Epilepsy with myoclonic absences in siblings.
BACKGROUND
Epilepsy with myoclonic absences (EMAs) is a distinct form of childhood epilepsy characterized by a peculiar seizure type that identifies this condition.


OBJECTIVE
To describe the clinical, electroencephalographic features, treatment strategies and outcome in this first case series of two siblings with normal intelligence presenting with EMAs.


METHODS
Both siblings underwent video-polygraphic investigations (simultaneous recording of electroencephalogram [EEG] and electromyogram [EMG] from deltoids), high-resolution magnetic resonance imaging (MRI), karyotyping, neuropsychological evaluation and language assessment.


RESULTS
Both the children had a mean age of onset of prototype seizures by 3.5 years. Myoclonic absences (MAs) were characterized by rhythmic, bilateral, synchronous, symmetric 3-Hz spike-wave discharges, associated with EMG myoclonic bursts at 3 Hz, superimposed on a progressively increasing tonic muscle contraction. The interictal EEG showed a normal background activity with bursts of generalized spike and waves (SWs) as well as rare focal SWs independently over bilateral temporal and frontal regions. Increase in the seizure frequency from 5 to 100/day was observed due to use of carbamazepine and phenobarbitone which decreased with its withdrawal and introduction of valproate. Though lamotrigine was given as an add on to valproate, it did not benefit them and was therefore replaced by topiramate at 3.5 mg/kg/day which has maintained them on remission at one year follow up.


CONCLUSIONS
Recognition of this ictal pattern allows identification and differentiation of EMAs from other seizure types. Idiopathic and symptomatic EMAs need to be differentiated from childhood absence epilepsy with myoclonia. MAs are worsened by drugs like carbamazepine while valproate either alone or in combination with topiramate (preferred to lamotrigine) gives excellent outcome.
Department of Neurology, Medical College Hospital, Trivandrum, Kerala, India.
Ajith
A
Cherian
Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India. Electronic address: drjabeennims@gmail.com.
Shaik Afshan
SA
Jabeen
Department of Neurology, Medical College Hospital, Trivandrum, Kerala, India.
Rukmini Mridula
RM
Kandadai
Department of Neurology, Medical College Hospital, Trivandrum, Kerala, India.
Thomas
T
Iype
Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India.
Pallavi
P
Moturi
Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India.
Muralidhar
M
Reddy
Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India.
Meena Angamuthu
MA
Kanikannan
Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India.
Rupam
R
Borgohain
Department of Neurology, Medical College Hospital, Trivandrum, Kerala, India.
Sandeep
S
Padmanabhan
D000927:Anticonvulsants / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D002648:Child; D002658:Developmental Disabilities / Q000209:etiology; D004569:Electroencephalography; D004831:Epilepsies, Myoclonic / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059906:Neuroimaging; D009483:Neuropsychological Tests; D010634:Phenobarbital / Q000627:therapeutic use; D035781:Siblings; D016896:Treatment Outcome
D000927:Anticonvulsants; D002220:Carbamazepine; D010634:Phenobarbital
3Hz; EMAs; Ethosuximide; Polygraphic VEEG; Tassinari; Topiramate; Valproate