Presentation
Early childhood Diverse seizures May or may not be present Not present Present Tonic spasms May or may not be present Present Not present Response to ACTH [2] Poor Good Poor Interictal EEG Suppression bursts Hypsarrhythmia Diffuse slow spike wave Differentiating [wikidoc.org]
Nonetheless, considerable overlap exists between the two syndromes in terms of clinical presentation, prognosis, and electroencephalographic signature. [ncbi.nlm.nih.gov]
The majority of the patients present within the first month of life. [neupsykey.com]
Neurologic
- Myoclonus
Subsequently, non-epileptic erratic myoclonus, various partial seizures and flexor spasms were observed. [ncbi.nlm.nih.gov]
Historical note and terminology Since 1978, numerous papers have been published that describe an epileptic syndrome with onset either neonatally or in the first months of life and characterized by erratic, fragmentary myoclonus, massive myoclonus, focal [medlink.com]
Since 1978, there have been published reports on 50 patients with the characteristic clinical picture—onset of symptoms during the first month of life consisting of erratic, fragmentary myoclonus, massive myoclonus, partial seizures, suppression-burst [neupsykey.com]
- Ataxia
Early infantile epileptic encephalopathy, ferro-cerebro-cutaneous syndrome 26993267,24259288,24706016 PLCB1 Epilepsy with migrating focal seizures in infancy (EMFSI); epileptic encephalopathy; AR inheritance, deletions reported 22690784,26818157 PNKP Ataxia [tests.labmed.washington.edu]
[…] apraxia; MCSZ – Microcephaly seizures and developmental delay; GEFSP – Generalized epilepsy with febrile seizures plus; CIAT – Cognitive impairment with or without cerebellar ataxia; SFN - Small fiber neuropathy; CIP – Congenital insensitivity to pain [centogene.com]
4 Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen, Deutschland Background/Purpose: Leukoencephalopathy with VWM is a neurodegenerative disorder mostly beginning during the first years of life with abnormalities of muscle tone and ataxia [thieme-connect.com]
AR 34 23 PNPO Pyridoxamine 5'-phosphate oxidase deficiency AR 15 31 POLG POLG-related ataxia neuropathy spectrum disorders, Sensory ataxia, dysarthria, and ophthalmoparesis, Alpers syndrome, Progressive external ophthalmoplegia with mitochondrial DNA [blueprintgenetics.com]
Ataxia developed in 3, and 3 had profound retardation with hypotonia or dyskinetic movements. [ 1 ] COMMENT. [pediatricneurologybriefs.com]
- Cerebellar Ataxia
[…] apraxia; MCSZ – Microcephaly seizures and developmental delay; GEFSP – Generalized epilepsy with febrile seizures plus; CIAT – Cognitive impairment with or without cerebellar ataxia; SFN - Small fiber neuropathy; CIP – Congenital insensitivity to pain [centogene.com]
- Nystagmus
Tonic seizure started clinically with a scream (vertical arrow) and episodic nystagmus (oblique arrows shows EM artefacts). [slideshare.net]
- Tremor
Myopathy- Abnormal Genitalia Syndrome X,XR,G 99.98 NA of NA MUSK Fetal Akinesia Deformation Sequence, Congenital Myasthenic Syndrome AR 95.58 23 of 25 MYBPC1 Distal Arthrogryposis Type 1b, Lethal Congenital Contracture Syndrome, Congenital Myopathy With Tremor [igenomix.es]
Workup
Extensive metabolic workup gave no valuable abnormalities. Her cMRI at 6 weeks showed delayed myelination with no progress 2 months later. [thieme-connect.com]
No definite etiology could be established for either case despite an extensive metabolic workup. CT performed within three months of age in both cases was normal. Other workers have also often been unable to find the etiology for EME. [indianpediatrics.net]
EEG
- Burst Suppression
Their persistence in our patients represents an anatomic condition for cortical disconnection providing a pathophysiologic basis to burst-suppression phenomena. [ncbi.nlm.nih.gov]
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Interictal EEG Burst suppression pattern with long bursts (with high amplitude slow waves mixed with spikes) and short suppressions. [brainscape.com]
- Hypsarrhythmia
Evolve to hypsarrhythmia and then to diffuse slow spike waves Transformation Persists for long period Evolves to West syndrome and then to Lennox-Gastaut syndrome Epidemiology and Demographics Early myoclonic encephalopathy (EME) is a rare disease with [wikidoc.org]
At five months, inter-ictal EEG revealed hypsarrhythmia, but his attacks were still only myoclonuses. ACTH treatment was effective and the myoclonus frequency markedly decreased. [ncbi.nlm.nih.gov]
EEG - suppression–burst activity, which evolves into hypsarrhythmia,accentuated during sleep,persists for prolonged periods. Inborn errors of metabolism mc causes. >50% die within weeks or months. 6. [slideshare.net]
- Multifocal Spikes
The EEG pattern often shows a suppression-burst pattern with high-voltage bursts of slow waves mixed with multifocal spikes alternating with isoelectric suppression phases ({2:Molinari et al., 2005}). [diseaseinfosearch.org]
West Syndrome (WS) aka as infantile spasms with hypsarrhythmia, EEG abnormality with asynchronous very high amplitude, irregular, continuous multifocal spike an slow wave discharges. [ijponline.biomedcentral.com]
Interictal EEGs of the patients with ZS showed infrequent bilateral multifocal spikes, predominantly in the frontal and pre-frontal motor cortex Patients with NALD had tonic seizures or epileptic spasms drug resistant. [graphyonline.com]
Besides, SB pattern may never be observed in a subgroup of EME cases resulting from NKHG. [4] However, EEG in them shows multiple paroxysmal abnormalities (generalized irregular spike-waves, polyspike-waves and independent focal or multifocal spikes) [neurologyindia.com]
