Abstracts

The entity of benign partial epilepsy of infancy (BPEI) was first described by Watanabe in 1987. Similar case series have been reported in the European literature. We believe this is the first report describing this entity in North America. Retrospective review of charts from our institution from 2002 to 2004 revealed 12 patients who satisfied the criteria for diagnosis of BPEI: onset of symptoms before 2 years of age, seizures of partial origin, with or without secondary generalization, and subsequent complete seizure freedom off anti-epileptic drugs (AEDs). There were 7girls and 5 boys; age of seizure onset ranged from day 2 of life to 20 months. Seizures were partial in all; 5 had apnea/cyanosis; the remaining had behavioral arrest (hypomotor) with/without tonic/clonic activity and eye deviation. Interictal EEGs were abnormal in 1/12 (focal spikes); ictal EEGs captured left and right independent electrographic seizures in 6 and from the midline in one. All had normal MRIs. Seizures were easily controlled on AEDs in 9; one child was not started on a AED, and 2 patients required multiple AEDs to control seizures. Seven of 12 have been weaned off AEDs; the remaining are in the process of being weaned off. Developmental outcome was normal in 8/12; the other 4 are improving as they are coming off the AEDs. Two of these 4 had shown a plateau in their development during increased seizure frequency and on multiple AEDs. None had a family history of seizures. We believe that the entity of BPEI exists and needs to be considered in the differential diagnosis of infants and young children with partial onset seizures in the first two years of life, especially with normal interictal EEGs and MRIs. Contrary to the belief that seizure onset in infancy usual predicts bad outcome, there may be a subset of children who have a good outcome.