What are the key features to differentiate between common childhood epilepsy syndromes during a clinical assessment?

During a clinical assessment to differentiate common childhood epilepsy syndromes, key features include:

• Detailed history taking: Obtain a comprehensive history of the seizure event, including onset age, seizure type, duration, frequency, and any precipitating factors, using eyewitness accounts or video footage if available to characterize seizure semiology accurately.
• Seizure type and syndrome-specific features: Identify seizure types such as generalized tonic-clonic, absence, myoclonic, or focal seizures, and note syndrome-specific patterns like the early onset and severe febrile seizures in Dravet syndrome.
• Age of onset: Different epilepsy syndromes have characteristic age ranges; for example, infantile spasms occur in children under 2 years, while self-limited epilepsy with centrotemporal spikes typically presents in school-aged children.
• EEG findings: Use routine EEG, ideally within 72 hours of a seizure, to support diagnosis and identify epilepsy syndromes by characteristic patterns such as generalized spike-and-wave discharges in absence epilepsy or centrotemporal spikes in benign epilepsy with centrotemporal spikes.
• Neuroimaging: MRI is recommended to identify structural causes or syndrome-specific brain abnormalities, except in idiopathic generalized epilepsies or self-limited epilepsy with centrotemporal spikes where imaging may be less critical.
• Risk factors and comorbidities: Consider associated features such as developmental delay, cognitive impairment, or family history that may point towards specific syndromes like Dravet syndrome.
• Referral to specialists: Early referral to paediatric neurologists with expertise in epilepsy is essential for accurate syndrome diagnosis and management planning.

These features collectively help differentiate childhood epilepsy syndromes during clinical assessment and guide appropriate investigations and treatment decisions.