Melinda Estes, MD
W. Douglas Knowles, PhD
Hermann Doose, MD
Heinz-Joachim Meencke, MD
Eli M. Mizrahi, MD
Soloman Moshé, MD
Question: Are changes in mesiotemporal sclerosis perhaps the result of febrile seizures early in life?
Dr. Meencke: No, it is our experience that mesiotemporal sclerosis and febrile convulsions are due to the same pathogenetic mechanism. In our cases, we have chiefly venous circulatory disturbances; these are due to mesiotemporal sclerosis and, at the same time, to febrile convulsions, if you have a genetic background or disposition.
Question: Are events thought to be brain stem seizures without EEG changes to be treated, and if so, how?
Dr. Mizrahi: At our institution, where we are able to monitor such babies on a 24-hour basis, we do not treat these events as epileptic seizures. The natural course of such clinical events is that they diminish spontaneously over time.
However, such events can be suppressed by anticonvulsants. This may be one of the reasons why, early on, they were thought to be of epileptic origin. Typically, very high dosages of anticonvulsants are required, so that the effect may be suppressive rather than antiepileptic.
In practice, we encourage identification at the bedside of those clinical events which are believed to be clearly epileptic in origin (i.e., focal clonic seizures) and initiate therapy at that point. If there is a question about the clinical event, we urge the physician to perform the clinical maneuvers we have described, either to evoke or suppress the events. If the behaviors can be elicited or suppressed by these maneuvers, then no treatment is instituted. This decision is confirmed by monitoring.. . .