Negative Epileptic Seizures

Negative seizures (Negative my oclonic-; atonic-1.1.4; astatic-1.1.5) are clinically defined as a lapse in activity including attention, tone, speech, and sensation (10). Negative seizures characterized by a fall or a head drop, in the absence of a motor phenomenon such as a convulsion, are broadly classified as falling seizures, drop attacks, or by the terminology proposed by the ILAE (1). These can be of partial or generalized onset and have been given many terms in the literature including astatic, akinetic, tonic, and drops. To better characterize and prognosticate, elec-tromyographic (EMG) recordings of the involved muscles during video-EEG can help assess tone fluctuations and distinguish tonic from atonic seizures. Drops of epileptic origin should be distinguished from other causes including syncope, cataplexy, and vestibular disease. The boxed case study #1 is an example of a falling seizure.

Case Study #1. A 6-year-old boy was brought to medical attention for balance difficulties. On further questioning, his mother reported "knee buckling" leading to stumbling and falls. Scalp EEG showed brief bursts of spike and wave discharges, maximal in the right parietal region during each "buckling" episode.

An example of a negative focal motor seizure is illustrated by case study #2.

Case Study #2. A 16-year-old female presented with episodic right hand weakness resulting in the dropping of objects. Initially this was thought to be a transient ischemic attack (TIA). An EEG later showed concomitant midline epileptiform discharges. Strength improved with resolution of each seizure (Figure 3.1.)

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