FOCAL FEATURES IN WEST SYNDROME INDICATING CANDIDACY FOR SURGERY

A subgroup of patients with West syndrome (WS) also have focal feature s, and some of these patients respond to surgical intervention, To det ermine the incidence of focal features in patients with WS and to esta blish the correlation of these features with outcome, all patients wit h WS treated in the Epilepsy Unit of the Children's Hospital (Boston, MA) during the years 1989 to 1992 were retrospectively evaluated, Foca l features included partial seizures, hemiparesis, focal radiologic fi ndings, asymmetric spasms, and lateralized hypsarrhythmia, The differe nt focal features were later correlated with the natural history of th e disease, Sixty-seven patients were included in the study, Sixty-six percent had asymmetric manifestations, Asymmetric spasms, hemihypsarrh ythmia, and partial seizures combined with infantile spasms had signif icant association with asymmetric brain pathology, Focal features did not correlate with age of onset and outcome, but were associated with etiology, Eight of the nine patients who underwent epilepsy surgery ha d at least two focal features or more, Two of the operated children ha d focal features in the absence of magnetic resonance imaging abnormal ities, thus indicating the necessity for positron emission tomography, the results of which justified surgery. (C) 1997 by Elsevier Science Inc.