Abstracts

Epileptologists must apply an ontogenetic approach to study the epileptic condition from a fetal neurology perspective, particularly during the last half of pregnancy.
Five case histories from our Pediatric Epilepsy Service are discussed which exemplify maternal, fetal, and placental conditions during the third trimester which contribute to childhood epilepsy.
Patient one is a one-year-old female with severe global delay, spastic quadriplegia, microcephaly and mixed seizure types who presented with neonatal encephalopathy and seizures at birth from an asphyxial [ndash] induced brain injury caused by chronic fetal thrombotic occlusive disease of the placenta. The child was diagnosed with an inherited thrombophilia from MTHFR deficiency.
Patient two is a two-year-old male with right hemiparesis and simple partial seizures who initially presented with neonatal seizures without encephalopathy after an uneventful delivery at term gestational age. Severe placental infarctions were observed despite a normal coagulopathy evaluation.
Patient three is a nine-year-old male with a mixed seizure disorder and learning disabilities who presented as a growth-restricted twin B 36-week gestational age with severe fetal anemia secondary to twin-to-twin transfusion syndrome. He subsequently was diagnosed with hypoplastic left heart syndrome as an infant requiring surgical repair.
Patient four is a five-year-old male with intractable epilepsy of mixed seizure types in the context of pervasive developmental delay who presented at birth with gastroschesis. He required surgical resection of his right frontal lobe with neuropathological documentation of cortical dysplasia.
Patient five is a six-year-old female with intractable epilepsy who presented at age two with focal seizures with secondary generalization. She was born as an asymptomatic 36-week gestation neonate whose mother suffered severe pr[euml]clampsia during the third trimester without documented coagulopathy. Resection of her temporal lobe was required for intractable seizures which documented cortical dysplasia in the context of white matter necrosis.
Historical data, clinical examination findings and laboratory information from obstetrical and neonatal records must be placed along a timeline that considers the perinatal period when brain damage occurred.
[Supported by: NS34508]