Investigators at the Paediatric Neurology Department, Great Ormond Street Hospital for Children, London, and other centers in the UK and USA carried out a population-based study of children, 1-24 months of age, with new-onset epilepsy, ascertained over 13 months from 15 boroughs of North London. A total of 57 children were enrolled, an incidence of 70.1/100,000 children <2 years of age/year; 23 (41%) were White, 21 (37.5%) Asian, and 10 (18%) Black. The risk was highest among Asian infants (p<0.001). An electroclinical syndrome was identified in 24 (42%) cases of which 21 were epileptic encephalopathies (West [16], Ohtahara [2], and Dravet [3] syndromes). Overall, an underlying etiology for the epilepsy was identified in 29 children (51% of the cohort). Developmental brain abnormalities (polymicrogyria, tuberous sclerosis) were most frequent, occurring in 11 (21%), followed by acquired brain insults in 9 (16%) infants. Acquired causes included meningitis in 5 (9%), HIE in 4 (7%), and metabolic disorder in 4 (7%). Chromosomal abnormalities occurred in 4 (7%). MR images of 51 cases showed abnormalities in 37 (72%) and etiologically relevant abnormality in 26 (51%). [1]

COMMENT. Infantile onset epilepsy frequently presents with intractable seizures and is commonly associated with diffuse encephalopathy, metabolic or structural brain abnormalities. Identification of specific electroclinical syndromes at seizure onset requires specialist intervention with video-EEG recordings, MRI, metabolic, and genetic studies. The EEG associated with an epileptic encephalopathy is diffusely abnormal and varies with cerebral maturation [2]. Details of EEG findings are important in the workup and in the classification of infantile seizures. Early referral of infantile seizure patients to a Pediatric Epilepsy Center is usually indicated for accurate seizure classification and optimal management. [3]