The frequency of epilepsy in children with cerebral palsy is 40 times higher than the common population rate. The presence of epilepsy aggravates the clinical course of cerebral palsy, complicates the rehabilitation, affects the prognosis of motor and intellectual functions, and could be life-threatening. Another problem is the possibility of aggravation of epileptic seizures and their appearance de novo due to application of some neurorehabilitation methods (electrophoresis, acupuncture, nootropic drugs, brain stimulators, etc.). Children with cerebral palsy have a broad spectrum of epilepsies—varying from favorable combinations with benign idiopathic forms to extremely severe epileptic encephalopathies. Frequent combination of epileptic and non-epileptic paroxysms causes difficulty in their interpretation and differential diagnosis. Video-EEG monitoring is the “golden standard” for differential diagnostic of epileptic and non-epileptic events, and it is very useful for investigation of patients with cerebral palsy. Treatment of epilepsy in combination with cerebral palsy strictly requires an individual approach due to the form of epilepsy, seizure types, age of the patient, comorbidity, and somatic and mental condition of the patient.
Part of the book: Cerebral Palsy
Malignant migrating partial seizures of infancy (MMPSI) is a rare and usually an unrecognized epileptic syndrome of infancy. The first publication was presented by Coppola and colleagues in 1995, and Dulac in 2005 summarized 24 patients’ follow-up in the Saint Vincent de Paul Hospital in Paris. Clinical cases have demonstrated a new epileptic syndrome, different from previously described forms of epileptic encephalopathies of infancy for the whole world of epileptology. Seizure onset before the age of 6 months but commonly start within a few weeks of birth. In the age of 1 to 10 months seizures become very frequent, polymorphic and usually get clustered nature; mental and motor retardation is clear observed. Clinical manifestation of seizures may include head and eyes version, lateralized clonic eyelid twitchings, fixed gaze, tonic tension or clonias of one limb or hemispasms, axial tonic spasms, chewing or sucking movements, episodes of apnea, flushing, hypersalivation, and secondary generalized seizures. MMPSI could be also considered as a special type of infantile status epilepticus. Video-EEG monitoring plays the most important role in the MMPSI diagnosis. Ictal EEG patterns involve different areas of the cerebral cortex of both hemispheres; initial zone of ictal patterns shifts from one region to another. MMPSI is a drug-resistant epilepsy with serious prognosis.
Part of the book: Epilepsy