Landau-Kleffner syndrome: Difference between revisions
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'''For patient information, click [[Landau-Kleffner syndrome (patient information)|here]]''' | '''For patient information, click [[Landau-Kleffner syndrome (patient information)|here]]''' | ||
{{DiseaseDisorder infobox | | {{DiseaseDisorder infobox | | ||
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}} | }} | ||
{{SI}} | {{SI}} | ||
{{CMG}} | {{CMG}} ; {{AE}} {{ADI}} | ||
{{SK}} Infantile acquired aphasia; acquired epileptic aphasia; aphasia with convulsive disorder | {{SK}} Infantile acquired aphasia; acquired epileptic aphasia; aphasia with convulsive disorder | ||
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==Overview== | ==Overview== | ||
'''Landau-Kleffner syndrome''' is a rare, childhood [[neurologic]]al [[syndrome]] characterized by the sudden or gradual development of [[aphasia]] (the inability to understand or express language) and an abnormal [[Electroencephalography|electroencephalogram]] (EEG). Landau-Kleffner syndrome affects the parts of the brain that control comprehension and speech | '''Landau-Kleffner syndrome''' is a rare, childhood [[neurologic]]al [[syndrome]] characterized by the sudden or gradual development of [[aphasia]] (the inability to understand or express language) and an abnormal [[Electroencephalography|electroencephalogram]] (EEG). Landau-Kleffner syndrome(LKS) affects the parts of the [[brain]] that control comprehension and [[speech]]. Typically, children with LKS develop normally but then lose their [[language]] skills. While many of the affected individuals have clinical seizures, some only have electrographic [[seizures]], including electrographic status epilepticus of sleep (ESES). <ref name="urlLandau-Kleffner Syndrome Information Page: National Institute of Neurological Disorders and Stroke (NINDS)">{{cite web |url=http://www.ninds.nih.gov/disorders/landaukleffnersyndrome/landaukleffnersyndrome.htm |title=Landau-Kleffner Syndrome Information Page: National Institute of Neurological Disorders and Stroke (NINDS) |format= |work= |accessdate=}}</ref> | ||
Approximately 80 percent of the children with LKS have one or more epileptic seizures that usually occur at night. Behavioral disorders such as hyperactivity, aggressiveness and depression can also accompany this | Approximately 80 percent of the children with LKS have one or more epileptic seizures that usually occur at night. Behavioral disorders such as hyperactivity, aggressiveness and [[depression]] can also accompany this disorder. | ||
==Historical Perspective== | ==Historical Perspective== | ||
| Line 27: | Line 28: | ||
==Pathophysiology== | ==Pathophysiology== | ||
All of the children with LKS appear to be perfectly normal until their first seizure | All of the children with LKS appear to be perfectly normal until their first [[seizure]]. There have been no reports of children who have a family history of LKS. Therefore, LKS is not likely to be an inherited disorder. | ||
==Causes== | ==Causes== | ||
| Line 33: | Line 34: | ||
The cause of LKS is unknown. Some experts think there is more than one cause for this disorder. | The cause of LKS is unknown. Some experts think there is more than one cause for this disorder. | ||
== | == Differentiating Landau-Kleffner Syndrome from other Diseases== | ||
The syndrome can be difficult to diagnose and may be misdiagnosed as [[autism]], pervasive developmental disorder, hearing impairment, learning disability, auditory/verbal processing disorder,[[Attention-deficit hyperactivity disorder|attention deficit disorder]], mental retardation, childhood [[schizophrenia]], or emotional/behavioral problems. It can be confused with other epileptic disorders and can be differentiated depending upon the cognitive and behavioral regression. | The syndrome can be difficult to diagnose and may be misdiagnosed as [[autism]], [[pervasive developmental disorder]], [[hearing impairment]], [[learning disability]], auditory/verbal processing disorder,[[Attention-deficit hyperactivity disorder|attention deficit disorder]], [[mental retardation]], childhood [[schizophrenia]], or emotional/behavioral problems. It can be confused with other epileptic disorders and can be differentiated depending upon the cognitive and behavioral regression. | ||
{| class="wikitable" | {| class="wikitable" | ||
| Line 41: | Line 42: | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
