| Purpose and Background:Generalized epilepsy is an epilepsy syndrome of generalized seizure as it’sclinical features,based on it’s etiology into idiopathic generalized epilepsy andsymptomatic generalized epilepsy; idiopathic generalized epilepsy is a group ofgenetic factors relevant and generalized seizure as seizure type’s epilepsysyndrome, accounting for15%~40%of all epilepsies, The International LeagueAgainst Epilepsy (ILAE) classified IGE as childhood absence epilepsy, juvenileabsence epilepsy, juvenile myoclonic epilepsy and IGE merge tonic-clonicseizures (GTCA); clinical features of absence, myoclonic and tonic-clonicseizures; This article reviews generalized epilepsy’s the cause and pathogenesisand clinical features and EEG changes among68patients, providing areference for the diagnosis and treatment of generalized epilepsy.Materials and Methods:This retrospective study, dating from the First Hospital of Jilin UniversityNeurology clinic and hospitalization patients with generalized epilepsy in July2007to July2011and pediatric clinic patients with generalized epilepsy inJune2011to December2011.They are in line with generalized epilepsy andvarious types of diagnostic criteria, in all68cases, and excluding partialseizures, partial seizures secondary generalized epilepsy seizures, pseudo~absences, transient ischemic attack cases. Of all the patients’ medical history,clinical manifestations, signs, electroencephalogram (ordinary video, dynamicEEG and long-range video EEG) and imaging data (head MRI or CT), pasthistory (birth history, family history of febrile seizures, history of head trauma,infection, tumors, cerebrovascular disease, congenital diseases, etc.) and type ofattack are to summarize, analyzing the cause and pathogenesis, clinical featuresand EEG characteristics about generalized epilepsy. Results:68patients in this group:(1) Gender:33males and35females; it’s ratiowas1:1.06;(2) Seizure types:65cases (95.59%) with idiopathic generalizedepilepsy, including idiopathic generalized tonic-clonic seizures in27cases(39.71%), childhood absence epilepsy in25cases (36.76%), adolescentsabsence epilepsy in6cases (8.82%), adult absence epilepsy in1cases (1.47%)and youth myoclonic epilepsy in6cases (8.82%); symptomatic generalizedtonic~clonic seizures in3cases (4.41%).(3) Age of onset: The idiopathicgeneralized tonic-clonic seizures’ onset age is7~35years old, the average ageis18.19years; the onset age of six cases among them is more than20years,another21cases is less than20years.The childhood absence epilepsy’s onsetage is2~10years old, the average age is7.12years. The juvenile absenceepilepsy’s onset age is10~16years, the average age is12.50years. The adultabsence epilepsy has only one patient, his onset age is7years old. The juvenilemyoclonic epilepsy,12~17years, the average age is15.33years.(4) Pastmedical history: one case of a family history among65cases of idiopathicgeneralized epilepsy patients, for patient’s mother suffering from epilepsy.Febrile seizures formerly in5cases, and no clear history in59cases; thesymptomatic generalized epilepsy in three cases: malnutrition of braindevelopment in one case, each case of cord around the neck history whenborning and birth dystocia history.(5) Attack duration and frequency of attacksin various clinical types:①The generalized tonic~clonic seizures in30cases:the highest frequency is1time every day in3cases(10%), the minimumfrequency is1time every2~3years in2cases(6.67%), the most frequency is1~2times every month in7cases(23.33%).The most attack durationis less thatfive minutes in27cases,accounting for90%.②25cases of childhood absenceepilepsy:Their clinical manifestation are all typical absence seizures, the mostseizure frequency is5~10times every day in11cases(44%), lasting for5~10 seconds in15cases is more common (60%).③The youth absence epilepsy insix cases：the clinical manifestation are all typical absence seizures, the mostseizure frequency is5~10times every day in4cases(66.67%), lasting for10~20seconds in4cases is more common(66.67%).④The adult absenceepilepsy in one case: his clinical manifestation is absence seizures associatedwith tonic~clonic seizures; absence seizure frequency is less than5times everyday, attack duration is less than5seconds, tonic-clonic seizures’ seizurefrequency is2~3times every month, seizures last for10minutes.⑤Thejuvenile myoclonic epilepsy in6cases: simple myoclonic seizure in one case,myoclonus associated with tonic~clonic seizures in five cases; the mostfrequency is1~2times every month in3cases (50%), both1~2times everymonth and one time every2~3months of the tonic-clonic seizure frequency areall common(each accounts for40%).(6) Auxiliary examination: this group ofpatients all check the head CT or MRI, idiopathic generalized epilepsy showedno abnormalities, symptomatic epilepsy have abnormal head CT or MRI results:one cases of abnormal brain development, another2cases have not seen theabnormalities.65patients check the ordinary video EEG,3cases check the24hours of long-range video EEG.①The idiopathic generalized tonic-clonicseizures in27cases,26cases check the ordinary video EEG: no attack, afterhyperventilation EEG show paroxysmal bilateral synchronous symmetricalsharp~slow~wave, spike-wave, multi-spike-slow-wave, lasting for1~4.5seconds. One case checks the24hours of long~range video EEG: All leadsshow spike-slow-wave, sharp-slow-wave burst in the awake and sleep period,lasting for2~3seconds.②The symptomatic generalized epilepsy in3cases:one case of brain development malnutrition, each case of umbilical cord aroundthe neck and dystocia when giving birth, all leads show high wave amplitudespike-slow-wave,sharp-wave, spike-slow-wave discharges, lasting for2~4seconds.③25cases of childhood absence epilepsy are ordinary video EEG to check: showing clinical seizures by hyperventilation test, during the attackperiod EEG all leads show the synchronization3.0HZ spike-slow-wave, lastingfor4~10seconds. The EEG of attack interval is normal.④The adolescentsabsence epilepsy in six cases, all checking for ordinary video EEG: showingclinical seizures by hyperventilation, after hyperventilation all leads show thesynchronization3.0HZ spike-slow-wave,lasting for5~15seconds.⑤The adultabsence epilepsy in one case, we haven’t monitored the clinical seizures, EEGshow3.0HZ spike-slow-wave discharges after hyperventilation test, lasting for8seconds.⑥The juvenile myoclonic epilepsy in6cases, ordinary video EEGin4cases,24hours long-range video EEG in two cases, simple myoclonicseizures in one case and EEG all leads show multi-spike-slow-wave burst,lasting for10seconds, myoclonus merge tonic-clonic seizures in five cases, allleads show high amplitude spike-slow-wave, lasting for1~2seconds.Conclusion:All the onset age of patients with generalized epilepsy are less than40years old, The idiopathic generalized tonic-clonic seizures and childhoodabsence epilepsy are more common, The cause of idiopathic generalizedepilepsy: genetics studies found that idiopathic generalized epilepsy is a set ofchannel disease, imaging studies found neurons damaged and gliosis in thehypothalamus. In this group we find that one case is a knid of familial juvenilemyoclonic epilepsy (1.54%), previous history of febrile seizure in5cases (7.69%). Symptomatic generalized epilepsy related to brain development dystrophyand cord around neck when giving birth in the etiology. Generalized epilepsy’svarious clinical types have its own unique clinical and EEG features. Accordingto the2001International League Against Epilepsy Medication Guide,generalized epilepy’s medication principle is monotherapy as far as possible,preferred sodium valproate. |
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