Landau-Kleffner syndrome beginning with stuttering: case report

Pharmacologic treatment of intractable epilepsy in children: a syndrome-based approach

The successful pharmacologic treatment of intractable childhood epilepsy is predicated upon an accurate classification of the epilepsy syndrome. The selection of an antiepileptic drug is facilitated by the knowledge of syndrome-specific efficacy, the anticipation of potential side effects, and a careful risk-benefit assessment tailored to each patient. As such, the identification of comorbidities and careful monitoring for treatment-emergent adverse events, especially cognitive and behavioral effects, is of utmost importance. Especially in refractory cases, polypharmacy may increase the likelihood of side effects, but carefully chosen combinations can result in synergistic benefit. For most epilepsy syndromes, newer antiepileptic drugs typically yield equivalent efficacy and superior tolerability. Nevertheless, continued research is needed to further contrast the syndrome-specific efficacy and tolerability of available drugs and to foster the development of new agents with superior efficacy and side effect profiles.

Speech, language, and cognitive dysfunction in children with focal epileptiform activity: A follow-up study

We reviewed the medical history, EEG recordings, and developmental milestones of 19 children with speech and language dysfunction and focal epileptiform activity. Speech, language, and neuropsychological assessments and EEG recordings were performed at follow-up, and prognostic indicators were analyzed. Three patterns of language development were observed: late start and slow development, late start and deterioration/regression, and normal start and later regression/deterioration. No differences in test results among these groups were seen, indicating a spectrum of related conditions including Landau-Kleffner syndrome and epileptic language disorder. More than half of the participants had speech and language dysfunction at follow-up. IQ levels, working memory, and processing speed were also affected. Dysfunction of auditory perception in noise was found in more than half of the participants, and dysfunction of auditory attention in all. Dysfunction of communication, oral motor ability, and stuttering were noted in a few. Family history of seizures and abundant epileptiform activity indicated a worse prognosis.

Differential Diagnoses and Treatment of Behavioral Disturbances Associated With Landau—Kleffner Syndrome The Case of T. R

This case report detailed the process of differential diagnosis and course of treatment for a 9-year-old male with Landau—Kleffner syndrome (LKS). He presented to a long-term inpatient psychiatric facility with primary complaints of physical aggression, property destruction, non-compliance, poor academic performance, and developmental regression. He had no history of seizures. Subsequent to several diagnoses and admits to the hospital, a neuropsychological evaluation was conducted. Findings revealed primary deficits in language (receptive and expressive). Observations during functional analysis indicated the possibility of seizure activity. EEG (electroencephalograph) confirmed this contention. The diagnosis of LKS was given and behavioral therapy was successfully used to extinguish the maladaptive behaviors associated with LKS. This complex case illustrated the necessity and utility of neuropsychological assessment, especially in cases where alternate diagnoses are feasible and also served as an informative case example of possible behavioral manifestations that can occur with LKS, and how to treat such.

Patterns of language and auditory dysfunction in 6-year-old children with epilepsy

In a previous study we reported difficulty with expressive language and visuoperceptual ability in preschool children with epilepsy and otherwise normal development. The present study analysed speech and language dysfunction for each individual in relation to epilepsy variables, ear preference, and intelligence in these children and described their auditory function. Twenty 6-year-old children with epilepsy (14 females, 6 males; mean age 6:5 y, range 6 y-6 y 11 mo) and 30 reference children without epilepsy (18 females, 12 males; mean age 6:5 y, range 6 y-6 y 11 mo) were assessed for language and auditory ability. Low scores for the children with epilepsy were analysed with respect to speech-language domains, type of epilepsy, site of epileptiform activity, intelligence, and language laterality. Auditory attention, perception, discrimination, and ear preference were measured with a dichotic listening test, and group comparisons were performed. Children with left-sided partial epilepsy had extensive language dysfunction. Most children with partial epilepsy had phonological dysfunction. Language dysfunction was also found in children with generalized and unclassified epilepsies. The children with epilepsy performed significantly worse than the reference children in auditory attention, perception of vowels and discrimination of consonants for the right ear and had more left ear advantage for vowels, indicating undeveloped language laterality.

A study of familial stuttering

Here we study 13 families with stuttering. Of the 13 families, 9 were persistent stutterers and 4 were recovered stutterers. In the 9 families with persistent stuttering, 24 were male and 10 were females. Of the 4 families with recovered stutterers, 17 were male and 3 were female. Of the 17 males, 12 were persistent stutterers and 5 recovered after adolescence. All females were recovered stutterers. We conclude with a short discussion of recent molecular studies.

Management of Landau-Kleffner syndrome

Landau-Kleffner syndrome (LKS) is an acquired epileptic aphasia disorder in which children, usually 3-8 years of age who have developed age-appropriate speech, experience language regression with verbal auditory agnosia, abnormal epileptiform activity, behavioral disturbances, and sometimes overt seizures. There are no controlled clinical trials investigating the therapeutic options for LKS. Only open-label data are available. Early diagnosis and initiation of prompt medical treatment appear to be important to achieving better long-term prognosis.Several antiepileptic drugs have been reported to be beneficial in treating this syndrome. These include valproic acid (valproate sodium), diazepam, ethosuximide, clobazam, and clonazepam. Reports on the efficacy of lamotrigine, sultiame, felbamate, nicardipine, vigabatrin, levetiracetam, vagal nerve stimulation, and a ketogenic diet are few and more experience is needed. Carbamazepine and possibly phenobarbital and phenytoin have been reported to occasionally exacerbate the syndrome. As initial therapy, valproic acid or diazepam is often empirically chosen. Subsequently, other antiepileptic drugs, corticosteroids, or intravenous immunoglobulin (IVIG) therapy are often used. Corticosteroid therapy should probably not be delayed more than 1-2 months after the initial diagnosis. Various corticosteroid regimens including oral prednisone and, recently, high doses of intravenous pulse corticosteroids, as well as corticotropin (adrenocorticotropic hormone) have been reported to be effective in LKS. Oral corticosteroids are used more often and usually need to be maintained for a long period of time to prevent relapses. The use of IVIG has been associated with an initial dramatic response in only a few patients. In our experience, a long-term worthwhile improvement has been noted in only 2 of 11 patients. These two patients had an immediate response to IVIG initially and after relapses before eventually achieving a long-term sustained remission. Surgical treatment by multiple subpial transection, which is reserved for patients who have not responded to multiple medical therapies, has been followed in selected cases by a marked improvement in language skills and behavior. However, a widely accepted consensus about suitable candidates for this surgery and about its efficacy is still lacking. Speech therapy, including sign language, and a number of classroom and behavioral interventions are helpful in managing LKS, and should be used in all patients.