! | ! Disease !! Clinical Features !! EEG Patterns | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| Autistic epileptiform regression || | | Autistic epileptiform regression<ref name="pmid16796825">{{cite journal |author=Canitano R, Zappella M |title=Autistic epileptiform regression |journal=Funct. Neurol. |volume=21 |issue=2 |pages=97–101 |year=2006 |pmid=16796825 |doi= |url=}}</ref> || Global regression during the second year that encompasses social skills || Centrotemporal spikes | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| | | Acquired epileptic aphasia<ref name="pmid20637551">{{cite journal |author=Deonna T, Roulet-Perez E |title=Early-onset acquired epileptic aphasia (Landau-Kleffner syndrome, LKS) and regressive autistic disorders with epileptic EEG abnormalities: the continuing debate |journal=Brain Dev. |volume=32 |issue=9 |pages=746–52 |year=2010 |month=October |pmid=20637551 |doi=10.1016/j.braindev.2010.06.011 |url=}}</ref> || Developmental language disturbance, autistic features || Epileptic spikes, electrical status epilepticus of sleep | ||
|- style="background:silver; color:black" | |- style="background:silver; color:black" | ||
| | | Electrical status epilepticus of sleep<ref name="pmid18555191">{{cite journal |author=Nickels K, Wirrell E |title=Electrical status epilepticus in sleep |journal=Semin Pediatr Neurol |volume=15 |issue=2 |pages=50–60 |year=2008 |month=June |pmid=18555191 |doi=10.1016/j.spen.2008.03.002 |url=}}</ref> || Global regression or auditory agnosia || Electrical status epilepticus of sleep | ||
| | |} | ||
==Epidemiology and Demographics== | |||
|- | Since description, almost 200 cases have been reported.<ref name="pmid21887181">{{cite journal |author=Bhardwaj P, Sharma VK, Sharma R, Gautam P |title=Acquired epileptic aphasia: Landau-Kleffner syndrome |journal=J Pediatr Neurosci |volume=4 |issue=1 |pages=52–3 |year=2009 |month=January |pmid=21887181 |pmc=3162843 |doi=10.4103/1817-1745.49114 |url=}}</ref> | ||
===Age=== | |||
Over 50% of the affected children present between the ages of three and eight years. | |||
===Gender=== | |||
There appears to be a male preponderance in an approximate male: female ratio of 2:1. | |||
==Natural History, Complications and Prognosis== | |||
===Natural History=== | |||
Generally, earlier manifestation of the disease correlates with poorer language recovery, and with the appearance of night seizures that last for longer than 36 months. LKS has a wide range of symptom differences and lacks a uniformity in diagnostic criteria between cases, and many studies don't include follow-ups on the patients, so no other relationships between symptoms and recovery have been made known | |||
===Prognosis=== | ===Prognosis=== | ||
There have not been many long-term follow-up studies of children with LKS. This lack of evidence, along with the wide range of differences among affected children, makes it impossible to predict the outcome of this disorder. Complete language recovery has been reported; however, language problems usually continue into adulthood. The continued language problems can range from difficulty following simple commands to no verbal communication. If recovery takes place, it can occur within days or years. So far, no relationship has been found between the extent of the language impairment, the presence or absence of seizures and the amount of language recovery. Generally, the earlier the disorder begins, the poorer the language recovery. | |||
== Diagnosis == | |||
=== History === | |||
A directed history has to be obtained to ascertain the onset of symptoms, duration and their prognosis. | |||
=== Symptoms === | |||
* [[Autism]] | |||
* [[Auditory agnosia]] or word deafness | |||
* [[Aphasia]] | |||
* [[Seizures]] | |||
* [[Hearing loss]] | |||
=== Physical Examination === | |||
====Neurologic==== | |||
* [[Hearing impairment]] | |||
* [[Mental retardation]] | |||
* If acquired aphasia is secondary to [[stroke]], [[hemiparesis]] can be noticed | |||
* Signs of increased [[intracranial tension]] in case of [[tumor]] | |||
** [[Bradycardia]] | |||
** [[Papilledema]] | |||
** Erratic respirations | |||
=== Laboratory Findings === | |||
====Electroencephalogram==== | |||
* Overnight sleep EEG is beneficial. | |||
* Findings of EEG | |||
** Activation and generalization of discharges | |||
** Continuous spike-and-wave discharges during slow-wave sleep | |||
[[Image:Landaukleffner.png|thumb|500 px|center|Continuous spike-and-wave discharges]] | |||
====MRI==== | |||
* Useful in excluding other causes of acquired [[aphasia]] like [[stroke]], [[neurocysticercosis]], [[tumors]] and [[cns infections]] | |||
====Other Imaging Findings==== | |||
* '''[[PET Scan]]''' | |||
The | ** Decreased metabolism of one or both [[temporal lobes]]. | ||
* '''Magnetoencephalography''' <ref>{{cite journal |author=Sobel DF, Aung M, Otsubo H, Smith MC |title=Magnetoencephalography in children with Landau-Kleffner syndrome and acquired epileptic aphasia |journal=AJNR Am J Neuroradiol |volume=21 |issue=2 |pages=301–7 |year=2000 |month=February |pmid=10696012 |doi= |url=}}</ref> | |||
