Re: epilepsy - landau kleffner

Posted By peds neuro md bm on March 18, 1998 at 10:21:50:

In Reply to: epilepsy - landau kleffner posted by Laura  on March 14, 1998 at 22:57:44:







: Please help me understand the treatment for this condition.  My 9 year old son has been diagnosed as borderline landau kleffner / brain wave disorder.  He has non-clinical seizures approx. every 5-6 seconds lasting 1/2 - 1 second in duration.  He is currently on depakane to counter act the siezures.  He also take risperdol for behavior management.  I guess what I would like to know is this:  Since the siezures are non-clinical how can I be sure he's no longer having them?  I assumed if he was not having siezures he might return to me mentally but at this tiime he has not.  As I said he is 9 years old and we have been dealing with since he was 5 and I am starting to get discouraged.

Dear Laura,
Landau Kleffner syndrome (LKS) is a seizure disorder that has two major
symptoms- acquired aphasia (loss of ability to speak) and EEG changes that
are activated during sleep. there are also two other symptoms and they are
psychomotor or behavioral disturbances and epilepsy.
Searches for causes of the syndromes have failed to revealed any structural
lesions in thebrain. There seems to be more males than females affected.In
70% of the cases, it begins with the aphasia before the age of 6.. Patients
are often misdiagnosed as having autism or being deaf.
Epileptic seizures are seen also in 70% of patients, and may present either
as a single seizure or status epilepticus. Recurrent seizures begin between
4-6 years old and only 20% still have seizures after age 10.
antiepileptic medication is indicated whenever there is acorrelation betyween
the aphasia, EEG and seizures. the seizure type and frequency however have
no influence on the overall prognosis. the EEG findings may fluctuate and the
prognosis of the epilepsy is generally favorable.
Many patients receive antiepileptic medication or steroids, or both with no
real changes in the language aspect of the disorder. Valproate, Ethosuximide
and benzodiazepines have had partial effects on the EEG.
To answer your questions:
1. how would you know if seizures are on going without clinical seizure?
    one would need to repeat the EEG preferably an overnight EEG which
    gives the maximal yield since the EEG findings are best seen during
    sleep.
2. he would be returning to me mentally?
    aphasia in majority of patients tend to persist even when no seizures
    are noted and the EEG becomes normal. Several authors have stated that
    majority of patients recover speech before adulthood. However, because
    of the neuropsychological sequelae and academic consequences of the
    aphasia, only 50% lead a normal life.
Speech therapy should be initiated if this has not been done. Surgery, such
as subplial transcection may lead to speech recovery.