Espícula-onda contínua durante o sono: aspectos clínicos e eletrencefalográficos

Guilhoto, Laura M.F. Ferreira; Machado-Haertel, Lúcia R.; Manreza, Maria Luíza G.; Diament, Aron J.

doi:10.1590/S0004-282X1997000500013

Resumos

Dezessete crianças com espícula-onda contínua durante o sono foram estudadas retrospectivamente. Cinco apresentavam distúrbio da fala após desenvolvimento normal da linguagem e crises epilépticas (síndrome de Landau e Kleffner - grupo 1). Doze crianças tinham atraso do desenvolvimento neuropsicomotor e/ou deficiência mental (grupo 2). Crises epilépticas estavam presentes em 11 pacientes deste grupo, tetraparesia em 5, hemiparesia em 2, microcefalia em 2, distúrbios de comportamento em 4 casos. O eletrencefalograma mostrou em todos os casos espícula-onda contínua durante o sono. Pacientes do grupo 1 apresentavam atividade epileptiforme difusa com acentuação das descargas nas regiões temporais em 4 de 5 casos; e os do grupo 2, descargas difusas, incluindo atividade multifocal (5/ 12), por vezes com predomínio anterior (7/12). Concluímos que espícula-onda contínua durante o sono é um padrão eletrográfico inespecífico de certos tipos de epilepsia na infância com diferentes manifestações clínicas, que mostra no entanto certa diferenciação topográfica, de acordo com os prováveis sítios lesionais.

afasia adquirida; epilepsia; espícula-onda contínua durante sono lento

Seventeen children were retrospectively evaluated. They exhibited continuous spike-wave activity during slow wave sleep (CSWS). Five of these had only speech problems and seizures (Landau-Kleffner syndrome) (group 1). The other cases had developmental milestones acquisition delay and/or mental retardation (group 2). Epileptic seizures were present in 11 of these, tetraparesis was observed in 5, hemiparesis in 2, microcephaly in 2 and behavior disturbances in 4 cases. The electroencephalogram showed in all cases diffuse CSWS. Group 1 showed diffuse activity, at times accentuated in the centrotemporal region (4/5). Group 2 had widespread discharges, including multifocal activity (5/12), sometimes with anterior predominance (7/12). We concluded that CSWS is a non specific electrographic pattern observed in some types of epilepsy in childhood that have different clinical presentation. It has however some topographic differentiation, depending upon the lesional sites.

acquired aphasia; epilepsy; continuous spike-wave during sleep

Espícula-onda contínua durante o sono: aspectos clínicos e eletrencefalográficos

Continuous spike-wave activity during sleep: clinical and electroencephalographical aspects

Laura M.F. Ferreira Guilhoto^I; Lúcia R. Machado-Haertel^II; Maria Luíza G. Manreza^III; Aron J. Diament^IV

^IDepartamento de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMSUP): Médica Pós-graduanda

^IIDepartamento de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMSUP): Médica Residente

^IIIDepartamento de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMSUP): Médica Assistente

^IVDepartamento de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMSUP): Chefe da Seção de Neurologia Infantil

RESUMO

Dezessete crianças com espícula-onda contínua durante o sono foram estudadas retrospectivamente. Cinco apresentavam distúrbio da fala após desenvolvimento normal da linguagem e crises epilépticas (síndrome de Landau e Kleffner - grupo 1). Doze crianças tinham atraso do desenvolvimento neuropsicomotor e/ou deficiência mental (grupo 2). Crises epilépticas estavam presentes em 11 pacientes deste grupo, tetraparesia em 5, hemiparesia em 2, microcefalia em 2, distúrbios de comportamento em 4 casos. O eletrencefalograma mostrou em todos os casos espícula-onda contínua durante o sono. Pacientes do grupo 1 apresentavam atividade epileptiforme difusa com acentuação das descargas nas regiões temporais em 4 de 5 casos; e os do grupo 2, descargas difusas, incluindo atividade multifocal (5/ 12), por vezes com predomínio anterior (7/12). Concluímos que espícula-onda contínua durante o sono é um padrão eletrográfico inespecífico de certos tipos de epilepsia na infância com diferentes manifestações clínicas, que mostra no entanto certa diferenciação topográfica, de acordo com os prováveis sítios lesionais.

