Eight patients matching the description of benign partial seizures of adolescence (BPSA), as described by Loiseau et al in 1978, were found among 92 teenagers, including 37 with new-onset focal seizures, enrolled in a prospective first-seizure study at the University of Melbourne, Victoria, Australia. Four of the 8 patients with BPSA were boys and 4 girls, aged 11-17 years. All seizures were Jacksonian in pattern, with a sensory/motor march, 6 were secondarily generalized, and 2 had only simple partial seizures before referral. The initial EEG was normal in 6; subsequent sleep deprived EEGs showed focal epileptiform transients in 3. Postictal recordings showed unilateral multifocal epileptiform discharges in one and a single occipital discharge in one. MRI was normal in all patients. Three were treated with carbamazepine for 2 years, and one had seizure recurrence after discontinuing treatment. Three had infrequent simple partial seizures at 2 year follow-up. [1]
COMMENT. Partial seizures of adolescence, characterized by a sensory/motor march, can be idiopathic and relatively benign, and may not invariably require antiepileptic therapy. The authors present a group of patients with so-called “benign partial seizures of adolescence,” representing 22% of new-onset focal seizures in teenagers enrolled in a prospective study.
When to start and stop anticonvulsant therapy is a question reviewed by Greenwood RS, Tennison MB [2]. In general, AEDs should be withheld until after a second seizure and tapered after 2 years without seizures. The risks and benefits are discussed. In practice, the decision must be individualized and a general rule does not apply.