A total of 187 patients with temporal lobe epileptic syndromes accompanying complex partial seizures with or without generalized tonic-clonic convulsions (GTC) were subclassified into three groups according to Lennox (1951), Canger (1966), and Janz (1969): 1) 62 patients with pure complex partial seizures who has had no GTC throughout the clinical course (pure group), 2) 43 patients with primary complex partial seizures whose initial attacks were complex partial seizures which were followed by GTCs (primary group), 3) 82 patients with secondary complex partial seizures whose initial attacks were GTCs which followed by complex partial seizures (secondary group).
The three groups were characterized by the respective clinical and EEG findings as follows. The pure group had comparatively more complicated febrile convulsions in the past history and the seizure symptomatology was characterized by more isolated auras or auras followed by impairment of consciousness compared with that of the other two groups especially with the secondary group. In interictal EEGs the pure group accompanied more well orgaized background activities and was more prone to reveal unilateral temporal epileptic discharges even during waking in comparison with the other two groups. On the other hand, the secondary group associated more frequently with intellectual deficiency and/or psychotic episodes, and the seizure manifestations were characteraized by impaired consciousness from the onset. In the interictal EEGs recorded during sleeping, bilateral epileptic discharges were more frequently found in the secondary group. In this context it was speculated that the primary group interposes between the pure and the seconday groups.
Thus the three subclassified groups of complex partial seizures were valiated by clinical as well as interictal EEG characteristics. From the pathoetiological point view, it appears to be possible that the focus is rather acquired and focalized in the pure group, whereas in the secondary group the propensity towards generalization in addition to the presence of lesional focus or foci in the temporal lobe is stronger compared with that of the other two groups.

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Studies on epileptiform EEGs of 132 infants and children without mental and motor deficit who had been followed up for more than 5 years with grand mal seizure revealed the following results.
1) Appearance and disappearance of epileptiform EEGs were depend on age rather than on the effect of anticonvulsants and/or types of EEG patterns. The peak incidence of epileptiform EEGs was seen between 6 to 10 years. Epileptiform EEGs had a tendency to improve with advancing age after the peak age and diminished to only 11.7% when these cases were 17-year-old.
2) There were 7 cases without medication in their entire course, all of their epileptiform EEGs had disappeared within 5 years after the first visit.
3) As far as the types of epileptiform EEGs, poorer prognosis was seen in cases having both cortical epileptic discharge and diffuse spike-wave than those with cortical discharge only or diffuse spike-wave only. Most of the former cases were in younger age group on the first visit, therefore the younger patients had a tendency to have both cortical epileptic discharge and diffuse spike-wave.
4) There was no correlation between EEG prognosis and serum concentration of anticonvulsants.
These results suggest the possibility that the epileptiform EEGs of infants and children of grandmal seizure without mental and motor deficit disappear spontaneously with age.

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Mental retardation in childhood epilepsy is a major medical and social problem. However, reliable data concerning the epidemiology of mental retardation in epileptic children are scarecely found. A neuroepidemiological investigation was performed in Okayama Prefecture, Japan, on December 31, 1975 as the prevalence day. Out of all 289, 650 child population under 10 years of age, 2, 378 epileptic children were identified. Combined mental retardation was also studied among these epileptic children.
Results:
1) On the prevalence day, mental retardation, namely less than 75 of IQ or DQ, was noted in 410 epileptic children which consisted 17.2% of all identified epileptic cases. The prevalence rate was 1.4 per 1, 000.
2) Regarding the incidence of mental retardation in relation to seizure type, mental retardation was frequently noted among the cases with Lennox syndrome, West syndrome and myoclonic seizure, i.e. 90.6%, 68.3% and 42.1%, respectively.
On the other hand it was rarely noted in petit mal absence and autonomic seizure, i.e. 0% and 5.1%, respectively.
3) The epileptics with their onset of seizures within the first six months of life showed high association of mental retardation.
4) In relation to the presumed etiology of epilepsy, mental retardation was frequently noted among the cases with vascular disorders, encephalitis, neonatal asphyxia and premature birth, i.e. 100%, 66.7%, 31.5%, and 29.4%, respectively.
On the other hand, it was less frequently noted in the cases with associated immunization, predisposition to convulsions or epilepsy, head trauma and unknown causative factor, i. e. 0%, 6.5%, 15.8%, and 17.1%, respectively.

