Paroxismos occipitais após o fechamento dos olhos: correlações clínico-eletrencefalográficas em 24 casos

Fonseca, Lineu Corrêa; Tedrus, Glória M.A.

doi:10.1590/S0004-282X1994000400009

Resumos

Paroxismos occipitais aparecendo com o fechamento dos olhos (POFO) constituem o padrão eletrencefalográfico fundamental da epilepsia idiopática da infância com paroxismos occipitais (EIIPO). A associação de POFO e epilepsia idiopática tem sido questionada. Estudamos 24 pacientes que apresentavam POFO. A idade esteve compreendida entre 3 e 25 anos. Em 12 casos havia atividade epileptiforme de outras localizações (generalizada em 8 e rolândica em 4). Em 4 casos havia desorganização da atividade de base. Crises epilépticas espontâneas foram relatadas em 16 pacientes sendo focais em 9, generalizadas em 6 e inclassificáveis em um caso. Foi possível identificar as seguintes síndromes epilépticas: EIIPO em 7 casos; epilepsia benigna com pontas centro-temporais em um; EIIPO ou epilepsia benigna com pontas centro-temporais em um; epilepsia parcial sintomática/criptogênica em 4; idiopática generalizada em 2 e convulsões febris em 2 pacientes. Assim, concluímos que POFO foram mais comumente associados às epilepsias benignas da infância mas ocorreram em várias síndromes epilépticas ou mesmo em pacientes sem manifestações convulsivas.

epilepsia focal; eletrencefalografia; infância

Paroxysms of high-amplitude spike-waves or sharp waves recurring rhythmically on the occipital areas when the eyes are closed (POEC) are primarily observed in childhood epilepsy with occipital paroxysms (CEOP). An association of this electroencephalographic (EEG) pattern with idiopathic epilepsy has been disputed. We studied EEG and clinical features in 24 patients (age ranging from 3 to 25 years) with POEC. The EEG showed generalized discharges in 8 cases, rolandic spikes in 4 and background abnormalities in 4 cases. Eigtheen (75%) patients manifested epileptic seizures. The nonfebrile seizures (16 cases) were partial (9 cases), generalized (6 cases) and unclassified (one patient). Two children had neurological examination or computed tomography abnormalities. Clinical and EEG data allowed for the following epileptic syndromes diagnosis: CEOP, 7 cases; benign childhood epilepsy with centrotemporal spikes, one case; CEOP or benign childhood epilepsy with centrotemporal spikes, one case; partial symptomatic/cryptogenic epilepsy, 4 cases; generalized idiopathic, 2 cases; febrile convulsions, 2 cases. We conclude that POEC may be observed in cases with different types of idiopathic partial, cryptogenic/symptomatic and idiopathic generalized epilepsies and may also occur in patients with no seizures.

focal epilepsy; electroencephalography; childhood

Paroxismos occipitais após o fechamento dos olhos: correlações clínico-eletrencefalográficas em 24 casos

Occipital paroxysms after eye closure: clinical and electroencephalographic features in 24 cases

Lineu Corrêa Fonseca^I; Glória M.A. Tedrus^II

^IDepartamento de Neuropsiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP): Professor Titular

^IIDepartamento de Neuropsiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP): Professora Assistente

RESUMO

Paroxismos occipitais aparecendo com o fechamento dos olhos (POFO) constituem o padrão eletrencefalográfico fundamental da epilepsia idiopática da infância com paroxismos occipitais (EIIPO). A associação de POFO e epilepsia idiopática tem sido questionada. Estudamos 24 pacientes que apresentavam POFO. A idade esteve compreendida entre 3 e 25 anos. Em 12 casos havia atividade epileptiforme de outras localizações (generalizada em 8 e rolândica em 4). Em 4 casos havia desorganização da atividade de base. Crises epilépticas espontâneas foram relatadas em 16 pacientes sendo focais em 9, generalizadas em 6 e inclassificáveis em um caso. Foi possível identificar as seguintes síndromes epilépticas: EIIPO em 7 casos; epilepsia benigna com pontas centro-temporais em um; EIIPO ou epilepsia benigna com pontas centro-temporais em um; epilepsia parcial sintomática/criptogênica em 4; idiopática generalizada em 2 e convulsões febris em 2 pacientes. Assim, concluímos que POFO foram mais comumente associados às epilepsias benignas da infância mas ocorreram em várias síndromes epilépticas ou mesmo em pacientes sem manifestações convulsivas.

Palavras-chave: epilepsia focal, eletrencefalografia, infância.

SUMMARY

Paroxysms of high-amplitude spike-waves or sharp waves recurring rhythmically on the occipital areas when the eyes are closed (POEC) are primarily observed in childhood epilepsy with occipital paroxysms (CEOP). An association of this electroencephalographic (EEG) pattern with idiopathic epilepsy has been disputed. We studied EEG and clinical features in 24 patients (age ranging from 3 to 25 years) with POEC. The EEG showed generalized discharges in 8 cases, rolandic spikes in 4 and background abnormalities in 4 cases. Eigtheen (75%) patients manifested epileptic seizures. The nonfebrile seizures (16 cases) were partial (9 cases), generalized (6 cases) and unclassified (one patient). Two children had neurological examination or computed tomography abnormalities. Clinical and EEG data allowed for the following epileptic syndromes diagnosis: CEOP, 7 cases; benign childhood epilepsy with centrotemporal spikes, one case; CEOP or benign childhood epilepsy with centrotemporal spikes, one case; partial symptomatic/cryptogenic epilepsy, 4 cases; generalized idiopathic, 2 cases; febrile convulsions, 2 cases. We conclude that POEC may be observed in cases with different types of idiopathic partial, cryptogenic/symptomatic and idiopathic generalized epilepsies and may also occur in patients with no seizures.

