- Top of page
- PATIENTS AND METHODS
Summary: Purpose: To analyze systematically the occurrence and age dependence as well as the localizing and lateralizing value of ictal autonomic symptoms (ASs) during childhood partial epilepsies and to compare our results with those of earlier adult studies.
Methods: Five hundred fourteen video-recorded seizures of 100 consecutive children 12 years or younger with partial epilepsy and seizure-free postoperative outcome were retrospectively analyzed.
Results: Sixty patients produced at least one AS; 43 (70%) of 61 with temporal and 17 (44%) of 39 with extratemporal lobe epilepsy (p = 0.012). Apnea/bradypnea occurred more frequently in younger children (p < 0.01), whereas the presence of other ASs was neither age nor gender related. Postictal coughing (p < 0.01) and epigastric aura (p < 0.05) localized to the temporal lobe, whereas no ASs lateralized to the seizure-onset zone.
Conclusions: Our study shows that ASs are common in childhood focal epilepsies, appearing in infants and young children, too. As in adults, childhood central autonomic networks might have a close connection to temporal lobe structures but do not lateralize the seizure-onset zone. To our knowledge, this is the first study comprehensively assessing ASs in childhood epilepsy.
Autonomic symptoms (ASs) during epileptic seizures are of both theoretical and clinical interest for different reasons. Periictal ASs can help us better understand the central representation of the autonomic nervous system (1), and some of them can add further information to the assessment of the epileptogenic focus, which is especially useful in presurgical evaluation of intractable epilepsy (2). Additionally, autonomic alterations, either in the periictal period or as a result of presumed interictal autonomic dysfunction, may play a role in the increasing incidence of sudden unexpected death in epilepsy patients (3). A variety of ASs have been described in adults, including cardiovascular, respiratory, gastrointestinal, cutaneous, pupillary, and urinary manifestations (3–8). Although such symptoms have unique importance in the evaluation of young and preverbal patients with epilepsy, no clinical study assessed ASs in children.
We performed this investigation, by using retrospective videotaped seizure analysis, to describe systematically the frequency and age dependence as well as the localizing and lateralizing value of childhood ASs and to compare our results with those of earlier adult studies.