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Cerebral Palsy, Cerebellar Ataxia, AIDS, Phacomatosis, Neuromuscular Disorders, and Epilepsy
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Autonomic symptoms are prominent in Panayiotopoulos syndrome (PS).90 UI occurs in 10%. It is benign with good prognosis. Half of patients have a single attack, and in the majority of the remainder, spontaneous remission occurs within a few years.
Cerebral
Published in A. Sahib El-Radhi, Paediatric Symptom and Sign Sorter, 2019
Beware of several sleep-related epileptic seizures: benign partial epilepsy with centrotemporal spikes (rolanic), benign epilepsy with affective symptoms, benign occipital epilepsy and Panayiotopoulos syndrome. Autonomic symptoms and secondary generalisation may occur in these sleep-related epilepsies.
Cerebral palsy, cerebellar ataxia, AIDS, phacomatosis, neuromuscular disorders, and epilepsy
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Christopher Kobylecki, Ling K. Lee, Mark W. Kellett
Autonomic symptoms are particularly prominent in the so-called Panayiotopoulos syndrome.166 Cardinal features of this condition include infrequent partial seizures that consist of a combination of autonomic and behavioral disturbances, vomiting, deviation of the eyes, often with impairment of consciousness, which can frequently progress to convulsions. Autonomic disturbances of pallor and sweating, alone or together with behavioral disturbances (mainly irritability), may predominate, particularly in the early stages of the ictus.167–170 Incontinence of urine occurs in 10% of cases, usually when consciousness is impaired even without convulsions; less commonly, fecal incontinence can occur with other autonomic or behavioral features even in nocturnal seizures. Seizures are typically long, often lasting for 5 or more minutes and, in 40% for hours, consistent with partial status epilepticus. The condition is considered benign with an excellent prognosis. About half of all patients only have a single attack, and in the majority of the remainder spontaneous remission occurs within a few years. For this reason, antiepileptic drug treatment is rarely used.
Withdrawal of antiseizure medications – for whom, when, and how?
Published in Expert Review of Neurotherapeutics, 2023
Francesco Brigo, Serena Broggi, Simona Lattanzi
A safe and effective withdrawal of ASMs can be considered and carried out in patients in whom epilepsy has “resolved’. Resolution of epilepsy, a term indicating that epilepsy is no longer present, occurs in individuals who have remained seizure-free for the last 10 years, without taking ASMs for at least the last 5 years. This clinical scenario obviously raises no questions related to the choice of withdrawing ASMs, since patients are already off medications. However, epilepsy is considered to be resolved also for patients with age‐dependent epilepsy syndrome who are past the applicable age [15]. Children can outgrow their epilepsy, as with childhood absence epilepsy. Interestingly to note, the age‐dependent prognosis of some of these epileptic syndromes has been emphasized in the most recent classification and definition proposed by the International League Against Epilepsy (ILAE). Accordingly, what was formerly known as benign Rolandic epilepsy or benign epilepsy with centrotemporal spikes is now termed self-limited epilepsy with centrotemporal spikes, whereas the Panayiotopoulos syndrome should now be defined as self-limited epilepsy with autonomic seizures [16]. Far from being mere formal changes devoid of any clinical meaning, this new terminology could effectively remind the treating physicians about the self-limited nature and the benign prognosis of these conditions, which can eventually achieve ‘resolution.’ In these conditions, ASMs can be withdrawn safely, with no or very low risk of seizure recurrence. Since prognosis strictly depends on the diagnosis, before considering a withdrawal of ASMs it is essential to make an accurate electro-clinical diagnosis to ensure that patients truly have an age‐dependent epileptic syndrome. However, the expected age of resolution varies not only from syndrome to syndrome but also from patient to patient. For instance, it is possible that some children achieve seizure freedom with ASMs far before the upper age limit of the syndrome is reached. Hence, it is extremely challenging to know a priori (i.e. before attempting an ASM withdrawal) if epilepsy has actually ‘resolved’ in an individual patient. Although valid in general, the theoretically appealing concept of ‘resolved’ epilepsy can be applied with some difficulties in single patients and should be regarded as a general prognostic guidance rather than a practical instrument to perform individualized prediction of seizure recurrence.