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. 
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. 
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.