** Evaluation of the [[aphasia]] | |||
** Presurgical localization of the electrical spike | |||
* '''Brain stem evoked potential''' <ref name="pmid9637098">{{cite journal |author=Zouari N, Choyakh F |title=[Early, middle-latency and late auditory evoked potentials in a case of acquired epileptic aphasia (Landau-Kleffner syndrome)] |language=French |journal=Rev Laryngol Otol Rhinol (Bord) |volume=118 |issue=4 |pages=267–70 |year=1997 |pmid=9637098 |doi= |url=}}</ref> | |||
** The amplitude of the middle latency and late cortical responses were decreased. | |||
==Treatment== | ==Treatment== | ||
Treatment for LKS usually consists of medications, such as [[anticonvulsant]]s and [[corticosteroid]]s, and speech therapy, which should be started early. | Treatment for LKS usually consists of medications, such as [[anticonvulsant]]s and [[corticosteroid]]s, and [[speech therapy]], which should be started early. | ||
Medication to control the seizures and abnormal brain wave activity (anticonvulsants) usually has very little effect on language ability. Corticosteroid therapy has improved the language ability of some children. Sign language instruction has benefited others. | Medication to control the [[seizures]] and abnormal brain wave activity (anticonvulsants) usually has very little effect on language ability. Corticosteroid therapy has improved the language ability of some children. Sign language instruction has benefited others. | ||
A controversial treatment option involves a surgical technique called [[multiple subpial transection]] in which multiple incisions are made through the [[Cerebral cortex|cortex]] of the affected part of the [[brain]], severing the [[axon]]al tracts in the subjacent [[white matter]]. | A controversial treatment option involves a surgical technique called [[multiple subpial transection]] in which multiple incisions are made through the [[Cerebral cortex|cortex]] of the affected part of the [[brain]], severing the [[axon]]al tracts in the subjacent [[white matter]]. | ||
==References== | ==References== | ||
{{reflist|2}} | |||
{{Mental and behavioural disorders}} | {{Mental and behavioural disorders}} | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Disease]] | |||
[[Category:Overview complete]] | [[Category:Overview complete]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 13:00, 10 August 2012
For patient information, click here Template:DiseaseDisorder infobox
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Synonyms and keywords: Infantile acquired aphasia; acquired epileptic aphasia; aphasia with convulsive disorder
Overview
Landau-Kleffner syndrome is a rare, childhood neurological syndrome characterized by the sudden or gradual development of aphasia (the inability to understand or express language) and an abnormal electroencephalogram (EEG). Landau-Kleffner syndrome(LKS) affects the parts of the brain that control comprehension and speech. Typically, children with LKS develop normally but then lose their language skills. While many of the affected individuals have clinical seizures, some only have electrographic seizures, including electrographic status epilepticus of sleep (ESES). [1]
Approximately 80 percent of the children with LKS have one or more epileptic seizures that usually occur at night. Behavioral disorders such as hyperactivity, aggressiveness and depression can also accompany this disorder.
Historical Perspective
This syndrome was first described in 1957 by Dr. William M. Landau and Dr. Frank R. Kleffner, who identified six children with the disorder.
Pathophysiology
All of the children with LKS appear to be perfectly normal until their first seizure. There have been no reports of children who have a family history of LKS. Therefore, LKS is not likely to be an inherited disorder.
Causes
The cause of LKS is unknown. Some experts think there is more than one cause for this disorder.
Differentiating Landau-Kleffner Syndrome from other Diseases
The syndrome can be difficult to diagnose and may be misdiagnosed as autism, pervasive developmental disorder, hearing impairment, learning disability, auditory/verbal processing disorder,attention deficit disorder, mental retardation, childhood schizophrenia, or emotional/behavioral problems. It can be confused with other epileptic disorders and can be differentiated depending upon the cognitive and behavioral regression.
| Disease | Clinical Features | EEG Patterns |
|---|---|---|
| Autistic epileptiform regression[2] | Global regression during the second year that encompasses social skills | Centrotemporal spikes |
| Acquired epileptic aphasia[3] | Developmental language disturbance, autistic features | Epileptic spikes, electrical status epilepticus of sleep |
| Electrical status epilepticus of sleep[4] | Global regression or auditory agnosia | Electrical status epilepticus of sleep |
Epidemiology and Demographics
Since description, almost 200 cases have been reported.[5]
Age
Over 50% of the affected children present between the ages of three and eight years.
