LENNOX-GASTAUT SYNDROME (LGS)

Mandatory seizures

• Tonic seizures from sleep (in slow wave sleep or on wakening) are mandatory. These can be subtle (e.g. eye widening/rolling only) or there may be truncal (causing vocalization) and/or limb muscle contraction (e.g. arms elevating and flexing and legs either flexing or extending). The tonic contraction can be with a vibratory component. If the patient is standing, there may be a fall with risk of injury. Tonic status epilepticus can occur.
• The patient must have one other seizure type, from the list below.

May have

• Generalized tonic-clonic seizures
• Atypical absence seizures, atypical absence status epilepticus can occur
• Atonic seizures
• Myoclonic seizures
• Myoclonic-atonic seizures
• Non convulsive status epilepticus is common (seen in half of patients), and can be of long duration (days to weeks), during which time all seizure types may increase in frequency
• Focal seizures
• Epileptic spasms

CAUTION If recurrent, prolonged, hemiclonic seizures are seen before 1 year of age consider Dravet syndrome.

CAUTION If myoclonic-atonic seizures predominate consider epilepsy with myoclonic atonic seizures.