Psychornotor Seizures in Childhood A Clinical Study

Abstract

Psychomotor seizures are more common in childhood than realized previously and require differentiation from nonictal behavior disorders. An intensive clinical analysis was made of seizure manifestations and problems in diagnosis and treatment. Twenty-five children has seizures characterized by auras of anxiety and visceral symptoms, followed by changes in consciousness associated with many varied, complex feeling and thinking states, and automatic somatic and autonomic motor behavior. At least a partial amnesia occurred in all instances. Nineteen children had interseizure personality disturbances mainly characterized by overactive, aggressive behavior. Etiologic factors in the background such as birth trauma and central nervous system infection were in high incidence (60%). The major abnormalities in the eeg were either unilateral or bilateral temporal spike or bilateral, diffuse, slow spike-wave discharges. In particular, the eeg findings are felt to implicate both the temporal-limbic and centrencephalic systems. There were no major clinical differences between these groups, nor were there any major differences between younger and older children except for the predominance of more simple automatism in the younger group and the higher occurrence of more complex thought disorders in the older. Twenty-two children achieved some measure of control with diphenylhydantoin in combination with phenobarbital or primidone. The diones were ineffective. However, relatively satisfactory control of seizures was obtained in only 60% of the cases, and it is felt that there is still a great need for a more effective anticonvulsant medication for psychomotor seizures. Also, the psychologic problems involved in this group require much further evaluation and understanding.