Gender
There appears to be a male preponderance in an approximate male: female ratio of 2:1.
Natural History, Complications and Prognosis
Natural History
Generally, earlier manifestation of the disease correlates with poorer language recovery, and with the appearance of night seizures that last for longer than 36 months. LKS has a wide range of symptom differences and lacks a uniformity in diagnostic criteria between cases, and many studies don't include follow-ups on the patients, so no other relationships between symptoms and recovery have been made known
Prognosis
There have not been many long-term follow-up studies of children with LKS. This lack of evidence, along with the wide range of differences among affected children, makes it impossible to predict the outcome of this disorder. Complete language recovery has been reported; however, language problems usually continue into adulthood. The continued language problems can range from difficulty following simple commands to no verbal communication. If recovery takes place, it can occur within days or years. So far, no relationship has been found between the extent of the language impairment, the presence or absence of seizures and the amount of language recovery. Generally, the earlier the disorder begins, the poorer the language recovery.
Diagnosis
History
A directed history has to be obtained to ascertain the onset of symptoms, duration and their prognosis.
Symptoms
- Autism
- Auditory agnosia or word deafness
- Aphasia
- Seizures
- Hearing loss
Physical Examination
Neurologic
- Hearing impairment
- Mental retardation
- If acquired aphasia is secondary to stroke, hemiparesis can be noticed
- Signs of increased intracranial tension in case of tumor
- Bradycardia
- Papilledema
- Erratic respirations
Laboratory Findings
Electroencephalogram
- Overnight sleep EEG is beneficial.
- Findings of EEG
- Activation and generalization of discharges
- Continuous spike-and-wave discharges during slow-wave sleep
MRI
- Useful in excluding other causes of acquired aphasia like stroke, neurocysticercosis, tumors and cns infections
Other Imaging Findings
- PET Scan
- Decreased metabolism of one or both temporal lobes.
- Magnetoencephalography [6]
- Evaluation of the aphasia
- Presurgical localization of the electrical spike
- Brain stem evoked potential [7]
- The amplitude of the middle latency and late cortical responses were decreased.
Treatment
Treatment for LKS usually consists of medications, such as anticonvulsants and corticosteroids, and speech therapy, which should be started early.
Medication to control the seizures and abnormal brain wave activity (anticonvulsants) usually has very little effect on language ability. Corticosteroid therapy has improved the language ability of some children. Sign language instruction has benefited others.
A controversial treatment option involves a surgical technique called multiple subpial transection in which multiple incisions are made through the cortex of the affected part of the brain, severing the axonal tracts in the subjacent white matter.
References
- ↑ "Landau-Kleffner Syndrome Information Page: National Institute of Neurological Disorders and Stroke (NINDS)".
- ↑ Canitano R, Zappella M (2006). "Autistic epileptiform regression". Funct. Neurol. 21 (2): 97–101. PMID 16796825.
- ↑ Deonna T, Roulet-Perez E (2010). "Early-onset acquired epileptic aphasia (Landau-Kleffner syndrome, LKS) and regressive autistic disorders with epileptic EEG abnormalities: the continuing debate". Brain Dev. 32 (9): 746–52. doi:10.1016/j.braindev.2010.06.011. PMID 20637551. Unknown parameter
|month=ignored (help) - ↑ Nickels K, Wirrell E (2008). "Electrical status epilepticus in sleep". Semin Pediatr Neurol. 15 (2): 50–60. doi:10.1016/j.spen.2008.03.002. PMID 18555191. Unknown parameter
|month=ignored (help) - ↑ Bhardwaj P, Sharma VK, Sharma R, Gautam P (2009). "Acquired epileptic aphasia: Landau-Kleffner syndrome". J Pediatr Neurosci. 4 (1): 52–3. doi:10.4103/1817-1745.49114. PMC 3162843. PMID 21887181. Unknown parameter
|month=ignored (help) - ↑ Sobel DF, Aung M, Otsubo H, Smith MC (2000). "Magnetoencephalography in children with Landau-Kleffner syndrome and acquired epileptic aphasia". AJNR Am J Neuroradiol. 21 (2): 301–7. PMID 10696012. Unknown parameter
|month=ignored (help) - ↑ Zouari N, Choyakh F (1997). "[Early, middle-latency and late auditory evoked potentials in a case of acquired epileptic aphasia (Landau-Kleffner syndrome)]". Rev Laryngol Otol Rhinol (Bord) (in French). 118 (4): 267–70. PMID 9637098.