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Epileptic negative drop attacks in atypical benign partial epilepsy: a neurophysiological study
Yoshiko Hirano1, Hirokazu Oguni, Makiko Osawa
1Department of pediatrics, Tokyo women medical university, Shinjuku-ku, 162 Tokyo, Japan.
Insights
Drop attacks in atypical benign partial epilepsy (ABPE) are epileptic negative drop attacks originating from bilateral centro-temporo-parietal foci. These attacks involve proximal and axial muscles, differing from generalized epilepsy drop attacks.
Area of Science:
- Neurophysiology
- Epileptology
- Pediatric Neurology
Background:
- Atypical benign partial epilepsy (ABPE) can present with complex seizure manifestations.
- Understanding the neurophysiological underpinnings of drop attacks in ABPE is crucial for accurate diagnosis and management.
Observation:
- A pediatric case of ABPE exhibiting focal motor seizures, epileptic negative myoclonus (ENM), and drop attacks was analyzed.
- Video-polygraphic and computer-assisted back-averaging techniques were employed to study ENM and drop attacks.
Findings:
- Episodic drop attacks and ENM were time-locked to centro-temporo-parietal (CTP) spike-and-wave complexes (SWC).
- Drop attacks exhibited significantly larger SWC spike and slow-wave components compared to ENM episodes.
- Short latencies were observed between SWC onset and the manifestation of ENM and drop attacks.
Implications:
- Drop attacks in ABPE are characterized as epileptic negative drop attacks involving axial and proximal muscles.
- These findings differentiate ABPE-related drop attacks from those seen in generalized epilepsies like Lennox-Gastaut syndrome.
- This study provides insights into the specific neurophysiological mechanisms of drop attacks in ABPE.
Purpose:
We conducted a computer-assisted polygraphic analysis of drop attacks in a child with atypical benign partial epilepsy (ABPE) to investigate neurophysiological characteristics.
Subject And Methods:
The patient was a six-year two-month-old girl, who had started to have focal motor seizures, later combined with daily epileptic negative myoclonus (ENM) and drop attacks, causing multiple injuries. We studied episodes of ENM and drop attacks using video-polygraphic and computer-assisted back-averaging analysis.
Results:
A total of 12 ENM episodes, seven involving the left arm (ENMlt) and five involving both arms (ENMbil), and five drop attacks were captured for analysis. All episodes were time-locked to spike-and-wave complexes (SWC) arising from both centro-temporo-parietal (CTP) areas. The latency between the onset of SWC and ENMlt, ENMbil, and drop attacks reached 68 ms, 42 ms, and 8 ms, respectively. The height of the spike as well as the slow-wave component of SWC for drop attacks were significantly larger than that for both ENMlt and ENMbil (p < 0.05).
Conclusion:
Drop attacks were considered to be epileptic negative myoclonus involving not only upper proximal but also axial muscles, causing the body to fall. Thus, drop attacks in ABPE are considered to be epileptic negative drop attacks arising from bilateral CTP foci and differ from drop attacks of a generalized origin seen in Lennox-Gastaut syndrome and myoclonic-astatic epilepsy.
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