CASE STUDY Epileptic falls and gait disturbance in two young children with a sharp wave focus at the vertex: a variant of benign partial epilepsy of childhood? VIRGINIE CHAVES VISCHER, 1 MALIN MAEDER-INGVAR, 2 FABIENNE PICARD, 3 CLAIRE MAYOR DUBOIS, 1 VERONIQUE DAVIDOFF, 1 THIERRY DEONNA, 1 CHARLES ANTOINE HAENGGELI, 4 ELIANE ROULET PEREZ 1 1 UniteÂdeNeuropeÂdiatrie, CHUVLausanne, 2 Explorations Fonctionnelles-EEG, Service de Neurologie, CHUV Lausanne, 3 Laboratoire d'EEG, Clinique de Neurologie, HUG, GeneÁve, 4 Ho Ãpital des Enfants, HUG, GeneÁve, Switzerland We describe two young children who presented with frequent falls and myoclonic jerks affecting the trunk and legs associated with a sharp and slow wave epileptic focus at the vertex. The initial neurological examination and brain magnetic resonance imaging were normal. Both patients had a persistent gait dysfunction, sometimes asymmetrical, fluctuating with the intensity of the epilepsy and the electroencephalogram abnormalities. The localization of the epileptic focus at the vertex, corresponding to the motor control of the legs and trunk, can explain this peculiar semiology. The seizures were difficult to treat, but one patient is currently in remission. Although epileptic falls are most often a feature of severe epilepsies of childhood, we think that these two patients present a variant of benign partial epilepsy of childhood. Keywords: Epileptic falls. Gait dysfunction. Vertex sharp and slow waves. Benign partial epilepsy. Introduction Epileptic falls in childhood occur in severe epileptic syndromes, such as Lennox±Gastaut syndrome or myoclonic±astatic epilepsy of early childhood. 1 Falls result from tonic, myoclonic or atonic seizures and are associated with various seizure types. Developmental outcome is often guarded. Epileptic falls can occur in normal children with benign partial epilepsy of childhood BPEC), in association with orofacial and absence seizures. 2 Some authors used the term `atypical benign partial epilepsy of childhood' ABPEC), 2 and others the name `pseudo-Lennox syndrome'. 3,4 The falls are due to partial or generalized seizures and in these patients, the epileptic activity is usually general- ized with a focus described in the centrotemporal regions. Recently Capovilla reported on two patients suffering from idiopathic partial epilepsy who presented repetitive falls and a sustained faecal incontinence, associated with a sharp and slow wave focus at the vertex. 5 We report on two young children with a partial epilepsy and a sharp and slow wave focus at the vertex, who presented with frequent falls and myoclonic jerks affecting the trunk and legs. In addition, they had a peculiar, more persistent but fluctuating asymmetry of gait, that we interpreted as an `epileptic gait disorder' as discussed by Neville. 6 The cerebral magnetic resonance imaging MRI) showed no lesion and we think that in these cases, the particular electroclinical picture repre- sents a variant of benign partial epilepsy of childhood. doi: 10.1053/ejpn.2002.0586 available online at http://www.idealibrary.com on European Journal of Paediatric Neurology 2002; 6: 169±178 0090±3798/02/06/0169+10 $35.00 & 2002 European Paediatric Neurology Society Received 24.09.01. Revised 31.01.02. Accepted 12.02.02. Correspondence: Virginie Chaves Vischer, Unite  de Neurope Âdiatrie, CHUV, 011 Lausanne, Switzerland Tel: +41 21 314 3563; Fax: +41 21 314 3558; e-mail: Virginie.Chaves-Vischer@bluewin.ch