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Archives de pédiatrie
Volume 11, n° 4
pages 347-349 (avril 2004)
Doi : 10.1016/j.arcped.2004.01.017
Received : 19 December 2002 ;  accepted : 19 January 2004
Symptômes psychiatriques et syndrome des pointes-ondes continues du sommeil : à propos d'une observation
Neuropsychiatric abnormalities and continuous spikes and waves during slow sleep syndrome: a case report

F.  Ducuing,  M.F.  LeHeuzey * ,  V.  Rouyer,  M.C.  Mouren-Simeoni
Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France 

*Auteur correspondant.
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Le syndrome des pointes-ondes continues du sommeil (POCS) est une forme rare d'épilepsie qui peut se manifester par des troubles neurocognitifs et/ou psychiatriques, accompagnés ou non de crise clinique.

Observation. - Un enfant de cinq ans présentait un trouble du langage et des anomalies du comportement de type autistique. La pratique d'un électroencéphalogramme (EEG) a montré des pointes-ondes tempororolandiques gauches sans décharge critique. L'imagerie cérébrale a éliminé un processus extensif intracrânien. Un EEG de 24 heures a permis de porter le diagnostic de syndrome des POCS en montrant des décharges de pointes-ondes continues et diffuses au cours du sommeil à ondes lentes. L'évolution a été favorable grâce au traitement antiépileptique et à la rééducation orthophonique.

Conclusion. - Devant un trouble du langage complexe et des anomalies du comportement, il est nécessaire, même en l'absence de crise convulsive, de pratiquer un EEG à la recherche d'anomalies électriques. Malgré les incertitudes d'étiologie et de traitement concernant le syndrome des POCS, il semble nécessaire de traiter l'enfant par un antiépileptique. En effet, la normalisation de l'EEG sous traitement anticomitial s'accompagne habituellement d'une amélioration neuropsychologique significative bien que partielle. Par ailleurs, la prise en charge orthophonique reste utile et complémentaire au traitement pharmacologique.

Mots clés  : Pointes-ondes continues du sommeil ; Épilepsie ; Troubles du langage ; Troubles neuropsychologiques.

Abstract

Continuous spikes and waves during slow wave sleep syndrome (CSWS) is a seldom form of epilepsy which may manifest by neurocognitive and/or psychiatric abnormalities, with or without clinical seizures.

Case report. - A 5-year-old child was presented with a language disorder and behaviour abnormalities. A standard electroencephalograph (EEG) showed left tempororolandic spikes waves without any electrical discharges. Cerebral imaging excluded an underlying expansive disease. A continuous EEG recording revealed a CSWS syndrome by showing continuous and diffuse spike waves during slow wave sleep. Thanks to antiepileptic medications and orthophonic therapy, evolution was positive.

Conclusion. - In complex cases of language and behavioural disorders, it is necessary to perform an EEG even in the absence of convulsive seizures, to diagnose a CSWS syndrome. Given the etiological and treatment difficulties concerning the CSWS, a treatment with antiepileptic seems necessary. EEG normalisation under antiepileptic medications usually leads to significant, although partial, neuropsychological improvement. Furthermore, orthophonic therapy seems useful as a complement to pharmacological treatment.

Mots clés  : Epilepsy, psychic equivalent ; Language disorders ; Cognitive symptoms ; Antisocial personality disorder ; Electroencephalography ; Child.




© 2003  Elsevier SAS. All Rights Reserved.

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