Psychomotor Epilepsy in Childhood

The most poorly understood and most frequently misdiagnosed seizure state of childhood is psychomotor epilepsy. Difficulties in diagnosis are related to the variety of possible clinical manifestations which characteristically differ from one child to another. In addition, psychomotor epilepsy can occur at any age, even during infancy. Therefore, the child's ability to verbalize the perceptive and affective sensations of this seizure state is obviously limited by his chronologic age. The diagnostic dilemma is further complicated as physicians tend to confuse psychomotor seizures and petit ma! epilepsy. INCIDENCE AND ETIOLOGY The terms psychomotor and temporal lobe epilepsy are often used synonymously and interchangeably. At times the seizure state may also be called uncinate epilepsy, epileptic automatisms or epileptic fuges. However, not all psychomotor seizures are associated with temporal lobe lesions, nor is temporal lobe pathology always productive of psychomotor epilepsy. Abnormalities and electrical foci from areas other than the temporal lobe can produce this seizure state. For these reasons, the term psychomotor epilepsy is preferred, and temporal lobe epilepsy, if used, should be restricted to those psychomotor seizures that result from primary temporal lobe pathology. Ten to 20% of children in most pediatric seizure clinics have psychomotor epilepsy. Focal lesions are often considered to be the responsible etiologic factor, but diffuse encephalopathies, above all in children, are more commonly encountered. Prolonged febrile convulsions, perinatal trauma and hypoxia, craniocerebral trauma or meningoencephalitis can be the specific etiologic condition. Expansive lesions including neoplasms, vascular malformations, cysts and abscesses must be considered, especially when there is clinical or electrical evidence of a focal lesion.