This study retrospectively evaluated the efficacy and pharmacokinetics of fosphenytoin (fos-PHT) in treating status epilepticus (SE) and cluster seizures in a group of 24 children (n=10 aged<2 years, n=14 aged≥2 years). Common etiologies were acute symptomatic SE in the<2 years old group (42.3%) and remote symptomatic SE in the≥2 years old group (80.0%). Fos-PHT was effective in treating approximately 70% of subjects in both groups. Transient hypotension was apparent as a mild adverse side effect in one child in the≥2 years old group. Serum PHT levels gradually decreased after initial Fos-PHT administration (22.5mg/kg) with no significant difference between the two groups, and reached suboptimal levels within 10-15 h. Longer maintenance fos-PHT therapy (7.5mg/kg/day) also could not maintain optimal serum PHT levels. We conclude that fos-PHT is effective and safe for treating status epilepticus and cluster seizures in children including those aged<2 years. To maintain optimal serum PHT levels, high doses of fos-PHT, similar to those administered outside of Japan, might be required.

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We studied the optimal dose in 122 cases who were controlled with epileptic seizure 2 years or more with carbamazepine (CBZ) mono therapy. The age of epilepsy onset ranged from 1 to 74 years old, the mean age was 23.5±18.8 years old, and the median age was 21 years old. The dose range CBZ was 100mg/day to 1,000mg/day with a, mean dose of 412.1±203.3mg/day, and median dose was 400mg/day. Only 4 cases have doses beyond 800mg/day. There was a significant negative correlation between dose and age of epilepsy onset. The number of patients with complex partial seizure (CPS) only was 29 and the most common. The cases who were effective with CBZ mono therapy were controlled by smaller doses. The cases who were not controlled with doses beyond 800mg/day must be switched from CBZ to other antiepileptic drugs (AED), added on new AED and be examined as to whether surgery is appropriate or not.

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In this study, we investigated the effects of low-dose (2.5mg/kg) carbamazepine (CBZ) therapy on 15 infants and young children (6m to 3 y) admitted to our hospital with convulsions associated with mild gastroenteritis. Before admission, each patient had had 1 to 5 seizures and 2 of them had been treated with diazepam IV. We gave all 15 patients a single dose of CBZ (2.5mg/kg), after which the seizures ceased. CBZ caused no side effects-such as sleepiness, rash, etc. -in any of the patients. Our finding is that low-dose single treatment CBZ therapy is an effective and safe treatment for convulsions associated with mild gastroenteritis.

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We conducted long-term video-EEG monitoring in a 26-year-old woman who had onset of paroxysmal kinesigenic dyskinesia (PKD) at 8 years of age. Video-EEG recorded dystonia on both left and right sides. However, complex partial seizure was observed following dystonia of the right upper extremity only, but was not observed following dystonia of the left upper extremity. A head MRI showed enlargement of left amygdala. We hypothesize that discharge in left basal ganglion that causes right dystonia may elicit a kindling phenomenon in the enlarged left amygdala, causing epilepsy. Both dystonia and complex partial seizure responded well to CBZ.

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Among our patients diagnosed with symptomatic partial epilepsy based on the clinical course, symptoms, and examination findings, we encountered one patient with rapid rhythm-like discharges that resemble the EEG findings observed in Lennox-Gastaut syndrome.
The following clinical characteristics of the patient were different from those of Lennox-Gastaut syndrome: late onset at 15 years of age, complex partial seizure as the main seizure type, and interictal EEG showing no slowing of background waves but rather normal background activity consisting mainly of α activity. This patient was found to have ectopic gray matter along the lateral ventricle in bilateral cerebral hemispheres, and is classified as belonging to "structural-metabolic causes" in the new classification of epilepsies proposed by ILAE. In the context of this proposed new classification, the present case gives an example of a seizure type that cannot be solved by the conventional classification of broadly dividing into "generalized seizures" and "partial seizures", and may provide new more practical perspectives to the ILAE classification currently being developed. For that purpose, further studies of collecting more cases and accumulating knowledge including depth EEG and magnetoencephalographic findings are needed.

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