- Spike-and-Slow-Waves
West Syndrome (WS) aka as infantile spasms with hypsarrhythmia, EEG abnormality with asynchronous very high amplitude, irregular, continuous multifocal spike an slow wave discharges. [ijponline.biomedcentral.com]
[…] paroxysms of polyspikes or spikes-slow waves. Ictal EEG Varies according to seizure type. 16. [slideshare.net]
Early infantile epileptic encephalopathy with suppression burst (Ohtahara syndrome) - Interictal EEG Burst suppression pattern with long bursts (with high amplitude slow waves mixed with spikes) and short suppressions. [brainscape.com]
- Burst Suppression (EEG)
Mutations in STXBP1 occur in patients with Ohtahara and West syndromes and are also present in 10% of patients with undefined early-onset epileptic encephalopathies without the burst-suppression EEG, typical of Ohtahara syndrome. [pediatricneurologybriefs.com]
This is an example of a burst suppression EEG. Each of the letters correspond to a burst of high voltage across the brain and a myoclonic jerk. [seizuresinfant.com]
Treatment
The seizures were initially thought to be infantile spasms, and vigabatrin (50 mg /kg/day) was started for the treatment of seizures. Rapidly progressive deterioration was noticed after a few days. [ncbi.nlm.nih.gov]
In majority of the cases, the cause of LGS is known; however, for about 20-30% of the patients, the exact cause cannot be identified The treatment of Lennox-Gastaut Syndrome needs a team of healthcare professionals. [dovemed.com]
Brand-new chapters in the drug and diet section cover perampanel, ezogabine, and lacosamide, while the existing chapters on major medical treatments have been comprehensively updated to reflect the latest trials and studies. [books.google.de]
The seizures are resistant to treatment. The neurology is very abnormal and patients often do not live beyond one year. [en.wikipedia.org]
CLOSE Medical Disclaimer The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. [diseaseinfosearch.org]
Prognosis
prognosis, and additional useful information HERE. [dovemed.com]
Nonetheless, considerable overlap exists between the two syndromes in terms of clinical presentation, prognosis, and electroencephalographic signature. [ncbi.nlm.nih.gov]
Complications Severe neurological impairment Mental retardation Vegetative state Prognosis The prognosis for early myoclonic encephalopathy is poor. Children survive in a persistent vegetative state or die within the first or second year of life. [wikidoc.org]
Prognosis severe. Copyright © Fois; licensee BioMed Central Ltd. 2014 [ijponline.biomedcentral.com]
Etiology
They are typically distinguished from each other according to specific clinical and etiologic criteria. [ncbi.nlm.nih.gov]
Causes: There is overlap in the etiologies that cause Ohtahara syndrome and early myoclonic encephalopathy. [epilepsydiagnosis.org]
In this updated article, the authors review the clinical and neurophysiological data, management, and etiologic factors. [medlink.com]
A gender difference, with female-to-male ratio of 1:1.3, is seen in the 30 cases published in the English literature. 10 Etiology In most cases, the etiology of EME is unknown. [neupsykey.com]
Epidemiology
[…] adult-onset Parkinsonism Synonym(s): - Early myoclonic encephalopathy with suppression-bursts Classification (Orphanet): - Inborn errors of metabolism - Rare genetic disease - Rare neurologic disease Classification (ICD10): - Diseases of the nervous system - Epidemiological [csbg.cnb.csic.es]
An epidemiologic study of childhood epilepsy in Japan detected 4 cases of EME (0.168%) among 2,378 children with epilepsy >10 years of age. 6, 28 In a study of 75 infants with epilepsy of neonatal onset, Watanabe et al. 42 observed 2 cases (2.7%) of EME [neupsykey.com]
From basic mechanisms and epidemiology, through diagnosis and therapy, to quality of life issues, the new edition of this established reference covers every aspect of childhood epilepsy and will continue to be the definitive core text for all professionals [books.google.de]
Summary Epidemiology The prevalence is unknown but Early myoclonic encephalopathy is a rare disease with only around 30 cases described so far. [orpha.net]
[…] states Course SB's persist to childhood with transient transformation to hypsarrhythmia Evolve to hypsarrhythmia and then to diffuse slow spike waves Transformation Persists for long period Evolves to West syndrome and then to Lennox-Gastaut syndrome Epidemiology [wikidoc.org]
Pathophysiology
Moreover, recent molecular genetics studies implicate ErbB4 in the pathophysiology of schizophrenia. However, the phenotypic consequences of haploinsufficiency of ErbB4 are not known, as no coding mutations have been identified until now. [ncbi.nlm.nih.gov]
Prevention
Prospective treatment with oral sodium benzoate, the N-methyl-d-aspartate receptor antagonist ketamine, and dextromethorphan can favorably modify the early neonatal course of severe nonketotic hyperglycinemia, but does not prevent poor long-term outcomes [ncbi.nlm.nih.gov]
GABAA receptors bearing the mutant ß2 subunit were poorly trafficked to the cell membrane and prevented β2 subunits from trafficking to the cell surface. [arizona.pure.elsevier.com]
The prognosis of Lennox-Gastaut Syndrome is generally guarded Please find comprehensive information on Lennox-Gastaut Syndrome regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, [dovemed.com]
This mutation effects the β2 subunit on the GABA A receptor, preventing the brain from its necessary inhibition. In other words the brain becomes hyper-excitable, which result in seizures. [seizuresinfant.com]