Key words: focal epilepsy, electroencephalography, childhood.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 11-abril-1994.

Dr. Lineu Corrêa Fonseca - R. Sebastião de Souza 205 conj 122 - 13020-020 Campinas SP - Brasil

1. Beaumanoir A. Infantile epilepsy with occipital focus and good prognosis. Eur Neurol 1983, 22: 43-52.
2. Comission on Classification and Terminology of the International League against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989, 30: 389-399.
3. Cooper GW, Lee SI. Reactive occipital epileptiform activity: is it benign? Epilepsia 1991, 32: 63-68.
4. DeMarco P, Tassinari CA. Extreme somatosensory evoked potential (ESEP): an EEG sign forecasting the possible occurrence of seizures in children. Epilepsia 1981, 22: 569-575.
5. Fonseca LC, Tedrus GMA, Odashima NS. Epileptic syndromes in children with somatosensory evoked spikes (Abstr). Epilepsia 1991, 32(Suppl 1): 88.
6. Gastaut H. L'épilepsie benigne de l,enfant à pointe ondes occipitales. Rev EEG Neurophysiol Clin 1982, 12: 179-201.
7. Gastaut H. A new type of epilepsy: benign partial epilepsy of childhood with occipital spike-waves. Clin Electroencephalogr 1982, 13: 13-22.
8. Gastaut H. Benign epilepsy of childhood with occipital paroxysms. In: Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985, p 159-170.
9. Gobbi G, Sorrenti G, Santucci M, Rossi GP, Ambrosetto P, Michelucci R, Tassinari CA. Epilepsy with bilateral occipital calcifications: a benign onset with progressive severity. Neurology 1988, 38: 913-920.
10. Lerman P, Kivity-Ephraim S. Focal epileptic EEG discharges in children not suffering from clinical epilepsy: etiology, clinical significance and management. Epilepsia 1981, 22: 551-558.
11. Magaudda A, Meduri M, Longo M, Daniele O, Tortorlla G, Dalla Bernardina B. The syndrome of bilateral occipital calcifications, epilepsy and celiac disease: clinical and neuroimaging features of 13 patients. Epilepsia 1991,32 (Suppl 1): 119-120.
12. Newton R, Aicardi J. Clinical findings in children with occipital spike-wave complexes supressed by eye-opening. Neurology 1983, 33: 1526-1529.
13. Panayotopoulos CP. Benign nocturnal childhood occipital epilepsy: a new syndrome with nocturnal seizures, tonic deviation of the eyes, and vomiting. J Child Neurol 1989, 4: 43-48.
14. Talwar D, Rask CA, Torres F. Clinical manifestations in children with occipital spike-wave paroxysms. Epilepsia 1992, 33: 667-674.
15. Tanarro FJH, Lope ES, Sassot SC. La pointe-onde occipitale avec et sans epilepsie benigne chez l,enfant. Rev EEG Neurophysiol 1984, 14: 1-7.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Dez 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Beaumanoir A. Infantile epilepsy with occipital focus and good prognosis. Eur Neurol 1983, 22: 43-52.

[2] 2. Comission on Classification and Terminology of the International League against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989, 30: 389-399.

[3] 3. Cooper GW, Lee SI. Reactive occipital epileptiform activity: is it benign? Epilepsia 1991, 32: 63-68.

[4] 4. DeMarco P, Tassinari CA. Extreme somatosensory evoked potential (ESEP): an EEG sign forecasting the possible occurrence of seizures in children. Epilepsia 1981, 22: 569-575.

[5] 5. Fonseca LC, Tedrus GMA, Odashima NS. Epileptic syndromes in children with somatosensory evoked spikes (Abstr). Epilepsia 1991, 32(Suppl 1): 88.

[6] 6. Gastaut H. L'épilepsie benigne de l,enfant à pointe ondes occipitales. Rev EEG Neurophysiol Clin 1982, 12: 179-201.

[7] 7. Gastaut H. A new type of epilepsy: benign partial epilepsy of childhood with occipital spike-waves. Clin Electroencephalogr 1982, 13: 13-22.

[8] 8. Gastaut H. Benign epilepsy of childhood with occipital paroxysms. In: Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985, p 159-170.

[9] 9. Gobbi G, Sorrenti G, Santucci M, Rossi GP, Ambrosetto P, Michelucci R, Tassinari CA. Epilepsy with bilateral occipital calcifications: a benign onset with progressive severity. Neurology 1988, 38: 913-920.

[10] 10. Lerman P, Kivity-Ephraim S. Focal epileptic EEG discharges in children not suffering from clinical epilepsy: etiology, clinical significance and management. Epilepsia 1981, 22: 551-558.

[11] 11. Magaudda A, Meduri M, Longo M, Daniele O, Tortorlla G, Dalla Bernardina B. The syndrome of bilateral occipital calcifications, epilepsy and celiac disease: clinical and neuroimaging features of 13 patients. Epilepsia 1991,32 (Suppl 1): 119-120.

[12] 12. Newton R, Aicardi J. Clinical findings in children with occipital spike-wave complexes supressed by eye-opening. Neurology 1983, 33: 1526-1529.

[13] 13. Panayotopoulos CP. Benign nocturnal childhood occipital epilepsy: a new syndrome with nocturnal seizures, tonic deviation of the eyes, and vomiting. J Child Neurol 1989, 4: 43-48.

[14] 14. Talwar D, Rask CA, Torres F. Clinical manifestations in children with occipital spike-wave paroxysms. Epilepsia 1992, 33: 667-674.

[15] 15. Tanarro FJH, Lope ES, Sassot SC. La pointe-onde occipitale avec et sans epilepsie benigne chez l,enfant. Rev EEG Neurophysiol 1984, 14: 1-7.