibanti, S., Copioli, C., Sisti, L., Turco,
E.C., 2009. Development of epilepsy in newborn with moderate
hypoxic-ischemic encephalopathy and neonatal seizures. Brain
Dev. 31, 64—68.
Srinivasan, G., Pildes, R.S., Cattamanchi, G., Voora, S., Lilien, L.D.,
1986. Plasma glucose values in normal neonates: a new look. J.
Pediatr. 109, 114—117.
Traill, Z., Squier, M., Anslow, P., 1998. Brain imaging in neonatal
hypoglycemia. Arch. Dis. Child. Fetal Neonatal Ed. 79,
F145—F147.
Villani, F., D’Incerti, L., Granata, T., Battaglia, G., Vitali, P., Chiapparini,
L., Avanzini, G., 2003. Epileptic and imaging findings
in perinatal hypoxic-ischemic encephalopathy with ulegyria.
Epilepsy Res. 55, 235—243.
Williamson, P.D., Thadani, V.M., Darcey, T.M., Spencer, D.D.,
Spencer, S.S., Mattson, R.H., 1992. Occipital lobe epilepsy:
clinical characteristics, seizure spread patterns, and results of
surgery. Ann. Neurol. 31, 3—13.
Yalnizoglu, D., Halioglu, G., 2007. Neurological outcome in patients
with MRI pattern of damage typical for neonatl hypoglycemia.
Brain Dev. 29, 285—292.
Zafeiriou, D.I., Kontopoulos, E.E., Tsikoulas, I., 1999. Characteristics
and prognosis of epilepsy in children with cerebral palsy. J.
Child Neurol. 14, 289—294.