Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit.

Purpose: We set out to determine clinical and EEG features of seizures presenting with falls, epileptic drop attacks and atonia in the video EEG monitoring unit.

Methods: We searched the video EEG monitoring reports over a 5-year-period for the terms "drop", "fall" and "atonic".

Results: Seizures presenting as epileptic drop attacks, falls or atonia were found in 23/1112 (2%) admissions. About half of the patients suffering from these seizure types had developmental delay and learning difficulties and in half of the patients a lesion was seen on MRI which was often frontal. The presumed epileptogenic zone was frontal in many cases (43%), unclear with regards to a region or multifocal in 48% and posterior temporal/occipital in 2 patients (9%). EEG patterns recorded were paroxysmal fast activity, spike and wave discharges and EEG attenuation. Seizure related falls were seen in 8 cases (34%) with injuries recorded during Video EEG monitoring in half of those.

Conclusion: Clinical and EEG features outlined here can help the clinician to recognise patients at risk for these devastating seizure types.