Seizures with fronto-parietal opercular features occur, with hemifacial (lip, mouth and tongue) clonic movements (which may be unilateral), laryngeal symptoms, articulation difficulty (aphasia), swallowing or chewing movements and hyper-salivation. Seizures are typically brief (<5 minutes), usually few in number (most have less than 10 seizures) and may occur sporadically, with frequent seizures seen over a few days or weeks and then several months until the next seizure.
NOTE the terms fronto-parietal opercular, centrotemporal, sylvian and rolandic seizures are synonymous, referring to seizures involving the region around the central sulcus. However, in typical seizures that occur in this epilepsy syndrome, cognitive (e.g. gustatory hallucinations), emotional (e.g. fear), and autonomic features are not seen.
Seizures may evolve to clonic activity in the ipsilateral upper limb, to ipsilateral hemiclonic seizure, or to a focal to bilateral tonic-clonic seizure (bilateral upper limb or bilateral upper and lower limb clonic activity; typically nocturnal events). Todds paresis may be seen after seizures.
CAUTION Atypical absence seizures, focal atonic seizures and focal motor seizures with negative myoclonus with loss of balance and falls consider atypical childhood epilepsy with centrotemporal spikes.
Generalized tonic-clonic seizures during wakefulness.