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Mandatory seizures

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.

May have

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 Focal motor or focal to bilateral tonic-clonic status epilepticus persisting >30 minutes is rare (<5% of patients) and if present should lead to review of the diagnosis.

CAUTION Atypical absence seizures, focal atonic seizures and focal motor seizures with negative myoclonus with loss of balance and falls right arrow consider atypical childhood epilepsy with centrotemporal spikes.

CAUTION Prolonged focal non-motor seizures with prominent autonomic features, especially ictal vomiting right arrow consider Panayiotopoulos syndrome


Generalized tonic-clonic seizures during wakefulness.

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