Caracteristicas clinicas, eletrograficas e de imagem no diagnostico diferencial entre epilepsias parcial e generalizada idiopatica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2002

RESUMO

Idiopathic generalized epilepsy (IGE) is often not recognized, they resulting in serious consequences for the sufferers. We examined factors contributing to the errors in the diagnosis of IGE in 41 adults attending our epilepsy clinic who had previous diagnosis of partial epilepsy but semiology or EEG findings suggesting a possible differential diagnosis. After careful re-evaluation, the diagnosis of IGE was established in 25(61%) patients: 22 (88%) being diagnosed as juvenile myoclonic epilepsy (JME), one juvenile absence, one perioral myoclonia with absences, one eyelid myoclonia with typical absences. Myoclonic jerks, the hallmark of the JME and other IGE, were not usually reported by patients and misdiagnosed as focal motor seizures. Brief and infrequent absence seizures and focal EEG abnormalities were other factors contributing to not being able to recognize JME. All 25 patients did not achieve seizure control before re-evaluation of diagnosis. After appropriate diagnosis of IGE and change of AED to valproate or valproic acid, 19 (76%) became seizure free and six (24%) had a significant improvement on seizure control. Association with lamotrigine provided further improvement in three of these patients. In 16 patients, semiologic and EEG findings were not sufficient for a definitive syndromic diagnosis. The diagnosis of partial epilepsy was confirmed by imaging studies using thin slices and multiplanar reconstruction and ictal EEG recordings in 7 patients. Only five patients (31,3%) have had satisfactory seizure control on medication. We conclude that in certain patients only a complete investigation with video-EEG and MRI can allow us to reach the correct diagnosis. An appropriate questioning to identify myoclonic and absence seizures and a proper interpretation in the context of whole clinical constellation are essential for a correct seizure classification and diagnosis of IGE in adults

ASSUNTO(S)

ressonancia terapeutica epilepsia eletrofisiologia

ACESSO AO ARTIGO

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