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Migrating Focal Seizures in Infancy: Analysis of the Electroclinical Patterns in 17 Patients

Neurology Department, Children's Hospital "Prof Dr Juan P. Garrahan", rhcaraballo{at}arnet.com.ar

Elena Fontana, MD

Child Neuropsychiatry Unit, University of Verona, Italy

Francesca Darra, MD

Child Neuropsychiatry Unit, University of Verona, Italy

Laura Cassar, MD

Neurology Department, Children's Hospital "Prof Dr Juan P. Garrahan"

Francesca Negrini, MD

Child Neuropsychiatry Unit, University of Verona, Italy

Elena Fiorini, MD

Child Neuropsychiatry Unit, University of Verona, Italy

Hugo Arroyo, MD

Neurology Department, Children's Hospital "Prof Dr Juan P. Garrahan"

Stella Ferraro, MD

Child Neurology Department, Italian Hospital, Buenos Aires, Argentina

Natalio Fejerman, MD

Neurology Department, Children's Hospital "Prof Dr Juan P. Garrahan"

Bernardo Dalla Bernardina, MD

Child Neuropsychiatry Unit, University of Verona, Italy

We describe the electroclinical features, therapy, and long-term evolution of 17 patients with migrating focal seizures in infancy, and analyzed the charts of these patients seen between February 1985 and July 2005. Three different electroclinical patterns were recognized: (1) 8 cases with alternating simple focal motor seizures at onset. The ictal electroencephalography (EEG) pattern was characterized by recurrence of rhythmic focal spikes or rhythmic sharp activity in the Rolandic region; (2) 5 cases with complex focal seizures and progressive appearance of polymorphic - activity in 1 temporo-occipital region recurring independently; (3) 4 cases with focal complex seizures with motor manifestations. Ictal EEG showed flattening or fast activity in 1 frontotemporal region followed by unilateral fast poly-spikes in alternating clusters in both hemispheres. The focal seizures were refractory to antiepileptic drugs, and all patients except 3 had severe developmental delay. Migrating focal seizures in infancy is a newly defined and rare, but underrecognized, epileptic encephalopathy.

Key Words: bromide • epileptic encephalopathy • focal seizures • multifocal seizures • refractory epilepsy

This version was published on May 1, 2008

Journal of Child Neurology, Vol. 23, No. 5, 497-506 (2008)
DOI: 10.1177/0883073807309771


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