Kazuyoshi Watanabe

artial epilepsies had been consid-I W ered infrequent in infancy (1-3), but this may be because partial seizure manifestations in infants are subtle and often difficult to identify unless they show definite focal motor phenomena. It is often difficult to distinguish partial from generalized seizures on the basis of clinical observations and interictal encephalograms (EEGs) (4). In a previous study of seizures in the first year of life (2), partial seizures comprised only 12%, whereas infantile spasms accounted for 41% and generalized motor seizures for 35%. Generalized motor seizures, however, may represent partial seizures that are secondarily generalized. Generalized tonic-clonic seizures are very rare in infants, if present, and ictal EEGs of such seizures usually display partial seizure patterns evolving to secondarily generalized tonic-clonic seizures (5, 6). In another study, partial epilepsy comprised 12%, whereas West syndrome represented 69% of the cases (7). Later studies of epilepsies in the first years of life revealed an increased incidence of partial epilepsies, although West syndrome remained the most common syndrome: 17-36% for partial epilepsies vs. 39-48% for West syndrome (8-10). Recent studies have reported a higher incidence of partial epilepsies in the first 2 years of life: 43% for partial epilepsies vs. 28% for infantile spasms at a tertiary center (11), and 60% vs. 35% in the first 2 years of life in a regional general hospital (12). This increased incidence is probably due to an increased recognition of partial seizures with or without secondary generalization in infants.

The prognosis of partial epilepsy in infancy had been considered poor, and benign partial epilepsy was reported to be extremely rare or nonexistent in infancy (13, 14). Complex partial seizures of infancy were reported to be medically intractable and often associated with mental handicap, necessitating aggressive treatment (15). However, Watanabe et al (16) first reported the presence of partial epilepsy in infancy with complex partial seizures in 1987, and, subsequently, of benign partial epilepsy with secondarily generalized seizures (17).

This chapter reviews symptomatic, cryptogenic, and idiopathic benign partial epilepsies and related syndromes in the first 2 years of life, excluding neonatal seizures.

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