Palavras-chave: afasia adquirida, epilepsia, espícula-onda contínua durante sono lento.

ABSTRACT

Seventeen children were retrospectively evaluated. They exhibited continuous spike-wave activity during slow wave sleep (CSWS). Five of these had only speech problems and seizures (Landau-Kleffner syndrome) (group 1). The other cases had developmental milestones acquisition delay and/or mental retardation (group 2). Epileptic seizures were present in 11 of these, tetraparesis was observed in 5, hemiparesis in 2, microcephaly in 2 and behavior disturbances in 4 cases. The electroencephalogram showed in all cases diffuse CSWS. Group 1 showed diffuse activity, at times accentuated in the centrotemporal region (4/5). Group 2 had widespread discharges, including multifocal activity (5/12), sometimes with anterior predominance (7/12). We concluded that CSWS is a non specific electrographic pattern observed in some types of epilepsy in childhood that have different clinical presentation. It has however some topographic differentiation, depending upon the lesional sites.

Key words: acquired aphasia, epilepsy, continuous spike-wave during sleep.

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Aceite: 19-agosto-1997.

Dra Laura M.F.F. Guilhoto - Departamento de Neurologia, Hospital das Clínicas, FMUSP - Av. Dr. Enéas de Carvalho Aguiar s/n - 05403-900 São Paulo SP - Brasil.

