PII: S097475591000153-2

Though described in 1978 [2,3] with more than 200 cases described so far, there is lack of awareness of this entity among pediatricians [1,4], due to which patients are put on long term anticonvulsants. We present our experience with this condition over a period of three years.

A retrospective chart review of patients of epilepsy/seizures attending the pediatric neurology clinic with the diagnosis of BPSA was done. The clinic is run by a single qualified pediatric neurologist, and all patients and their investigations were evaluated by him. Diagnosis of BPSA comprised of adolescent patients with partial seizures that occurred in isolation or in a cluster, with or without secondary generalization during the first 24-48 hours after onset, with normal neurologic and mental examination and normal brain imaging.

The age cut off of the first unprovoked seizure was from 11- 18 years. None of the patients received long term treatment with antiepileptic drugs. Patients with known mental or neurologic deficits or neuroradiologically documented lesions were excluded. Patients with a diagnosis of generalized epilepsy, benign childhood epilepsy with centro-temporal spikes or childhood epilepsy with occipital paroxysm (CEOP) were excluded [5,6].

The patient and seizere characteristics, neuroimaging and EEGs (sleep and awake) that were recorded after 7 days of seizure, were also analyzed. The patients had been followed up in the clinic every 3 months in the first year and then biannually as per our clinic protocol. Those who missed follow ups were interviewed telephonically. Those who had recurrence of seizures and were started on AEDs were excluded from the study. Only patients who had a minimum follow up of 12 months were included in the study.

The total number of epilepsy cases seen in the clinic over a period of 3 years was 678 and seven patients (5 boys and 2 girls) of these met the inclusion criteria for BPSA (Table I). None of the patients had a personal or family history of epilepsy or febrile seizures. All of them were intellectually normal and were going to school. Most of the seizures lasted for less than ten minutes and none of them had any postictal deficit. While five of them had seizures when they were awake, two had them in the night. All of the patients had a normal interictal EEG and neuroimaging findings (6 had 1.5 T magnetic resonance imaging and 1 computed tomography). Four of our patients who were referred to us were given loading dose of AEDs and were on maintenance therapy. The remaining three who presented to our hospital were not given any AED but were observed for 48 hours before discharge. All patients including those who were on AEDs were sent home without AEDs and were followed up.

TABLE I



Clinical Features and Follow-up of Patients with Benign Partial Seizures of Adolescence

Ten patients were suspected to have BPSA at presentation, but because of recurrence of seizures during follow up were excluded from the study. All of these had a normal neuroimaging and EEG at presentation. Five of these were diagnosed as frontal lobe seizures, three as BCETS and two patients as CEOP subsequently based on the semiology and repeat EEG findings.

Benign partial seizures of adolescence is a transitory condition occurring predominantly in male subjects, starting in the second decade of life, with a peak of onset between ages 13 and 14 years. It is characterized by simple partial motor and somatosensory seizures with secondary generalization, occurring isolated or in a cluster in the first 24 to 48 hours after onset. The seizures happen predominantly when the patient is awake and have benign course. The interictal EEG (both sleep and awake), neurologic examination, and neuroradio-logic images are normal, and a family history of epilepsy is rare [4]. The prognosis is excellent; in 80% of patients, there is a single, isolated seizure event and, in the remaining 20%, a cluster of 2-5 seizures all occurring within 36-48 hours. For the same reason, no drug treatment is needed and only counseling of the adolescent and parents will suffice.

The results of our series are in consonance with previous reports [4,7,8]. The most important differential diagnosis of BPSA is cryptogenic focal epilepsy, in which normal neurologic examination and normal neuroradiologic imaging are often found. Electroclinical features and evolution in patients with focal cryptogenic epilepsy are different from those found in BPSA. Late-onset benign focal epilepsies of childhood may be considered as a differential diagnosis but the EEG findings and seizure recurrence differentiate these from BPSA [4,5].

In resource poor settings where facilities for neuroimaging and EEG are not readily available, patients can be started on AEDs till the results of these tests are available. If the results are normal, then the AEDs can be carefully withdrawn and patients kept on regular follow-up to look for recurrence of seizures. If seizures recur, then a diagnosis of epilepsy should be considered and patients put on long term AEDs.

Contributors: MK conceived and designed the study and was involved in management of patients. He will act as guarantor of the study. VC and PP collected the data and drafted the paper. The final manuscript was approved by all authors.

Funding: None. Competing interests: None stated.

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