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Seizures involving the supplementary sensorimotor area in children: a video-EEG analysis
M B Connolly1, L Langill, P K Wong
1Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Insights
Supplementary sensorimotor seizures, often seen in adults, typically begin in childhood. This study details 12 children, finding similar clinical features to adults, highlighting the need for accurate diagnosis in pediatric epilepsy.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Clinical Neurophysiology
Background:
- Supplementary sensorimotor seizures are frequently reported in adults with refractory epilepsy.
- However, these seizures typically manifest in childhood, suggesting a diagnostic gap.
Purpose of the Study:
- To describe the electroclinical characteristics of supplementary sensorimotor seizures in a pediatric cohort.
- To compare pediatric presentations with adult reports and identify diagnostic challenges.
Main Methods:
- Retrospective analysis of 12 children diagnosed with supplementary sensorimotor seizures via video-EEG.
- Inclusion criteria: bilateral tonic posturing, preserved consciousness, no postictal confusion.
Main Results:
- Sensory auras reported in 8/9 older children; speech arrest in all assessed.
- Subtle ictal EEG changes and normal interictal EEGs (49%) were common.
- Etiology identified in only 2/12; brain imaging normal in 10/12.
Conclusions:
- Pediatric supplementary sensorimotor seizures share clinical features with adult cases.
- Misdiagnosis is a significant concern across all age groups.
- Effective seizure control was achieved with antiepileptic drugs in 50% of cases.
Abstract:
Most reports of supplementary sensorimotor seizures have been of adults with medically refractory epilepsy. Typically, supplementary sensorimotor seizures have onset in childhood. We describe the electroclinical features in 12 children. Cases were selected from an EEG laboratory population in whom video-EEG was performed routinely on all children. Supplementary sensorimotor seizures were diagnosed when there was bilateral tonic posturing of the upper or lower extremities, preserved consciousness, and lack of postictal confusion. Sensory auras were reported by 8 of 9 children aged > 3 years who had daytime seizures. Speech arrest occurred in all patients in whom it could be assessed, and abnormal vocalization was observed in 7 children. Interictal EEGs were often normal (49% of recordings), and ictal EEG changes could be subtle. An etiology was demonstrated in only 2 children, and brain imaging studies were normal in the other 10 patients. Seizures were controlled with antiepileptic drugs (AEDs) in 6 of the 12 children. The clinical manifestations of supplementary sensorimotor seizures in children are similar to those reported in adults; misdiagnosis is common at all ages.