Abstract
The terminology used to describe epileptic falls has been a matter of controversy: a number of descriptions from the lowest level of fits (Jackson, 1886), to motor seizures with falling (Gastaut 1982), the distinctions between them being rather arbitrary.
The reason for the uncertainty encountered is the fact that all the events related to the falls take place very suddenly and end in a fraction of second, and therefore there are unavoidable technical limitations in documentation. With the advent of the CCTV-EEG, we can record and analyze epileptic falls more precisely.
In our study dealing with 48 falls in 15 patients with Lennox-Gastaut syndrome, a fall was defined as a complete loss of the maintenance of either standing or sitting posture, which took place within 1 second. Through precise analysis, it was possible to classify them into the following 4 types: a) tonic type, b) flexor-spasms type, c) myoclonic-atonic type, and d) atonic type. In contrast to the generally accepted view, it was found that atonic or myoclonic-atonic falls were rather exceptional. The patients whose falls were categorized as the flexor spasms type, which is remniscent of infantile spasms, in fact experienced in their past history West syndrome before it evolved to Lennox-Gastaut syndrome. The extreme pathophysiological complexity of epileptic falls is stressed.
