Family studies and human leukocyte antigen class II typing in Indian probands with seizures in association with single small enhancing computed tomography lesions

Purpose: To define the clinical features of the syndrome of seizures associ ated with single, small, enhancing computed tomography (CT) lesions (SSELs) in 235 Indian probands and seizure types among their family members. Human leukocyte antigen (HLA) class II genomic typing in randomly selected 41 pr obands was done to identify the role of hereditary factors in this syndrome . Methods: The seizure types among 235 probands, their clinical outcome, and seizures in their family members were studied. Family data were collected o n relatives of 212 additional probands with neurologic diseases other than epilepsy. HLA class II antigens were studied by using polymerase chain reac tion (PCR) amplified DNA and sequence-specific oligonucleotide probe (PCR-S SOP) hybridization. Results: The seizures in 86% were partial with or without generalization; 7 7% had fewer than five seizures before the first CT scan. Evanescent focal neurologic deficits after seizures were noted in 40%. Most patients (97%) w ere treated with a single antiepileptic drug (AED). Significant resolution of the CT scan lesion was noted within 6 months in 125 (53%) of 235 cases. Two thirds of patients had no seizures while taking a single AED, and an ad ditional 18% had no seizures even after their AEDs were discontinued. Epile psy among relatives of Indian probands having seizures in association with SSELs was more common as compared with relatives of probands with other neu rologic diseases. A family history of seizures was noted in 21% probands, t he ratio of affected first- to second-degree relatives was 4.3:1, and 60% o f affected sibs had syndromic concordance with probands. There was a positi ve association of HLA-DRB1*13 (P-c = 0.036) with this syndrome. Conclusions: The syndrome of seizures in association with SSELs seems to be a benign localization-related epileptic syndrome. Our results of HLA studi es point to an inherited susceptibility to an infective agent, which in mos t cases is of cysticercal etiology.