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Background – Ketogenic diet (KD) is an effective treatment for pharmacoresistant epilepsy: more than half of the patients show a greater than 50% reduction in seizures. Objective – To identify clinical or electroencephalogram (EEG) variables predicting the response to KD. Methods – Clinical and EEG data were retrospectively analysed from 50 consecutive patients treated by KD for severe, pharmacoresistant epilepsy. Most of the patients (70%) had retarded mental and motor development. Results – Three months after the start of the KD two-thirds (33) of the patients were responders (had a more than 50% reduction in seizure frequency). The presence of epileptiform EEG discharges in the temporal region correlated with an unfavourable response (P = 0.03). The presence of bilateral synchronous epileptiform discharges, and the presence of complex partial seizures approached significance but all other variables did not. Conclusions – Our results further support that KD is efficient in a wide variety of epileptic patients with a broad range of EEG features. However, patients with epileptiform discharges in the temporal region are less likely to achieve therapeutic response.

The frequency distribution of different types of epilepsy (according to the classification model of the International League against Epilepsy) concerning 402 children is reported. The investigation showed a moderate preponderance of partial as against generalized epilepsies. Elemental and complex symptomatology were about equally frequent. As regards generalized epilepsies, the petit mal group was considerably smaller than most often reported previously; conversely, myoclonic-astatic epilepsy (Lennox-Gastaut's syndrome) was more frequently encountered. The definitory criteria and the concept of the Lennox-Gastaut Syndrome are discussed. 91.8 % of the whole pediatric population (age less than 15 years at time of investigation) could be categorized according to the classification model. This, in agreement with earlier investigations on this subject, shows the contemporary international classification model to be useful and relevant.

The relative frequency of different types of epilepsy in accordance with the International Classification of Epilepsies is reported, concerning 1,508 consecutive outpatients with epilepsy, who at the time of investigation were at age 15 years and above. The investigation showed a marked preponderance for partial epilepsies as against generalized epilepsies; partial epilepsies with complex symptomatology were especially frequent, contributing by more than one third of all cases.

Objectives – To study the risk of teratogenicity in infants of women with epilepsy. Material and methods – Prospective data from 1996 to 2000 comprised 147 pregnancies. The most frequent antiepileptic drugs (AEDs) used were lamotrigine (LTG) 35% (n = 51), oxcarbazepine (OXC) 25% (n = 37) and valproate (VPA) 20% (n = 30). Seventy-four per cent (n = 109) received monotherapy. Folic acid supplementation was taken during first trimester by 118 patients (80%). Results – The overall risk of malformations among newborns in the AED-exposed group was 3.1% (n = 4). Two children were born with multiple malformations (VPA monotherapy), two children had ventricular septal defects (one OXC monotherapy, and one OXC and LTG). The risk of malformations was 2.0% in women treated with LTG and 6.7% in women treated with VPA (NS). Conclusion – Despite the small number of cases in the study these data indicate that treatment with LTG during pregnancy might be relatively safe. Larger prospective studies are needed to obtain adequate power for statistical analysis.

— 12 patients with absence epilepsy were treated with alternatively 1 or 3 daily doses of sodium valproate (VPA) in a double-blind cross-over design. Seizure frequency, EEG paroxysmal activity, clinical side-effects and laboratory findings were assessed for both treatment periods. There was no statistically significant difference between the 2 dosage schedules, and the simplicity of monodose treatment is an important factor in good patient compliance. The apparent discrepancy between plasma half-life and biological action of VPA is discussed.

– A 47-year-old man with a typical obstructive sleep apnea syndrome (OSAS) secondary to a large oral cyst is reported. Although the patient also had a nasal septum deviation with narrowed air passage, removal of the cyst resulted in complete and lasting relief from clinical symptoms despite persisting sleep apnea and unchanged arousal reaction in the EEG. The concurrent mechanisms of OSAS in the present case are discussed, and the importance of searching for a curable underlying disorder in clinical overt OSAS is emphasized.