Pure Petit Mal (Absence) Clinical and Electroencephalographic - Studies- Tohru SEKI, M. D., Itoko MORI, M. D., Setuko SUGIURA, M. D., Nobuko INADA, M.
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1 Pure Petit Mal (Absence) Clinical and Electroencephalographic - Studies- Tohru SEKI, M. D., Itoko MORI, M. D., Setuko SUGIURA, M. D., Nobuko INADA, M. D., Mototugu KYO, M. D., Yo shihumi YAMAMOTO, M. D. and Yukio FUKUYAMA, M. D. (Department of Pediatrics, Tokyo Women's Medical College, Tokyo (Director: Prof. Y. FUKUYAMA)) This report was based on 37 cases with pure petit mal (absence), which were observed at the Departments of Pediatrics of Tokyo Women's Medical College, Keio University, and at the Section of Neurology, National Children's Hospital, from April 1967 to August ) The onset of the illness occurred mostly between the fourth and ninth years of life. Two thirds of the affected cases were girls. 2) Twenty-three cases (62.2%) were not preceded by other epileptic seizures, 12 cases (32.4%) had grand mal or febrile convulsion (mixed form by Fukuyama) prior to the onset of pure petit mal. 3) The material was classified according to the clinical manifestation during the absence attacks. Absence (simple form) was abserved in 29 cases (78.4%). absence with automatism in 7 cases (18.9 %), absence with focal motor seizure in 1 case (2.7%). 4) As to the EEG abnormalities in addition to the burst of bilateral synchronous 3 c/s spike and wave complex, focal spikes were observed in 3 casas (r-frontal region in 2 cases, r-antetemporal region in 1 cases), focal spike and wave complex (ć-occipital region) in 1 case. The background activity showed the slightly or moderately diffuse irregular slow waves in 22 cases (59.5%), and this pattern was commonly seen in cases associated with grand mal or febrile convulsion. 5) Of 23 cases who had been followed for at least three years after the initial attack of absence, 3 cases (13.0%) developed subsequent grand mal. This percentage was rather lower than the results of previous studies. Twenty cases (87.0%) had ceased to have pure petit mal and other epileptic attacks clinically, 2 cases continued to have pure petit mal, 1 case to have both grand mal and pure petit mal.
2 6) Seven cases were tested with repetitive systemic injections otismall doses (1mg/kg) of thiopental sodium, postulating that the test might be able to differentiate primary or secondary bilatral synchrony. The most common EEG response obtained among subjects was of type. I which was considered characteristic for primary bilateral synchrony according to Lombroso's description. to be Absence, EEG, Primary bilateral synchrony, Secondary bilateral synchrony. Definition of pure Petit Mal (Absence)
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4 Equivocal response (Type 4) good induction of beta rhythms, with persistence or activation of the bilateral spike & wave discha rges; or a questionable indication of focal elements, etc. klombroso C T et al25) l
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11 1) Lennox W G, Lennox M A: Epilepsy and related disorders. Vol. 1 Little Brown Co, Boston, ) Gibbs F A, Davis H, Lennox W G: The electroencephalogram in epilepsy and in conditions of impaired conciousness. Arch Neurol Psychiat 34: , ) Gibbs F A, Gibbs E L: Atlas of Electroencephalography. Epilepsy, Vol. 2 Addison-Wesley Publ Co Inc Reading, Mass, ) Penfield W, Jasper H H Epilepsy and the Functional Anatomy of the Human Brain. Little Brown Co, Boston, ) Fukushima Y: Variable manifestation of 5) Paal G: Katamnestische Untersuchung and EEG bei Pyknolepsie. Arch Psychiat Zschr f Ges Neurol 196: 48-62, ) Holowach J, Thurston D L, O'Leary J L: Petit mal epilepsy. Pediatrics 30: , ) Less F, Liversedge L A: The prognosis of "petit mal" and minor epilepsy. Lancet 2: , ) Currier R D, Kooi K A, Saidman L J Prognosis of "pure" petit mal. Neurology 13 : , petit mal absence. Folia psychiat Neurol Jap 18: , 1964.
12 13) Kuhlo W: Katamnestische Untersuchungen zur pyknolepsie. Arch Psychiat Zschr f Ges Neurol 207: , ) Kuhlo W: Petit-mal-Epilesie. Modern Problems of Pharmacopsychiatry Vol. 4 Epilepsy, S, Karger, Basel, New York, 1970, pp ) Doose H, Scheffner D: Uber die Beziehungen zwishen Absencen, psychomotorischen und focalen Anfallen. Arch Psychiat Zschr f Ges Neurol 206: , ) Livingston S, Torres J, Pauli L et al.: Petit mal epilepsy. Results of a prolonged follow up study of 117 patients. JAMA 194: , ) Gibberd F B: The prognosis of Petit mal. Brain 89: , ) Millichap J G, Aymat E: Treatment and prognosis of petit mal epilepsy. Pediat Clin North Amer 14: , ) Charlton M H, Yahr M D: Long-term follow-up of patients with petit mal. Arch Neurol 16: , ) Rodin B: The prognosis of patients with epilepsy. C C Thomas Publ, Springfield, ) Dalby M A: Epiepsy and 3 per second spike and wave rhythms. Acta Neurol Scand Suppl 40, Vol. 45, ) Janz D: Die Epilepsien, Spezielle Pathologie und Therapie. G, Thieme Verlag, Stuttgart, ) Gastaut H, Caveness F A, Landolt H et al.: A proposed international classification of epileptic seizures. Epilepsia 5: , ) Clinical and electroencephalographical classification of epileptic seizures. Epilepsia Suppl 10: S2-S13, ) Lombroso C T, Erba G: Primary and secondary bilateral synchrony in epilepsy. Arch Neurol 22: , ) Klass D, Daly D D: Petit mal seizures (sound movie recording). Electroenceph din Neurophysiol 13: ) Jasper H H: Some physiological mechanisms involved in epileptic automatisms. Epilepsia 5: 1-20, ) Daly D D: Reflections on the concept of petit mal. Epilepsia 9: , ) Bancaud J: Physiopathogenesis of generalized epilepsy of organic nature. The Physiopathogenesis of the epilepsies. C C Thomas Publ, Springfield, 1969, pp ) Mazars G: Cingulate gyrus epileptogenic foci as an orgin for generalized seizures. The physiopathogenesis of the epilepsies. C C Thomas Publ, Springfield, 1969, pp ) Stevens J R : Foal abnormality in petit mal epilepsy. Neurology 20: , ) Scollo G, Hess R: Generalized epilepsy by focal subcortical lesions. The Physiopathogenesis of the epilepsies. C C Thomas Springfield, 1969, pp Publ, 34) Niedermeyer E: Common generalized epilepsy and generalized synchronous seizure discharge. Modern Problem of Pharmacopsychiatry. Vol. 4 Epilepsy, S, Karger, Basel, New York, 1970, pp ) Gloor P: Generalized cortico-reticular epilepsies. Epilepsia 9: , ) Gloor P: Neurophysiological basis of generalized seizures termed centrencephalic. The physiopathogenesis of the epilepsies. C C Thomas Publ, Springfield, 1969, pp ) Ajmone-Marsan C: Pathophysiology of the EEG pattern characteristic of petit mal epilepsy, a critical review of some of the experimental data. The physiopathogenesis of the epilepties. C C Thomas Publ, Springfield, 1969, pp
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