Early recognition of benign partial epilepsy in infancy

Purpose: The aim of this study is to determine how precisely we can recognize the outcome in infants with epilepsy beginning in the first year of life. Methods: We performed a prospective 5-year follow-up study on 63 patients who developed epilepsy in the first year of life. We first judged that patients met the criteria of possible benign partial epilepsy in infancy (BPEI) on enrollment in this study. At 2 years of age, we reevaluated the seizure and developmental outcome in the patients who were diagnosed as having possible BPEI. We finally judged that patients met the criteria of definite BPEI at age 5 years. Possible BPEI was defined as epilepsy meeting all the following conditions: (a) complex partial seizures and/or secondarily generalized seizures; (b) normal psychomotor development and neurologic findings before onset; (c) normal interictal electroencephalograms; (d) normal cranial computed tomography (CT) and magnetic resonance imaging (MRI) findings, and (e) no seizures during the first 4 weeks of life. Definite BPEI was defined as epilepsy meeting all the following criteria in addition to those of possible BPEI: (a) normal psychomotor development beyond age 5 years, and (b) no seizures beyond age 2 years. Results: Thirty-two of the 63 patients met the inclusion criteria completely and were included in the possible BPEI group. Twenty-five of the 32 patients completed the 5-year follow-up. At age 2 years, four patients were excluded From the possible BPEI group because of seizure recurrence and/or delayed development. By age 5 years, one had a recurrence of seizures, and another exhibited mildly delayed psychomotor development. We finally diagnosed 19 patients as having definite BPEI, Definite BPEI accounted for 76% of the patients diagnosed as having possible BPEI at the first presentation and 90% of those who met the conditions on reevaluation at age 2 years. Conclusions: Recognition of BPEI is possible, to some extent, at the first presentation, and reevaluation at age 2 years is useful for a more precise diagnosis.