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Table 2. Differential diagnosis between typical absences and limbic tempor
Limbic CPS (mesial TLE)
History
Febrile convulsions Frequent; usually multiple, prolonged or com
Family history Usually of febrile convulsions; rarely of par
Onset Usually within the second half of the first de
Course (natural history) Often bi-phasic
Diurnal variation Non-specific
Ictal clinical features Frequent
Aura
Exceptional
Precipitation by HV Exceptional
Precipitation by IPS
Lapse of awareness Usually profound
Automatisms Almost invariably, often involving trunk an
automatisms associated with contralateral d
Clonic components 40% of patients late in the seizure
Rare; unilateral – if present – and late in the
Reactive automatisms Frequent
> 1 min duration As a rule
Non-convulsive status
Post-ictal symptoms/signs Exceptional
Inter-ictal EEG (scalp) Invariably confusion, recent memory deficit
dominant side. Relatively rapid clearing ma
Unilateral or bilateral independent temporal
activity. Brief bilateral and synchronous bur
in the context of obvious or occult secondar
Ictal EEG (scalp) Focal onset
Neurological examination Normal (a degree of facial asymmetry may
