What is a syndrome?
A syndrome is a group of signs and symptoms that, added together, suggest a particular medical condition. In epilepsy, examples of these signs and symptoms would be things like the age at which seizures begin, the type of seizures, whether the child is male or female and whether they have physical or learning disabilities, or both. The results of an electroencephalogram (EEG) are also used to help identify epilepsy syndromes.
Other names for migrating partial epilepsy in infancy
• migrating partial seizures of infancy
• malignant migrating partial seizures in infancy
Migrating partial epilepsy in infancy
This epilepsy syndrome was described for the first time in 1995. This makes it one of the newer epilepsy syndromes. It is very rare.
Most children start having seizures in the first few weeks of life and all will start having seizures by six months of age.
Different things happen in the seizures.
- There may be some stiffness of the body, arms or legs (either affecting one side of the body or both sides of the body).
- There may be chewing movements or some very brief cycling movements of the arms or legs.
- There may be some unusual features during the seizures, including flushing of the face, drooling of saliva and tears.
All of these symptoms are types of focal (also called partial) seizures, meaning the seizures start in one area of the brain. Sometimes these seizures may then progress into secondarily generalised seizures – and these are called tonic-clonic seizures. This more commonly affects older children (aged two years and above).
The seizures may only happen now and then in the first few weeks after the epilepsy starts. However, very rapidly, the seizures increase in frequency to the point where they may happen many times every day. Seizures are usually shorter in younger children, lasting 30 seconds to one minute. But in older children the seizures may last many minutes.
No cause has been found to explain this type of epilepsy although doctors think the cause is likely to be in the child’s genes. Although results of tests to look for a cause are normal, with time the MRI scan may show the brain shrinks in size (brain atrophy). It is not due to any ‘birth injury’ and even though it is thought be a genetic condition, it does not seem to run in families.
Most babies make very little developmental progress or can even lose the progress they have made. They will be dependent for all their care and have problems with feeding.
Epilepsy Action has more information about the MRI.
This is made by taking a very detailed account of the seizures and especially at what age they start.
The EEG may be very helpful. It will confirm the diagnosis if the baby has seizures during the EEG recording, as it will show that the seizures come from different parts of the brain. This is why it is called ‘migrating’ partial epilepsy of infancy (as the seizures ‘migrate’ or move from one part of the brain to another).
Epilepsy Action has more information about diagnosing epilepsy.
It is unlikely that any epilepsy medicines will ever fully control the seizures. Sometimes medicines will have an effect for a short time, but this will then wear off. Frequent changes to epilepsy medicines are made. Sometimes more uncommon epilepsy medicines are tried, including stiripentol or triple bromides (the oldest epilepsy medicines ever used). Other treatments such as the ketogenic diet, steroids (prednisolone) or the vagus nerve stimulator may also be used. Babies with this type of epilepsy should be referred to a paediatric neurologist.
Epilepsy Action has more information about treating epilepsy.
The prognosis is usually very poor. This is because the seizures never come under control for more than a few days or a week at a time and sometimes they are never controlled. Sadly, many children with this syndrome die in childhood due to the complications of the disorder, including repeated chest infections. Those who do survive are usually severely disabled and will continue to have seizures despite treatment.
HemiHelp is a charity providing support and information to people with hemiplegia and their families in the UK.
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Epilepsy Action would like to thank:
- Dr Richard Appleton, and Dr Rachel Kneen, consultant paediatric neurologists at Alder Hey Children’s Hospital,Liverpool,UKand
- Dr Stewart Macleod, consultant paediatric neurologist at RoyalHospitalfor Sick Children, Glasgow, UK.
They have kindly prepared the information on this page. It is based on their own research, experience and expertise.