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REVIEW QUESTIONS

1. Do epileptiform abnormalities oblige the diagnosis of epilepsy?

2. What is dyshormia?

3. What is the distinction between simple and complex typical absence seizures?

4. What is the distinction between typical and atypical absence seizures?

5. What is the significance of OIRDA?

6. What is the characteristic EEG finding in JME?

7. What are features of the two benign occipital epilepsies of childhood?

8. What defines the syndrome of IS (West Syndrome)? What are its classical interictal and ictal EEG findings?

9. What defines LGS? What is the EEG of LGS?

10. What features are common to both LKS and CSWS?

REVIEW ANSWERS

1. No, epileptiform abnormalities may be seen in as many as 3.5% of healthy children. Therefore, epilepsy is a clinical diagnosis, supported by appropriate EEG findings.

2. Dyshormia is an abnormal paroxysmal feature intermixed with normal sleep elements in the EEG. Epileptiform features embedded within vertex waves, for example, represents dyshormia. It has been suggested to indicate the possibility of a lower than normal seizure threshold.

3. Simple absence seizures lack associated motor phenomena. Complex absence seizures have associated motor or autonomic elements.

4. Typical absence seizures have a sudden onset and offset and tend to be briefer. Their EEG illustrates a 3-Hz generalized spike-and-wave pattern. Atypical absence seizures have less clearly defined beginning and end, more change in tone, tend to last longer, and often are in the company of mental retardation and other seizure types. Their EEG typically has a slower frequency of 1.5 to 2.5 Hz, is more apt to be asymmetric, and usually has a slow background.

5. OIRDA is a childhood pattern of paroxysmal rhythmic delta activity, sometimes with admixed notched or spike elements. It is a nonspecific pattern, but seems to occur with great frequency in children with epilepsy, mostly absence epilepsy. However, it can be seen in other scenarios and need not be an epileptic finding.

6. JME is associated with a fast spike-and-wave pattern, 3.5- to 6-Hz spike-and-wave or polyspike-and-wave complexes. Photosensitivity occurs quite frequently.

7. The early form of benign occipital epilepsy involves children ages 2 to 12 yr having seizures involving vomiting, eye deviation, and altered awareness. The later type (age 3-16 yr) has visual seizures with visual hallucinations, feeling of ocular movement or pain, eye deviation, ictal blindness, and focal or generalized seizures. Both show giant spikes with morphologies resembling those of BRE.

8. IS is defined by a triad of myoclonic or tonic seizures, hypsarrhythmia, and mental retardation. The classic interictal finding is the hypsarrhythmia pattern involving high voltage and a disorganized background with multifocal spike and sharp waves. It is usually sleep activated. The classic ictal finding is the electrodecremental pattern with an initial generalized spike or sharp wave, then a diffuse attenuation of the EEG of variable duration.

9. LGS is a disorder characterized by mixed seizure types, mental retardation, and a slow (1.5-2.5 Hz) spike-and-wave pattern on EEG. Background slowing is typical. It is commonly a highly refractory epilepsy. Tonic seizures and interictal epileptiform discharges are both sleep-activated features in LGS.

10. Both LKS and CSWS are uncommon epilepsies with profound sleep activation. In both, the sleep EEG may become dominated by epileptiform activity, even to the level of ESES (>85% of slow wave sleep with paroxysmal features). In LKS, the discharges are thought to be more bitemporal and/or biparietal, whereas in CSWS discharges are more diffusely seen. Seizures accompany both syndromes, but the more devastating clinical problems are language regression (in LKS) and global behavioral regression (in CSWS). Treatments involve anticonvulsants and often corticosteroids for both.

Nerve Conduction Studies and Electromyography

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