PARTIAL SEIZURES IN WEST SYNDROME

Purpose: To study the occurrence of partial seizures (PS) and elucidat e the characteristics of patients with West syndrome (WS) with PS. Met hods: We investigated the electroclinical and radiologic features in 9 2 children with WS who were older than 3 years at follow-up. Results: Thirty-six (39.1%) children had PS at some time during the course of t he disease. They had a significantly high incidence of asymmetric spas ms, hemiparesis, and asymmetric hypsarrhythmia, Their seizure prognosi s was significantly less favorable. PS appeared only before spasms (gr oup A, six children), concomitant with spasms (group B, 18 children), and only after spasms ceased (group C, 12 children). Five children in group B had PS after spasms stopped. PS in group A and during the peri od of active spasms in group B showed high seizure frequency and varia bility of both seizures and EEG manifestations. The PS and EEG epilept iform discharges were mainly in parietal-posterior temporal-occipital, and central regions. Late PSs in group B and PSs in group C were char acterized by stereotyped manifestations and relatively low seizure fre quency. These PSs originated mostly from frontal regions. Conclusions: In some children crith WS, cortical lesions can induce both PS and sp asms in series. whereas in others, both types of seizures occur with a bnormally increased excitability throughout the cortex rather than as the result of a single cortical lesion. These findings suggest caution in interpreting focal discharges, which may fluctuate and are not nec essarily indicative of a surgically accessible lesion. When the discha rges are a stable and correlate with an equally stable clinical patter n, the likelihood of an underlying cortical lesion is greater.