The syndrome of partial seizures in infancy

Partial seizures, the most frequent type of epilepsy at all ages, remain a distinct yet relatively understudied disorder in early life. Their true incidence has not been defined, despite an extremely unfavorable long-term prognosis. They differ from partial seizures presenting later in life in several important aspects and are prone to misdiagnosis because of the difficulties inherent in recognizing subtle seizure manifestations and in assessing level of consciousness in very young patients. Most seizures are symptomatic of assorted prenatally acquired hemispheric insults; perinatal damage and tumors are less common. Video-electroencephalographic studies indicate that the majority of ictal events consist of behavioral arrest, stereotyped automatisms, and motor phenomena. Oroalimentary and gross motor automatisms are frequent, whereas highly organized gestural and behavioral sequences are extremely rare. Lateralized or asymmetric tonic, clonic, and occasional myoclonic motor manifestations characterize the majority of episodes. Pure behavioral arrest is much less common. These seizure patterns imply immaturity of systems responsible for inhibiting access to motor pathways and for organizing motor expression. Ictal and interictal epileptiform discharges are often focal or lateralized but lack age-specific features. Although as a rule partial seizures persist, some individuals display generalized or mixed seizure disorders in later life.