Clinical Treatment And Follow-up Study Of 5 Cases With Electrical Status Epilepticus During Sleep

Background and Objective: Electrical status epilepticus,during,sleep (ESES) is an age-dependent,self-limited and abnormal,electroencephalogram (EEG) phenomenon,and its typical manifestation is extensive or nearly continous 1.5~3.0 HZ,spikes and waves,,duringdNon-,Rapid Eye Movement(NREM)period. ESES can be found in variant typeâ…¡of benign partial epilepsy of childhood with rolandic spikes (BECTS variantâ…¡), Lennox-Gastaut syndrome (LGS), Landau-Kleffner syndrome (LKS), and continuous spike wave during slow wave sleep (CSWS,)syndrome ,also in the brain dysplasia and secondary brain, injuries. The aim of this study is to discuss the clinical characteristics, treatment and prognosis so as to get early alertness, diagnosis, treatment and to improve the prognosis for ESES through reviewing the data from five children with ESES.Methods: Five children with ESES were diagnosed in pediatric department of the first hospital of JiLin University from January 2010 to 2011 January. Data including abnormal perinatal information,personal history or family history with epilepsy and febrile convulsion,ages of seizure onset, seizure types and frequencies,which was found during three months prior ESES, mental ,development, EEG, Magnatic Resonance Imaging (MRI) of head and drug used before, ESES. Ages of found ESES, seizure types and frequencies, psychological abnormality, features of 24-hour Video Electroencephalogram (24hVEEG)and drugs of, treatment. According to the time of finding ESES, their seizure types, seizure frequencies,psychological,improvment, 24hVEEG ,drugs of being used and adverse,effects were, retrospectively summarized respectively in the first month, third month, sixth month, twelfth month.Results: Four of the five (80%)cases were diagnosed as epileptic syndrome, such as variant typeâ…¡of BECTS, LKS, LGS and CSWS syndrome, but one case in five(20%) was symptomatic, for viral, encephalitis sequela change. Birth asphyxia was found in the case with LGS and child with CSWS syndrome. Child with CSWS syndrome,had febrile convulsion and mental retardation, but MRI of head did not appear,obvious abnormity. Child with LGS had mental delay and, pachygyria. Epileptic seizures were found in all five (100%)patients, including complex partial seizures(CPS)in three (60%)cases , partial seizures(PS )in one(20%) and general, tonic seizures (GTS) in one, respectively.Topiramate (TPM) administration in three cases(60%), Oxcarbazepine(OXC) in two(40%), Levetiracetam (LEV) in one and Phenobarbital(PB) in one were recorded. With onset of ESES,seizure types such as atypical absence seizures (AAS), atonic seizures (AS) and general tonic clonic seizures(GTCS) and psydeveloped and psychological alteration such as irritation, hyperactivity, inattention, salivation, movement and speech developmental disorders etc. Spike-Wave Index (SWI)in NREM period, ranged from 55% to 80%. Follow up time varied in length, through the application of LEV, Valproic acid sodium (VPA), TPM and adrenocortico- tropin hormone (ACTH) etc., seizures of the child with BECTS variationâ…¡type were completely controlled, and the phenomenon of ESES disappeared, psychology back to normal. Seizures of the child with LKS were treated powerfully and auditory agnosia was improved slightly. The treatment for epilepsy in the rest of three cases was effective, and psychology also got different degrees of improvement. SWI was decreased by 55% in children with the variant typeâ…¡of BECTS and CSWS syndrome, 40% in LKS, 25% in LGS and 15% in the rest case, respectively.Conclusions:(1),Aggravation of epileptic seizures or psychologic alteration are found with onset of ESES, so it is important for clinician to order the long-time EEG monitoring so as to find ESES as early as possible and improve prognosis.(2),The higher SWI in NREM period, the more obvious mental damage, and the poorer prognosis.(3),The treatmental response of children with ESES are relevant to the severity of seizures and degrees of brain tissue damage, timely medication and appropriate drug administration before ESES. (4), Individual therapy is essential for ESES. .