1. Beaumanoir A. The Landau-Kleffner syndrome. In Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P, (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985:181-191.
2. Billard C, Autret A, Laffont F, Lucas B, Degiovanni E. Electrical status epilepticus during sleep in children: a reappraisal from eight new cases. In Sterman MB, Shouse MN, Passouant P, (eds). Sleep and epilepsy. New York: Academic Press, 1982: 481-494.
3. Billard C, Autret A, Lucas B, Degiovanni E, Gillet P, Santini JJ, De Toffol B. Are frequent spike-waves during non-REM sleep in relation with an acquired neuropsychological deficit in epileptic children? Neurophysiol Clin 1990;20:439-453.
4. Boel M, Casaer P. Continuous spikes and waves during slow sleep: a 30 months follow-up study of neuropsychological recovery and EEG findings. Neuropediatrics 1989;20:176-180.
5. Commission on classification and terminology of the international league against epilepsy. Proposal for classification of epilepsies and epileptic syndromes. Epilepsia 1985;26:268-278.
6. Commission on classification and terminology of the international league against epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389-399.
7. DeMarco P. Electrical status epilepticus during slow sleep: one case with sensory aphasia. Clin Electroencephalogr 1988;19:111-113.
8. Deonna T. Acquired epileptiform aphasia in children (Landau-Kleffner syndrome). J Clin Neurophysiol 1991;8:288-298.
9. Dugas M, Masson M, Le Heuzey MF, Regnier N. Aphasie acquise de l'enfant avec épilepsie (syndrome de Landau et Kleffner). Rev Neurol (Paris) 1992;138:755-780.
10. Dulac O, Billard C, Arthuis M. Aspects électro-cliniques et évolutifs de l'épilepsie dans le syndrome aphasie-épilepsie. Arch Fr Pediatr 1983;40:299-308.
11. Farnarier G, Kouna P, Genton P. Amplitude EEG mapping in three cases of CSWS. In Beaumanoir A, Bureau M, Deonna T, Mira L, Tassinari CA, (eds). Continuous spikes and waves during slow sleep: electrical status epilepticus during slow sleep. London: John Libbey & Co, 1995:91-98.
12. Genton P, Guerrini R. What differentiates Landau-Kleffner syndrome from the syndrome of continuous spikes and waves during slow sleep? Arch Neurol 1993;50:1008-1009.
13. Genton P, Maton B, Ogihara M, Samoggia G, Guerrini R, Medina MT, Dravet C, Roger J. Continuous focal spikes during REM sleep in a case of acquired aphasia (Landau-Kleffner syndrome). Sleep 1992;15:454-460.
14. Guilhoto LMFF. Síndrome de Landau e Kleffner: aspectos clínicos e eletrencefalográficos. Dissertação de mestrado, Faculdade de Medicina da Universidade de São Paulo. São Paulo, 1995
15. Guilhoto LMFF, Morrell F. Electrophysiological differences between Landau-Kleffner syndrome and other conditions showing the CSWS electrical pattern (Abstr). Epilepsia 1994;35:126.
16. Hoeppner J, Morrell F, Smith MC, Chez M, Hasegawa H. The Landau-Kleffner syndrome: a peri-sylvian epilepsy. Epilepsia 1992:33:122.
17. Holmes GL, Mckeever M, Saunders Z. Epileptiform activity in aphasia of childhood: an epiphenomenon? Epilepsia 1981;22:631-639.
18. Jayakar PB. Seshia SS. Electrical status epilepticus during slow-wave sleep: a review. J Clin Neurophysiol 1991;8:299-311.
19. Landau WM. Landau-Kleffner syndrome: an eponymic badge of ignorance. Arch Neurol 1992;49:353.
20. Landau WM, Kleffner FR. Syndrome of acquired aphasia with convulsive disorder in children. Neurology 1957;7:523-530.
21. Morikawa T, Seino M, Osawa T, Yagi K. Five children with continuous spike-wave discharges during sleep. In Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P, (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985:205-212.
22. Morikawa T, Seino M, Watanabe Y, Watanabe M, Yagi K. Clinical relevance of continuous spike-waves during slow wave sleep. In Manelis J, Bental E, Loeber JN, Dreifuss FE, (eds). The XVII^th, epilepsy international symposium. New York: Raven Press, 1989:359-363 (Advances in epileptology, 17).
23. Morrell F, Hoeppner T, Lewine J. Dipole source localization in Landau-Kleffner syndrome: magnetic and electrical potential distributions confirmed at electrocorticography. (Abstract). Electroenceph Clin Neurophysiol 1994,95:20
24. Paquier PF, Van Dongen HR, Loonen MCB. The Landau-Kleffner syndrome or acquired aphasia with convulsive disorder. Arch Neurol 1992;49:354-359.
25. Patry G, Lyagoubi S, Tassinari A. Subclinical electrical status epilepticus induced by sleep in children. Arch Neurol 1971;24:242-252.
26. Rodriguez I, Niedermeyer E. The aphasia-epilepsy syndrome in children: electroencephalographic aspects. Clin Electroencephalogr 1982;13:23-35.
27. Roulet E, Deonna T, Gaillard F, Peter-Favre C, Despland PA. Acquired aphasia, dementia, and behavior disorder with epilepsy and continuous spike and waves during sleep in a child. Epilepsia 1991;32:495-503.
28. Shoumaker RD, Benett DR, Bray PF, Curless RG. Clinical and EEG manifestations of an unusual aphasic syndrome in children. Neurology 1974;24:10-16.
29. Tassinari CA. The problems of 'continuous spikes and waves during slow sleep' or 'electrical status epilepticus during slow sleep' today. In Beaumanoir A, Bureau M, Deonna T, Mira L, Tassinari CA.(eds). Continuous spikes and waves during slow sleep: electrical status epilepticus during slow sleep. London: John Libbey & Co, 1995:251-255.
30. Tassinari CA, Bureau M, Dravet C, Dalla Bernardina B, Roger J. Epilepsy with continuous spikes and waves during slow sleep. In Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P, (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985:194-204.
31. Tassinari CA, Bureau M, Dravet C, Roger J, Natalè OD. Electrical status epilepticus during sleep in children (ESES). In Sterman MB, Shouse MN, Passouant P, (eds). Sleep and epilepsy. New York: Academic Press, 1982:465-479.
32. Tassinari CA, Terzano G, Capocchi G, Dalla Bernardina B, Vigevano F, Daniele O, Valladier C, Dravet C, Roger J. Epileptic seizures during sleep in children. In Penry JK, (ed). Epilepsy, the eighth international symposium. New York: Raven Press, 1977:345-354.
33. Toso V, Moschini M, Gagnin G, Antoni D. Aphasie acquise de l'enfant avec épilepsie. Rev Neurol (Paris) 1981; 137:425-434.

