LENNOX GASTAUT SYNDROME

Overview
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Seizure Classification
Generalized onset seizure
- Motor Onset
- Non-Motor Onset
Focal Onset Seizure
- By Onset Feature
- Focal to Bilateral Tonic-Clonic
- Hemispheric lateralization
- Lobar localization
  - Frontal
  - Temporal
  - Parietal
  - Occipital
Unknown Onset Seizure
Epilepsy Classification
Generalized Epilepsy
Focal Epilepsy
Generalized and Focal Epilepsy
Unknown Epilepsy
Epilepsy Syndromes
Neonatal/Infantile
- Self-limited neonatal seizures and Self-limited familial neonatal epilepsy
- Self limited familial and non-familial infantile epilepsy
- Early myoclonic encephalopathy
- Ohtahara syndrome
- West syndrome
- Dravet syndrome
- Myoclonic epilepsy in infancy
- Epilepsy of infancy with migrating focal seizures
- Myoclonic encephalopathy in non-progressive disorders
- Febrile seizures plus, genetic epilepsy with febrile seizures plus
Childhood
- Epilepsy with myoclonic-atonic seizures
- Epilepsy with eyelid myoclonias
- Lennox-Gastaut syndrome
- Childhood absence epilepsy
- Epilepsy with myoclonic absences
- Panayiotopoulos syndrome
- Childhood occipital epilepsy (Gastaut type)
- Photosensitive occipital lobe epilepsy
- Childhood epilepsy with centrotemporal spikes
- Atypical childhood epilepsy with centrotemporal spikes
- Epileptic encephalopathy with continuous spike-and-wave during sleep
- Landau-Kleffner syndrome
- Autosomal dominant nocturnal frontal lobe epilepsy
Adolescent/Adult
- Juvenile absence epilepsy
- Juvenile myoclonic epilepsy
- Epilepsy with generalized tonic-clonic seizures alone
- Autosomal dominant epilepsy with auditory features
- Other familial temporal lobe epilepsies
Any Age
- Familial focal epilepsy with variable foci
- Reflex epilepsies
- Progressive myoclonus epilepsies
Epilepsy Etiologies
Genetic Etiology
- Chromosomal abnormalities
- Gene abnormalities
Structural Etiology
- Malformations of cortical development
- Vascular malformations
- Hippocampal sclerosis
- Hypoxic-Ischemic
- Traumatic brain injury
- Tumors
- Porencephalic Cyst
Metabolic Etiology
Immune Etiology
- Rasmussen syndrome
- Antibody mediated
Infectious Etiology
Unknown Etiology
- Febrile infection related epilepsy syndrome
Epilepsy imitators

LENNOX GASTAUT SYNDROME

Background

The EEG background is abnormal in all cases from onset of seizures, with generalized or focal slowing.

CAUTION If there is prominent bi-parietal rhythmic theta right arrow consider epilepsy with myoclonic-atonic seizures.

Interictal

There may be focal or multifocal spike-and-wave or sharp-slow waves, with an anterior predominance. Slow (<2.5 Hz) spike-and-wave and paroxysmal fast activity (10 Hz or greater) in slow sleep are mandatory requirements. Periods of suppression of the EEG may occur.

CAUTION Fast spike-and-wave (3 Hz or higher) right arrow consider other epilepsy syndromes.

CAUTION Continuous spike-and-wave during slow sleep right arrow consider epileptic encephalopathy with continuous spike-and-wave during sleep or Landau Kleffner syndrome.

Activation

Hyperventilation (if adequate co-operation) may facilitate spike-and-wave and atypical absences. Slow (<2.5Hz) spike-and-wave and paroxysmal fast activity are prominent in slow sleep. Focal and multifocal abnormalities seen in the awake state become bisynchronous in sleep.

CAUTION If activation with intermittent photic stimulation right arrow consider epilepsy with myoclonic-atonic seizures.

Ictal

For ictal EEG patterns, refer to individual seizure types.