The Lennox-Gastaut syndrome (LGS) is the prototypic encephalopathic generalized epilepsy with an electroclinical profile that includes frequent uncontrolled mixed seizures, mental retardation, and slow-spike-and-wave (SSW) on EEG. Epileptic spasm (treated with ACTH) may precede LGS and some seizures may appear bizarre and falsely mimic "pseudoseizures". Tonic seizures are characteristic and maybe subclinical with video-EEG disclosing variable degrees of posturing during bursts of low-voltage ictal fast activity evolving (above) or as bursts of GPFA. Tonic-clonic, atypical absence, and myoclonic seizures may also co-exist and occur as status epilepticus though commonly resulting in injury. In this case vEEG demonstrated that all the events were epileptic and were not appropriately treated with continuing behavioral modification. VNS was effective in reducing generalized seizures. Corpus callosotomy was offered with potentially greater efficacy but associated with a higher risk of complications1.
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