The evolution of epileptic syndromes in 75 children with EEG-confirmed epilepsies of neonatal onset was studied at Nagoya University, Japan. Seizures were partial in 63 (84%) patients followed for a minimum of 3 years, including 23 with benign neonatal convulsions; generalized in 9; and both generalized and partial in 3. Partial seizures occurred with idiopathic and symptomatic epilepsies, whereas generalized seizures were present mainly in early infantile epileptic encephalopathy. Seizures were cryptogenic in 7 infants, despite intractable partial seizures, and none developed into other epileptic syndromes. Of 44 patients with symptomatic epilepsies, 18 (41%) developed West syndrome (WS). Fifteen of these WS patients had presented with localization-related epilepsy as neonates, and of these, 7 developed localization-related epilepsy after WS was diagnosed. [1]

COMMENT. Benign neonatal convulsions, classified as generalized epilepsies in the International Classification, should be reclassified as partial, localization-related epilepsy. The term “age-dependent epileptic encephalopathy” is usually applied to cases of early infantile epileptic encephalopathy which evolve into West syndrome and later Lennox-Gastaut syndrome. Symptomatic localization-related epilepsy with transient West syndrome in infancy is recognized as an additional age-dependent epileptic syndrome.

The burst-suppression electroencephalogram is discussed by Niedermeyer E et al [2]. Generalized burst-suppression (BS) in the EEG may occur with ‘Early Infantile Epileptic Encephalopathy’ (Ohtahara syndrome) and ‘Early Myoclonic Encephalopathy’ (Aicardi and Goutieres). It is also observed in deep stages of anesthesia and sedative overdose, with cardiorespiratory arrest, anoxia, and undercutting of the cortex. “The term BS should not be applied to the brief flat stretches that may occur during NREM sleep in infants with hypsarrhythmia.”