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Editorial
Message from the editor
Jean Aicardi
Review article
The mortality of epilepsy revisited
Athanasios Gaitatzis, Josemir W Sander
assessed by means of particular parameters; the mortality rate, the standardised mortality ratio, and the proportional mortality rate. An overview of their use and significance is given here. A number of epidemiological studies have assessed mortality in people with epilepsy in the general population and in populations from hospitals, out‐patient departments, and epilepsy centres. Methodological issues concerning the study of mortality in these populations are discussed. Epidemiological data are presented to describe the overall and cause‐specific mortality, as well as determinants of mortality in epilepsy, such as epilepsy and seizure types, time from diagnosis, and age. It has become clear from population studies with long‐term follow‐up that epilepsy has a higher mortality in the first few years after diagnosis that tends to decrease over time. The pattern of mortality in epilepsy can reflect the underlying conditions causing epilepsy or be associated with the effect of seizures. Emphasis is given to preventable causes of death in epilepsy, such as sudden unexpected death in epilepsy and suicide, which are discussed more extensively. The size of the problem and measures to avoid more deaths in epilepsy are discussed in the light of recently published data.
Original Article
Anoxic‐epileptic seizures: home video recordings of epileptic seizures induced by syncopes
John Stephenson, Galen Breningstall, Chris Steer, Martin Kirkpatrick, Iain Horrocks, Alla Nechay, Sameer Zuberi
an anoxic‐epileptic seizure. A few examples of such anoxic‐epileptic seizures, including the induction of status epilepticus, have been reported in books and medical journals, but no video‐recordings have been published. We show here home video recordings of the first three known examples of the transition from the triggering syncope and anoxic seizure, to the subsequent epileptic seizure. In the first two children, a neurally‐mediated syncope, probably mediated by prolonged expiratory apnoea (so‐called breath‐holding spells), induces a long, clonic epileptic seizure with some features of myoclonic absence. In the third example, a compulsive Valsalva in an older autistic child provokes a vibratory tonic epileptic seizure. In addition, we show two further video clips of the most usual type of epileptic seizure induced by syncopes in very young children. In one, the video recording begins after the end of the triggering syncope and shows a rhythmic clonic seizure that includes repetitive vocalizations. The final recoding is of a spontaneous epileptic seizure with features of myoclonic absence: this child had both epilepsy and identical episodes induced by syncopes, that is, anoxic‐epileptic seizures. Not only paediatricians and paediatric neurologists, but also adult neurologists and epileptologists in general, should be aware of the important clinical scenario of true epileptic seizures induced by syncopes. This phenomenon is not considered in any international classification. (Published with videosequences)Presented in part by Dr Alla Nechay to the European Paediatric Neurology Society, Taormina, Italy, October 25, 2003 and by Dr Iain Horrocks to the American Epilepsy Society, Boston USA, December 9, 2003.
Knowledge of epilepsy and attitudes towards the condition among schoolteachers in Bobo‐Dioulasso (Burkina Faso)
Athanase Millogo, Antoine S. Siranyan
was conducted to assess 260 teachers‘ knowledge and attitude towards epilepsy. They answered a semi‐structured questionnaire in order to quantify their knowledge of and attitude towards epilepsy in Bobo‐Dioulasso. Teachers were chosen at random. Almost all the teachers had heard about epilepsy, with 43.2% of them linking epilepsy to a central nervous system disturbance. Some teachers still thought that epilepsy was contagious or hereditary, and 15.4% objected to having epileptic children in their classes. Their knowledge of the clinical characteristics and first aid for a person during a seizure was unsatisfactory, and 56.5% of teachers who believed that epilepsy could be cured, thought that this disease should be treated by both modern and traditional medicines. The majority of teachers were interested in training involving clinical manifestations, aetiology of epilepsy and first aid procedures. Schools should offer some kind of information and assistance in health matters, and physicians should ensure that teachers have sufficient knowledge of epilepsy. More knowledge among primary school teachers should avoid discrimination against pupils with epilepsy.
Split‐screen synchronized display. A useful video‐EEG technique for studying paroxysmal phenomena
Paolo Tinuper, Carlo Grassi, Francesca Bisulli, Federica Provini, Giuseppe Plazzi, Elena Zoni, Elio Lugaresi
of different episodes. Five presentations of two seizures recorded in each of five patients are shown, in which apparently different ictal features are strongly superimposed and stereotyped. Split‐screen synchronized display is a simple and valid technique for studying and presenting particular semeiological aspects of epileptic seizures. (Published with videosequences)
Childhood epilepsy: a critical review of cost‐of‐illness studies
Ana Argumosa, José Luis Herranz
methodologies used in these studies make it difficult to compare them or even to compare the cost of childhood epilepsy treatment with that of adult epilepsy. Nevertheless, studies highlight important differences in the distribution of costs associated with childhood epilepsy and epilepsy in adults. It is understandable that direct costs represent the higher percentage of the total cost associated with childhood epilepsy treatment, given the higher number of hospital admissions and investigations, as well as the complexity of therapeutic trials, while indirect costs represent the greater proportion in adult epilepsy treatment. In addition to age, the total cost associated with epilepsy also depends on other factors such as seizure frequency, the moment at which the illness cost is estimated and the local health care system. In summary, chronic illnesses not only have an influence on the physical and psychological development of children, they also impose costs on the family and society. Childhood epilepsy has greater economic costs than those generated by more prevalent, chronic illnesses.
Unruptured intracranial aneurysm as a cause of focal epilepsy: an excellent postoperative outcome after intra‐arterial treatmen
Robert Kuba, Petr Krupa, Lenka Okácová, Ivan Rektor
postoperative outcome in terms of the epilepsy. A 52 year‐old, right‐handed woman had been suffering for three years from focal seizures, characterized by loss of consciousness, and oroalimentary and hand automatisms. The epilepsy was not controlled by carbamazepine monotherapy. Magnetic resonance imaging and digital subtraction angiography revealed a saccular aneurysm at the bifurcation of the middle cerebral artery, in contact with the cortex of the temporal opercular region. An intra‐arterial embolisation, using a detachable, mechanical spiral (MDS, Bold Platinum), was performed, with no complications. The purpose of embolisation was the treatment of the aneurysm. The patient had two more, complex partial seizures (CPS) in the early postoperative period, but was seizure‐free between September 1998 and September 2002. This is the first case report that presents the successful treatment of UIA‐related epilepsy by means of intravascular embolisation.
Alternating hemiplegia of childhood: presentation of two cases regarding the extent of variability
Sema Saltik, Ozlem Çokar, Turkan Uslu, Derya Uludz, Aysin Dervent
a representative of the classical picture and the other with unusual features, are presented by video display. Some clinical manifestations and the variability of symptoms are discussed with regard to their place in the diagnosis of the disease. (Published with videosequences)
Video Case report
Sandifer syndrome misdiagnosed as refractory partial seizures in an adult
Sriudomkajorn Somjit, Yong Lee, Samuel F Berkovic, A. Simon Harvey
were misdiagnosed and treated as partial seizures. Associated vomiting and haematemesis led to the correct diagnosis and treatment of reflux oesophagitis. The episodes immediately resolved and a diagnosis of Sandifer syndrome was made. This is only the second report of Sandifer syndrome in adult, a movement disorder of unknown mechanism that occurs almost exclusively in young children, often misdiagnosed as epilepsy or episodic dystonia. (Published with videosequences)
Book review
Book review
Edouard Hirsch
