~6% of epilepsies that start before the age of 3 years.
~1/30,000 live births.
Age at onset
First year of life at a peak age of 5 months.
Males (66%) predominate.
Neurological and mental state
Normal prior to the onset of seizures.
Mostly genetically determined with mutations in sodium channel genes. It is the most severe phenotype of autosomal dominant epilepsy with FS+.
Tetrad of seizures: (1) early infantile febrile clonic convulsions; (2) myoclonic jerks; (3) atypical absences; and (4) complex focal seizures.
Three periods of evolution: (1) relatively mild with clonic seizures usually occurring during febrile illnesses; (2) relentlessly aggressive period with numerous myoclonic, atypical absence and complex focal seizures and status epilepticus lasting for hours or days; and (3) static period where seizures improve but serious and residual mental and neurological abnormalities remain forever.
On arousal and during alert states; uncommon in sleep (3%).
Febrile illnesses raised body temperature, hot baths, photic and pattern stimulation, movements, and eye closure.
MRI shows mild and non-specific abnormalities. Metabolic tests and skin and muscle biopsies are normal; mitochondrial cytopathy is exceptional.
Background progressively becomes slow, with frequent and severe generalized polyspikes-slow waves and 2 Hz spike-slow waves. Multifocal abnormalities of spikes and slow waves are common.
Varies according to the type of seizure.
Seizure deterioration, mental and neurological decline is relentless and often fatal.
Febrile convulsions, Lennox-Gastaut syndrome, EM-AS, benign myoclonic epilepsy in infancy, progressive myoclonic epilepsies.
Seizures are intractable to any AED. Carbamazepine, phenytoin and lamotrigine are contraindicated.
Early treatment of infectious diseases and hyperthermia (triggering factors of status epilepticus) are mandatory.
*Expert opinion, please check FDA-approved indications and prescribing information
This page was adapted from:
The educational kit on epilepsies
The epileptic syndromes
By C. P. Panayiotopoulos
Originally published by MEDICINAE
21 Cave Street, Oxford OX4 1BA
First published 2006 and reprinted in 2007
Reviewed and revised June 2008 by Steven C. Schachter, MD
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