title: Diagnostic issues and treatment of cryptogenic or symptomatic generalized epilepsies.
abstract: To clarify the diagnostic issues and treatment of patients with cryptogenic or symptomatic generalized epilepsies, not including West syndrome (WS), we investigated electroclinical change during the clinical course, and treatment effects in these patients. The selection criteria were minor generalized seizures as their main seizure type and diffuse epileptic discharges as their main EEG findings. Regarding EEG, we included EEGs that predominantly displayed multifocal spike-waves because of the inclusion of severe epilepsy with multiple independent spike foci (SE-MISF). We divided the subjects into two groups according to their main seizure types: Group A (54 patients) with brief tonic seizures and Group B (24 patients) with myoclonic seizures and/or atypical absences. The main epileptic syndromes were considered to be Lennox-Gastaut syndrome and SE-MISF in Group A, and epilepsy with myoclonic-astatic seizures in Group B. A history of WS was often seen in Group A, but it was exceptional in Group B. During the clinical course, seizure types did not basically change in Group A. EEG patterns were changeable in both groups. Although there was some overlap in electroclinical manifestations among epileptic syndromes, a transition between the two groups was not seen. High-dose valproate and ethosuximide were the most effective in Groups A and B, respectively. Long-term prognosis was significantly more favorable in Group B than in Group A.
authors.affiliation: Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Okayama, Japan. ohtsuka@md.okayama-u.ac.jp
authors.forename: Yoko
authors.initials: Y
authors.lastname: Ohtsuka
authors.forename: Harumi
authors.initials: H
authors.lastname: Yoshinaga
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ogino
authors.forename: Makio
authors.initials: M
authors.lastname: Oka
authors.forename: Minako
authors.initials: M
authors.lastname: Ito
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D011379:Prognosis; D013036:Spasms, Infantile / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000927:Anticonvulsants; D006728:Hormones; D000324:Adrenocorticotropic Hormone