Challenges in identifying Lennox–Gastaut syndrome in adults: A case series illustrating its changing nature

• Published in: Epilepsy & behavior case reports Vol. 5; no. C; pp. 38 - 43
• Main Authors: Piña-Garza, Jesus Eric, Chung, Steve, Montouris, Georgia D, Radtke, Rodney A, Resnick, Trevor, Wechsler, Robert T
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2016; Elsevier
• Subjects: Adult; Case Report; Diagnosis; Features; Lennox–Gastaut syndrome; LGS; Neurology; Symptoms; SW; EEG; SSW; Lennox–Gastaut syndrome; LGS; Adult; Features; Diagnosis; spike–wave discharge; electroencephalogram; slow spike–wave discharge; Symptoms; SSW, slow spike–wave discharge; LGS, Lennox–Gastaut syndrome; EEG, electroencephalogram; SW, spike–wave discharge
• ISSN: 2213-3232; 2213-3232
• DOI: 10.1016/j.ebcr.2016.01.004

Abstract The variable presentation and progression of Lennox–Gastaut syndrome (LGS) can make it difficult to recognize, particularly in adults. To improve diagnosis, a retrospective chart review was conducted on patients who were diagnosed as adults and/or were followed for several years after diagnosis. We present 5 cases that illustrate changes in LGS features over time. Cases 1 and 2 were diagnosed by age 8 with intractable seizures, developmental delay, and abnormal EEGs with 1.5–2 Hz SSW discharges. However, seizure type and frequency changed over time for both patients, and the incidence of SSW discharges decreased. Cases 3, 4, and 5 were diagnosed with LGS as adults based on current and past features and symptoms, including treatment-resistant seizures, cognitive and motor impairment, and abnormal EEG findings. While incomplete, their records indicate that an earlier LGS diagnosis may have been missed or lost to history. These cases demonstrate the need to thoroughly and continuously evaluate all aspects of a patient's encephalopathy, bearing in mind the potential for LGS features to change over time.