Tabla I. Casos con diagnóstico de epilepsia infantil benigna a los seis meses de evolución. |
|||||||
n |
Crisis |
Cluster |
Tratadas |
Edad de inicio (meses) |
|||
Mediana |
Rango |
||||||
Con historia familiar a |
Crisis generalizadas |
3 |
0 (0%) |
3 (100%) |
2 (67%) |
6 |
5-7 |
Crisis focales ± generalizadas |
10 |
1 (10%) |
8 (80%) |
9 (90%) |
5 |
4-12 |
|
Subtotal |
13 |
1 (8%) |
11 (85%) |
11 (85%) |
5 |
4-12 |
|
Sin historia familiar a |
Crisis generalizadas |
22 |
7 (32%) |
6 (27%) |
10 (45%) |
13 |
0-22 |
Crisis focales ± generalizadas |
42 |
11 (26%) |
26 (62%) |
27 (64%) |
8,5 |
0-22 |
|
Subtotal |
64 |
18 (28%) |
32 (50%) |
37 (58%) |
9 |
0-22 |
|
Total |
77 |
12 (16%) |
43 (56%) |
48 (62%) |
7 |
0-22 |
|
a Historia familiar de crisis epilépticas antes de los 24 meses de edad. |
Tabla II. Semiología de las crisis en los pacientes menores de 24 meses en el inicio de la epilepsia con una o más crisis focales, clasificados en cuatro grupos: con crisis autonómicas no estructurales, con epilepsia infantil benigna (EIB) familiar, con EIB no familiar y resto de los pacientes con crisis focales. Cada característica se consideró como presente cuando ocurrió al menos en una crisis durante los primeros seis meses de evolución. Se incluye a los pacientes con crisis aisladas. |
||||||||
Crisis autonómicas |
EIB |
EIB no |
Otras |
|||||
n |
% |
n |
% |
n |
% |
n |
% |
|
Crisis aisladas |
2 |
20 |
1 |
10 |
11 |
26 |
2 |
4 |
Etiología estructural |
0 |
0 |
0 |
0 |
0 |
0 |
38 |
81 |
Sexo (varón) |
2 |
10 |
4 |
40 |
21 |
50 |
28 |
60 |
Convulsiones febriles previas |
1 |
19 |
0 |
0 |
2 |
5 |
5 |
11 |
Crisis en familiares de primer grado |
1 |
10 |
10 |
100 |
1 |
2 |
2 |
4 |
Convulsiones neonatales |
0 |
0 |
0 |
0 |
4 |
10 |
4 |
9 |
Crisis de más de 5 minutos de duración |
6 |
60 a |
0 |
0 |
8 |
19 |
10 |
21 |
Cluster de crisis |
0 |
0 b |
8 |
80 |
26 |
62 |
33 |
70 |
Afectación de conciencia |
10 |
100 |
10 |
100 |
40 |
95 |
43 |
92 |
Versión cefálica u ocular |
8 |
80 |
4 |
40 |
20 |
48 |
27 |
57 |
Emesis (náuseas, arcadas o vómitos) |
10 |
100 b |
0 |
0 |
0 |
0 |
2 |
4 |
Cianosis o palidez |
4 |
40 |
2 |
20 |
2 |
5 |
8 |
17 |
Disminución del tono de los miembros |
1 |
10 |
2 |
20 |
9 |
21 a |
2 |
4 |
Aumento del tono de los miembros |
4 |
40 |
2 |
20 |
9 |
21 |
4 |
9 |
Contracciones clónicas focales |
2 |
20 |
1 |
10 |
9 |
21 |
18 |
38 |
Mirada fija |
3 |
30 |
6 |
60 |
16 |
38 |
14 |
30 |
Automatismos |
2 |
20 |
0 |
0 |
4 |
10 |
9 |
19 |
Más de la mitad de crisis durante el sueño |
3 |
30 |
1 |
10 |
5 |
12 |
4 |
9 |
a p < 0,05; b p < 0,001 (en comparación con el grupo ‘otras crisis focales’). |
Tabla III. Probabilidad de alcanzar una remisión inicial de tres años sin tratamiento en los pacientes con un diagnóstico de epilepsia infantil benigna a los seis meses de evolución y dos o más crisis epilépticas. Los casos perdidos se excluyen del cálculo. |
||||
n |
Perdidos |
Remisión |
||
Con historia familiar a |
Crisis generalizadas |
3 |
0 |
3/3: 100% (29-100%) |
Crisis focales ± generalizadas |
9 |
0 |
9/9: 100% (66-100%) |
|
Subtotal |
12 |
0 |
12/12: 100% (73-100%) |
|
Sin historia familiar a |
Crisis generalizadas |
15 |
2 |
13/13: 100% (75-100%) |
Crisis focales ± generalizadas |
31 |
0 |
23/31: 74% (57-91%) |
|
Subtotal |
46 |
2 |
36/44: 82% (69-94%) |
|
Total |
58 |
2 |
48/56: 86% (76-96%) |
|
a Historia familiar de crisis epilépticas antes de los 24 meses de edad. |
Frequency, semiology and prognosis of benign infantile epilepsy Introduction. Benign infantile epilepsy is an epileptic syndrome of infancy. Until now, only a small number of case-series have been published. Aim. To study the frequency, semiology and prognosis of benign infantile epilepsy. Patients and methods. The 827 patients with one or more epileptic seizures seen at our hospital between 1 June 1994 and 1 March 2011 were included and prospectively followed. A diagnosis of benign infantile epilepsy was made in patients that fulfilled the following criteria at six month of evolution: one or more focal and/or generalised seizures, onset before 24 months, no neurological deficit and normal neuroimaging and interictal EEG. Results. 77 cases (9%) met the diagnostic criteria. Semiology of the seizures was similar to that of other focal seizures in children under 24 months. 25% of the patients remained as isolated seizures. Among those with two or more seizures, the probability of achieving a 3 year initial remission without antiepileptic treatment was 86%. In the subgroup of patients with focal seizures without family history the probability was 74% and in five cases a global developmental delay/intellectual disability was detected thereafter. Conclusions. Benign infantile epilepsy is a frequent epileptic syndrome. Semiology of seizures is not useful to characterize the syndrome. A diagnosis of benign infantile epilepsy at six month of evolution implies a reasonably good prognosis, but possibly not as good as for other self-limited epilepsies of infancy. Key words. Child. Diagnosis. Epidemiology. Epilepsy. Infancy. Prognosis. |