Clinical features and clinical course

Complex partial seizures involving the temporal and frontal lobe is the most common condition, where complex neurological and psychiatric symptoms are seen in the same person. Complex symptoms include behavioural automatisms, perceptual alterations, changes in affect and memory, distorted thinking, and hallucinations. ^l,5.:2 Forms occurring in infancy and childhood include temporal lobe epilepsy, frontal-lobe epilepsy, infantile spasms, Lennox-Gastaut syndrome, Landau- Kleffner syndrome, and benign focal epilepsy.

Children with partial seizures and electroencephalographic evidence of frontal involvement have more severe formal thought disorders and deficits in communication discourse than those with temporal involvement. Because these seizures are rare in children, reports of symptoms are primarily found in case reports. For example, Saygi et alS53) and Stores et al.(54) have described sexual disinhibition, pressured and tangential speech, screaming, aggression, disorganized behaviour, and nightmares in children with epilepsy.

Frontal-lobe epilepsy should be considered if there are episodes of brief sudden unresponsiveness without loss of consciousness. These episodes occur with continued understanding of spoken language and clonic or tonic motor phenomena involving the face and arms bilaterally. Laughing, crying, pedalling movements, and sexual automatisms may also suggest this diagnosis. A normal electroencephalograph does not rule out the diagnosis. Left frontal hypometabolism on positron-emission tomography scanning or reduced cerebral blood flow to the frontal area, although not diagnostic, support this diagnosis.

The Lennox-Gastaut syndrome is characterized by early onset of intractable seizures and bilateral slow spike-wave complexes on the EEG. (52) The onset is typically between the ages of 1 and 7 years. The seizure pattern includes tonic, generalized tonic-clonic, atypical absence, atonic, and myoclonic seizures. Approximately half of children with the Lennox-Gastaut syndrome test as mentally retarded.(55) Marked language delay, overactivity, and irritability are characteristic. However, these behavioural symptoms may improve with seizure control. Ultimately, the diagnosis is based on the characteristic EEG finding of interictal slow spike-wave discharges in children with the early onset of poorly controlled seizures and a developmental disorder. In some instances, there is prolonged minor status epilepticus. Such episodes may last for several weeks during which the child engages in a variety of everyday activities but is socially unresponsive, aggressive, less articulate, and has minor twitching of the face and hands. This presentation must be differentiated from a psychiatric disorder.

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