Idiopathic catastrophic epileptic encephalopathy presenting with acute onset intractable status.
OBJECTIVE
To delineate a catastrophic childhood epileptic syndrome of unknown cause presenting with persistent intractable multifocal status.


METHODS
Case note review.


RESULTS
Six children aged 5 months to 6 years presented with focal seizures that progressed within days to intractable multifocal seizures with or without secondary generalisation, which recurred every few minutes and persisted for weeks. One developed impaired consciousness shortly before seizures started. The two younger children showed mild developmental delay before onset but the others were normal. The seizures were unresponsive to all conventional anticonvulsants, steroids or pyridoxine and could only be controlled with doses of thiopentone sufficient to cause electrical suppression. MRI scans were initially normal but later showed focal cortical swelling followed by generalised atrophy. Two developed hepatomegaly, with a normal liver biopsy in one and steatosis in the other. No cause has been found even after neuropathological investigation. Three have died, two within 3 months of onset, while the three survivors have very severe neurological impairment and continued seizures.


CONCLUSIONS
The similarity of the clinical features suggests that this is a consistent clinical syndrome.
Baxter
Peter
P
Childrens Hospital, Sheffield, UK. p.s.baxter@sheffield.ac.uk
Clarke
Antonia
A
Cross
Helen
H
Harding
Brian
B
Hicks
Elaine
E
Livingston
John
J
Surtees
Robert
R
D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006529:Hepatomegaly; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007223:Infant; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012640:Seizures / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000503:physiopathology*; D013874:Thiopental / Q000627:therapeutic use
D018686:Anesthetics, Intravenous; D000927:Anticonvulsants; D006993:Hypnotics and Sedatives; D013874:Thiopental