Children with onset of partial seizures from 10 mos to 13 yrs (average 4.9 yrs) were followed for an average period of 7.4 yrs at the Instituto di Neuropsichiatria, Rome, Italy. Of a total of 261 consecutive patients (136 male and 125 female) 89 had simple partial seizures, 109 had complex symptomatology, and 63 were partial with secondary generalization. Acquired etiological factors in 112 (43%) patients included cerebral birth injury in 62, head trauma in 31, and CNS infection in 19. Seizure outcome at 5 yr follow-up was favorable in 214 (82%); 153 patients had been seizure free for 2 yrs and 61 showed improved seizure frequency. Factors predictive of seizure control and a good prognosis were are follows: 1) a positive family history for epilepsy, 2) absence of acquired etiologies, 3) no antecedent generalized seizures, 4) normal EEG background activity, and 5) absence of mental retardation, neurological abnormalities or behavior disorders. An unfavorable seizure outcome correlated with 1) early onset of partial seizures, and 2) generalized seizures predating partial seizure onset. Factors of no prognostic value were 1) febrile convulsions preceding partial seizure onset, 2) normal initial EEG, and 3) cognitive and behavioral disorders. [1]

COMMENT. Positron emission tomography (PET) has been employed to determine metabolic patterns in 48 patients with complex partial seizures. Patients with frontal hypometabolism had shorter and milder seizures and those with mutilobar hypometabolism had prolonged seizures. An aura correlated with temporal hypometabolism [2]. SPECT (single photon emission computed tomography) in 14 children with seizure disorders was useful in localization and prognosis. In patients with radiological lesions, SPECT showed more extensive localizations and those with normal CTs often had areas of hypo or hyperperfusion. The pattern seen on SPECT was related to the clinical course and prognosis: extensive metabolic impairment on SPECT correlated with frequent seizure recurrence and mental retardation whereas all children with a normal SPECT had less than 2 seizures per year and normal neurological and intellectual development. [3]