Common generalized epilepsy. The so-called idiopathic or centrencephalic epilepsy.

Abstract

There is reason to presume the existence of an epileptological disease entity called ‘common generalized epilepsy’ (CGE) with generalized-synchronous seizure discharges and strictly nonfocal seizures (petit mal, grand mal, myoclonus) occurring chiefly in the age range from 4 to 16 years. There is no evidence of causative pathology. The basic functional disturbance is likely to involve arousal mechanisms (‘dyshormia’) and/or photosensitivity. The genetic factor is highly complex. This entity must be differentiated from electrically or epileptologically very similar conditions. Among 300 epileptics with predominantly generalized seizure discharges in the EEG, only 20% (61 patients) fell into the category or ‘pure’ CGE; another 24% (72 patients) were listed as atypical CGE and showed additional minimal focal abnormalities or evidence of insult to the brain in the history. Other conditions giving rise to generalized seizure discharges are hereditary essential myoclonus epilepsy (Lafora-Unverricht-Lundborg), deep seated lesions (hypothalamus, mesencephalon) and metabolic disturbances; this group amounted to no more than 4% (12 patients). A primary cortical epileptogenic focus giving rise to ‘secondary bilateral synchrony’ was presumed in 9% (26 patients). A large group of 125 patients (42%) were characterized by slow spike-wave complexes and mental retardation (Lennox-Gastaut syndrome). The 4 remaining patients (1%) had slow spike-wave complexes but represented an unusual type of post-traumatic epilepsy without the ictal-clinical symptomatology of the Lennox-Gastaut syndrome. The physiopathogenesis of CGE and its generalized seizure patterns is discussed.