Datas de Publicação

Publicação nesta coleção
07 Out 2010
Data do Fascículo
1997

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

[1] 1. Beaumanoir A. The Landau-Kleffner syndrome. In Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P, (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985:181-191.

[2] 2. Billard C, Autret A, Laffont F, Lucas B, Degiovanni E. Electrical status epilepticus during sleep in children: a reappraisal from eight new cases. In Sterman MB, Shouse MN, Passouant P, (eds). Sleep and epilepsy. New York: Academic Press, 1982: 481-494.

[3] 3. Billard C, Autret A, Lucas B, Degiovanni E, Gillet P, Santini JJ, De Toffol B. Are frequent spike-waves during non-REM sleep in relation with an acquired neuropsychological deficit in epileptic children? Neurophysiol Clin 1990;20:439-453.

[4] 4. Boel M, Casaer P. Continuous spikes and waves during slow sleep: a 30 months follow-up study of neuropsychological recovery and EEG findings. Neuropediatrics 1989;20:176-180.

[5] 5. Commission on classification and terminology of the international league against epilepsy. Proposal for classification of epilepsies and epileptic syndromes. Epilepsia 1985;26:268-278.

[6] 6. Commission on classification and terminology of the international league against epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389-399.

[7] 7. DeMarco P. Electrical status epilepticus during slow sleep: one case with sensory aphasia. Clin Electroencephalogr 1988;19:111-113.

[8] 8. Deonna T. Acquired epileptiform aphasia in children (Landau-Kleffner syndrome). J Clin Neurophysiol 1991;8:288-298.

[9] 9. Dugas M, Masson M, Le Heuzey MF, Regnier N. Aphasie acquise de l'enfant avec épilepsie (syndrome de Landau et Kleffner). Rev Neurol (Paris) 1992;138:755-780.

[10] 10. Dulac O, Billard C, Arthuis M. Aspects électro-cliniques et évolutifs de l'épilepsie dans le syndrome aphasie-épilepsie. Arch Fr Pediatr 1983;40:299-308.

[11] 11. Farnarier G, Kouna P, Genton P. Amplitude EEG mapping in three cases of CSWS. In Beaumanoir A, Bureau M, Deonna T, Mira L, Tassinari CA, (eds). Continuous spikes and waves during slow sleep: electrical status epilepticus during slow sleep. London: John Libbey & Co, 1995:91-98.

[12] 12. Genton P, Guerrini R. What differentiates Landau-Kleffner syndrome from the syndrome of continuous spikes and waves during slow sleep? Arch Neurol 1993;50:1008-1009.

[13] 13. Genton P, Maton B, Ogihara M, Samoggia G, Guerrini R, Medina MT, Dravet C, Roger J. Continuous focal spikes during REM sleep in a case of acquired aphasia (Landau-Kleffner syndrome). Sleep 1992;15:454-460.

[14] 14. Guilhoto LMFF. Síndrome de Landau e Kleffner: aspectos clínicos e eletrencefalográficos. Dissertação de mestrado, Faculdade de Medicina da Universidade de São Paulo. São Paulo, 1995

[15] 15. Guilhoto LMFF, Morrell F. Electrophysiological differences between Landau-Kleffner syndrome and other conditions showing the CSWS electrical pattern (Abstr). Epilepsia 1994;35:126.

[16] 16. Hoeppner J, Morrell F, Smith MC, Chez M, Hasegawa H. The Landau-Kleffner syndrome: a peri-sylvian epilepsy. Epilepsia 1992:33:122.

