Epileptic drop attacks in partial epilepsy: clinical features,evolution, and prognosis

OBJECTIVES—Sudden falls have been described inpatients with partial epilepsy. However, no study has detailed theclinical, EEG, and evolutive features of partial epilepsies with drop attacks.
METHODS—In a consecutive series of 222 patientswith partial epilepsy admitted for uncontrolled seizures over a 10 yearperiod, 31patients presented with epileptic drop attacks duringevolution of their illness. Twenty two patients had frontal, fivetemporal, and four multifocal or undefinable lobe epilepsy; 74% of thecases showed an EEG pattern of secondary bilateral synchrony during evolution. A statistical comparison of some clinical and EEG features between the patients with epileptic drop attacks and patients withpartial epilepsy without drop attacks (control group of 191patients)was carried out.
RESULTS—Seventy four per cent of patients had apoor prognosis and 45% were mentally retarded; 52% of patients withepileptic drop attacks continued to have epileptic falls associatedwith partial seizures and mental deterioration at the end of the followup. These characteristics of patients with epileptic drop attacks weresignificantly different from the control group.
CONCLUSION—Almost all literature reports concurthat the physiopathogenetic substrate of epileptic drop attacks is amechanism of secondary bilateral synchrony. A localised epileptic focusmay lead to a process of secondary epileptogenesis involving the wholebrain, causing a progressive cerebral disturbance with worsening of the epileptic seizures and higher cerebral functions.