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We studied the more-than-three-year prognosis of 100 infantile spasms. Of survivers, 9 went to ordinary school (7 with normal mentality, 2 with borderline mental retardation), and 46% have had no seizures at the time of this study. Mental prognosis was better in the following groups, 1) onset after 6 months of age, 2) normal pychomotor development before onset, and 3) idiopathic cases. Good seizure control was noted in the group with series formation and typical hypsarrhythmia as well as normal computed tomography or pneumoencephalography images. In addition, the children with good motor function have more opportunities to play with other children and thus encounter social problems.

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The process of discontinuing anticonvulsant medication was studied clinico-electroencephalographically on 285 children with epilepsy. The observation period after discontinuation of anticonvulsants was ranged from two years to 10 years and one month.
The subjects were divided into two groups electroencephalographically: 190 cases in which antiepileptic drugs were formally disconitnued after the complete suppression of epileptic discharge for over two years, and 95 cases in which anticonvulsants were informally discontinued. The relapse rate after discontinuation was significantly lower in the former group, 2.1%, than the latter group, 21.1%. Concerning the seizure-free period, the group of cases free from clinical seizures for over three years by the time of withdrawal showed significantly lower relapse rate than the rest of the cases. Since the relapse of clinical seizures was related to both the snike-free perind and the seizure-free period, the interrelationship between these factors was studied further-more. As the result the spike-free period proved to be a more reliable indirator for stopping medication than the seizure-free period. From these findings, the withdrawal of antiepileptic drugs should be started after suppression of epileptic discharges for over two years in childhood epilepsy.
However, since each epileptic patient is based on different pathophysiology and etiology, the discontinuation of antiepileptic drugs should be determined not only electroencephalographically, but also taking various clinical factors into consideration comprehensively.

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A girl who had both sylvian and atonic seizures was presented. She was born uneventfully and had no family history of convulsive disorder. Her development was normal untill the age of 4 years and 5 months, when she began to have tonic seizures of the upper limb with hemifacial twitching. One year and 5 months later, frequent atonic seizures appeared. At 8 years and 7 months old, when she was referred to our unit, her psychomotor development was normal. The EEG showed generalized sharp and slow waves dominant in central and midtemporal area, which became continuous as she fell in sleep. At 9 years and 4 months, a month later after administration of CBZ, she experienced frequent atonic seizures. After these seizures, she had no attachs and the EEG became normal. Her EEG finding and clinical course seemed to resemble atypical benign partial epilepsy of childhood described by Aicardi et al.

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A three-year-five-month old boy, with severe mental retardation and epilepsy caused as sequelae of acute encephalopathy, manifested a peculiar type of reflex epilepsy. He started to have only spontaneous atonic seizures at three years four months of age. Later, the same kind of atonic seizures began to be induced by hearing the specific words besides spontaneous seizures. At first, reflex seizures were induced exclusively by hearing the word “terebi”, which means a television, but triggering words gradually expanded to not only “terebi” but also “tehpu”, tape, and “te”, hand, and finally to any words with the sound of “te”.
The type of seizures both spontaneous and evoked, were atonic seizures. It was suggested that not only brainstem but also cerebral cortex played important roles in the provocation mechanism of heard-word-induced seizures, since the latency of beginning of desynchronization of EEG from the start of verbal stimulus was longer than 480 msec.
Conditioning treatment with the tape, in which the word “terebi” was recorded repeatedly, was found to be effective for the evoked seizures by hearing the specific word “terebi”.

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