[17] 17. Holmes GL, Mckeever M, Saunders Z. Epileptiform activity in aphasia of childhood: an epiphenomenon? Epilepsia 1981;22:631-639.

[18] 18. Jayakar PB. Seshia SS. Electrical status epilepticus during slow-wave sleep: a review. J Clin Neurophysiol 1991;8:299-311.

[19] 19. Landau WM. Landau-Kleffner syndrome: an eponymic badge of ignorance. Arch Neurol 1992;49:353.

[20] 20. Landau WM, Kleffner FR. Syndrome of acquired aphasia with convulsive disorder in children. Neurology 1957;7:523-530.

[21] 21. Morikawa T, Seino M, Osawa T, Yagi K. Five children with continuous spike-wave discharges during sleep. In Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P, (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985:205-212.

[22] 22. Morikawa T, Seino M, Watanabe Y, Watanabe M, Yagi K. Clinical relevance of continuous spike-waves during slow wave sleep. In Manelis J, Bental E, Loeber JN, Dreifuss FE, (eds). The XVII^th, epilepsy international symposium. New York: Raven Press, 1989:359-363 (Advances in epileptology, 17).

[23] 23. Morrell F, Hoeppner T, Lewine J. Dipole source localization in Landau-Kleffner syndrome: magnetic and electrical potential distributions confirmed at electrocorticography. (Abstract). Electroenceph Clin Neurophysiol 1994,95:20

[24] 24. Paquier PF, Van Dongen HR, Loonen MCB. The Landau-Kleffner syndrome or acquired aphasia with convulsive disorder. Arch Neurol 1992;49:354-359.

[25] 25. Patry G, Lyagoubi S, Tassinari A. Subclinical electrical status epilepticus induced by sleep in children. Arch Neurol 1971;24:242-252.

[26] 26. Rodriguez I, Niedermeyer E. The aphasia-epilepsy syndrome in children: electroencephalographic aspects. Clin Electroencephalogr 1982;13:23-35.

[27] 27. Roulet E, Deonna T, Gaillard F, Peter-Favre C, Despland PA. Acquired aphasia, dementia, and behavior disorder with epilepsy and continuous spike and waves during sleep in a child. Epilepsia 1991;32:495-503.

[28] 28. Shoumaker RD, Benett DR, Bray PF, Curless RG. Clinical and EEG manifestations of an unusual aphasic syndrome in children. Neurology 1974;24:10-16.

[29] 29. Tassinari CA. The problems of 'continuous spikes and waves during slow sleep' or 'electrical status epilepticus during slow sleep' today. In Beaumanoir A, Bureau M, Deonna T, Mira L, Tassinari CA.(eds). Continuous spikes and waves during slow sleep: electrical status epilepticus during slow sleep. London: John Libbey & Co, 1995:251-255.

[30] 30. Tassinari CA, Bureau M, Dravet C, Dalla Bernardina B, Roger J. Epilepsy with continuous spikes and waves during slow sleep. In Roger J, Dravet C, Bureau M, Dreifuss FE, Wolf P, (eds). Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey & Co, 1985:194-204.

[31] 31. Tassinari CA, Bureau M, Dravet C, Roger J, Natalè OD. Electrical status epilepticus during sleep in children (ESES). In Sterman MB, Shouse MN, Passouant P, (eds). Sleep and epilepsy. New York: Academic Press, 1982:465-479.

[32] 32. Tassinari CA, Terzano G, Capocchi G, Dalla Bernardina B, Vigevano F, Daniele O, Valladier C, Dravet C, Roger J. Epileptic seizures during sleep in children. In Penry JK, (ed). Epilepsy, the eighth international symposium. New York: Raven Press, 1977:345-354.

[33] 33. Toso V, Moschini M, Gagnin G, Antoni D. Aphasie acquise de l'enfant avec épilepsie. Rev Neurol (Paris) 1981; 137:425-434.