An analytic study of epileptic falls.

The subject of this study was a total of 48 epileptic falls or drop attacks in 15 children, captured by a self-tracking video monitoring system. A fall was defined as a complete loss of the maintenance of either standing or sitting posture, which took place within 1 s. The patients with epileptic falling attacks thus defined fulfilled the diagnostic criteria of Lennox-Gastaut syndrome. Through precise analysis of the ongoing sequence from the onset to the completion of the fall, it was possible to classify them into the following four types: (a) tonic type, 9 falls in five patients; (b) flexor spasms type, 25 falls in eight patients; (c) myoclonic-atonic type, 12 falls in three patients; and (d) atonic type, 2 falls in one patient. In contrast to the generally accepted view, it was found that atonic or myoclonic-atonic falls were rather exceptional. Seven of eight children whose falls were categorized as the flexor spasms type, which is reminiscent of infantile spasms in terms of clinical as well as EEG expressions, in fact experienced in their individual history West syndrome before it evolved to Lennox-Gastaut syndrome. In particular, the extreme pathophysiological complexity of epileptic falls or drop attacks is stressed.