The classification of epilepsy syndromes made initially on the basis of information at time of diagnosis was compared to that made 2 years later in a cohort of 613 children, followed by participating physicians in Connecticut, between 1993 and 1997. After 2 years, syndrome classifications were the same in 86% of the cohort. The diagnosis was changed in 10% (mainly incomplete syndromes), and syndrome evolution, mainly West to Lennox-Gastaut, occurred in 4%. Significant changes were rare. [1]

COMMENT. The identification of epileptic syndromes, for the most part, may be made accurately at the time of the initial presentation and diagnosis. Changes in diagnosis at follow-up, necessary in only 14%, are explained by difficulties in classification of incomplete syndromes and the evolution of West to Lennox-Gastaut syndomes with age and maturation.

Epileptic syndromes posing problems in diagnosis. Hirsch E et al (Strasbourg, France) review the heterogeneous nature and clinical management of partial epilepsies and incomplete syndromes. BECTS are the most common idiopathic localization-related epilepsy, and may be triggered by carbamazepine in some cases. Primary reading epilepsy and idiopathic occipital lobe epilepsies with photosensitivity are an overlap of idiopathic localization-related and generalized epilepsies, and respond to sodium valproate. Other variants of idiopathic localization-related epilepsies include autosomal dominant nocturnal frontal lobe epilepsy and benign familial infantile convulsions. AED resistance can be due to errors in diagnostic classification of these epilepsy syndromes. EEG-video evaluation may be necessary in refractory seizures. [2]

Post-ictal paralysis in BECTS. Dai A et al (State University of New York, Buffalo, NY) found a 9% association of post-ictal paresis among 68 children with benign rolandic epilepsy, and 50% had brief post-ictal aphasia. Todd’s paresis and aphasia do not exclude the diagnosis of BREC, and these transient complications are clinically benign. [3]