Abstracts

Rationale: “Tonic automatic attacks” were first described by Oller Daurella (1970) in patients with lennox gastaut syndrome (LGS). The aim of this study is to further delineate the electroclinical features of this unusual seizure type, which is currently not recognised in the ILAE classification of epileptic seizures (1981). Methods: Retrospective analysis of all patients with generalized epilepsies who were examined in our epilepsy monitoring unit from 1999-2007. Six patients demonstrated clinical and eeg patterns corresponding to the description of “tonic automatic attacks”. Results: Six patients [5 w, mean age 29 yrs (range 17-44), mean age at seizure manifestation 10 yrs (range 1-28 yrs)] were studied. All patients showed cognitive dysfunction (4 mild, 1 moderate, 1 severe). MRI was normal except for one patient, which exhibited a posttraumatic gliotic lesion over the left temporal region following a brain trauma due to a seizure. A total of 163 seizures could be recorded. The main clinical features characterizing “tonic automatic attacks" were tonic phenomena of the neck and / or both upper limbs followed by arrest, clouded consciousness and oral or gestural automatisms. Ictal EEGs demonstrated generalised fast rhythmic activity with consecutive slowing in three patients, generalised spike wave activity with following generalised fast activity in two patients and in one further patient initial right temporal rhythmic activity with consecutive hythmic generalised delta slowing was recorded. Interictal EEGs showed generalized epileptiform activity in all patients (ie generalised polyspike- waves, generalised slow sharp waves, generalised fast activity), an independent right temporal slowing was recorded in one. We suggested a cryptogenic generalized epilepsy in all patients, a LGS was diagnosed in two. Conclusions: Tonic automatic attacks should be classified as generalized seizures. They can be observed in several cryptogenic generalized epilepsies, not only in LGS.