Elsevier

Brain and Development

Volume 29, Issue 1, January 2007, Pages 43-46
Brain and Development

Ictal EEG in patients with convulsions with mild gastroenteritis

https://doi.org/10.1016/j.braindev.2006.06.002Get rights and content

Abstract

The aim of this study is to reveal detailed clinical manifestations and an evolution of ictal EEG discharges of convulsions with mild gastroenteritis (CwG). We recorded ictal EEGs of six patients with CwG. Clinical manifestations included loss of responsiveness, motion arrest, cyanosis, lateral eye deviation, and hemifacial convulsion. Automatism was not observed in any patients. A generalized tonic–clonic convulsion was observed in five of six patients. Ictal EEGs demonstrated that all seizures were of focal onset that evolved into a secondarily generalized seizure. The region of the onset of ictal discharge was the occipital area in three patients, parietal in one, central in one, and frontal in one, respectively. The seizure of patients with CwG is likely to be a partial seizure with secondary generalization.

Introduction

In 1982, Morooka first reported benign convulsions with mild gastroenteritis [1]. Since then, clinical features of convulsions with mild gastroenteritis (CwG) have been described in several reports [2], [3], [4]. At present, CwG is popular and well recognized among pediatricians in Japan.

CwG is characterized by: (a) afebrile generalized seizures associated with symptoms of gastroenteritis in previously healthy infants or young children aged between six months and three years; (b) seizures frequently occurring in clusters; (c) normal laboratory examination results including serum electrolytes, glucose, and cerebrospinal fluid; (d) normal interictal electroencephalogram (EEG); and (e) excellent seizure and developmental outcome [1], [2], [3], [4].

The seizures of patients with CwG have been often described as symmetrical generalized convulsions. However, some of the seizures had some focal features such as lateral eye deviation and hemiconvulsion [2] or resembled complex partial ones such as loss of responsiveness without convulsive movements [4]. Reports of ictal EEGs were rare, but they demonstrated that the seizures of patients with CwG were secondarily generalized ones [5], [6], [7], [8].

In the present study, we recorded ictal EEGs of six patients in order to clarify detailed clinical manifestations and an evolution of EEG discharges in patients with CwG.

Section snippets

Patients and methods

The subjects of this study were six patients with CwG whose ictal EEG was recorded in the Departments of Pediatrics in Anjo Kosei Hospital, Japan Red Cross Nagoya First Hospital, and Kamo Hospital between November 1996 and March 2005.

The definition of CwG was the same as that in the previous studies [4], [9]. CwG was diagnosed when a patient met both of the following: (a) seizures accompanied gastroenteritis without clinical signs of dehydration or electrolyte imbalance; and (b) a body

Result

The profiles of patients were shown in Table 1. There were two boys and four girls. The age of onset ranged from 14 months to 38 months (mean, 27.7 ± 8.0 months). A past history of CwG was noted in two patients (patients 4 and 5), but that of febrile convulsion was not present. A familial case of CwG (patient 1) was a pair of identical twins. Their clinical details were documented elsewhere [6]. A family history for CwG was positive in patients 1 and 5. The mother and aunt of patient 1 had

Discussion

Previous reports documented that most seizures in patients with CwG were symmetrical generalized convulsions [3]. However, some of the seizures were described to have focal features. Uemura et al. [4] analyzed 114 episodes in 105 patients, and reported that 11 patients (13%) had complex partial seizures with loss of responsiveness, eye deviation, cyanosis, and subtle convulsive movements. They did not mention the presence or absence of secondary generalization. Komori et al. [2] analyzed 19

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