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Atonic seizures in children with surgically remediable epilepsy: a motor system seizure phenotype? Volume 19, issue 3, September 2017

TEST YOURSELF

(1) Are there distinct electroclinical features of atonic seizures in early-onset structural epilepsy and can they change with age?

 

(2) Which cortical regions might be involved in ictal discharge during the emergence of atonic semiology?

 

(3) Can a paediatric patient with pharmacoresistant epilepsy and clinically generalized atonic semiology be a candidate for resective surgery?

 

 

 

 

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Answers

(1) According to our data, different electroclinical variants of focal-onset atonic seizures are likely to be encountered: “pure” atonic seizures, mimicking those of generalized syndromes and atonic seizures associated with lateralizing/focalizing electroclinical signs. Long-lasting generalized atonia was a predominant ictal feature in infancy and early childhood. At later age, it evolved into subtle segmental atonia and ictal semiology was dominated by positive motor signs.


(2) As demonstrated by SEEG recordings, the emergence of atonic semiology temporally correlated with a rapid discharge affecting both the lateral and mesial premotor and primary motor cortices. In the settings of structural epilepsy, ictal atonic semiology might not correspond to the involvement of just an isolated brain area, but could reflect a larger perturbation of the cortico-subcortical motor system networks.

 

(3) Early-onset epilepsy manifesting with atonic seizures should be considered for presurgical evaluation if other elements (clinical, EEG or neuroimaging) are suggestive of focal origin.

 

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