Differential Diagnosis for 3 Hz Generalized Spike Wave Discharge in a 5-year-old
- Single most likely diagnosis:
- Typical Absence Seizures: This is the most likely diagnosis due to the characteristic 3 Hz generalized spike-wave discharge on EEG, which is a hallmark of typical absence seizures. These seizures are common in childhood, typically starting between the ages of 4 and 10 years, and are characterized by brief, sudden lapses in consciousness.
- Other Likely diagnoses:
- Atypical Absence Seizures: Although less common than typical absence seizures, atypical absence seizures can also present with generalized spike-wave discharges, though often at a slower frequency. They are more commonly associated with other types of epilepsy and developmental delays.
- Myoclonic Seizures: Myoclonic seizures can sometimes be associated with generalized spike-wave discharges and may be considered in the differential, especially if there are myoclonic jerks accompanying the seizures.
- Do Not Miss diagnoses:
- Juvenile Myoclonic Epilepsy (JME): Although JME typically presents in adolescence, it's crucial not to miss this diagnosis as it requires long-term management. JME can present with myoclonic seizures, generalized tonic-clonic seizures, and sometimes absence seizures, all of which can be associated with generalized spike-wave discharges.
- Lennox-Gastaut Syndrome: This severe form of epilepsy can present with various seizure types, including atypical absences, and is associated with a specific EEG pattern that includes slow spike-wave discharges. It's essential to consider this diagnosis due to its significant impact on the quality of life and the need for aggressive management.
- Rare diagnoses:
- Subacute Sclerosing Panencephalitis (SSPE): A rare but fatal condition caused by a persistent measles virus infection. It can present with myoclonic seizures and generalized spike-wave discharges on EEG. Given its poor prognosis, it's essential to rule out SSPE in any child presenting with unexplained seizures and EEG abnormalities.
- Lafora Disease: A rare genetic disorder characterized by progressive myoclonus epilepsy, which can present with generalized spike-wave discharges. It typically starts in late childhood or early adolescence and leads to severe disability and death.