1. Seizure semiology of these patients was not
included in the study. Semiology may be helpful to further classify
these patients as benign partial epilepsy in infancy with complex
partial seizures versus benign partial epilepsy in infancy
with secondary generalized seizures (SGS). Though, proposal was made
to combine these syndromes in the past, some subtle differences
exist such as predominant seizures during wakefulness, and temporal
ictal onset with the first entity, but mostly extratemporal seizure
onset was noted with the latter.
2. Did they have a normal magnetic resonance
imaging of brain? Focal cortical dysplasia is the most common cause
of symptomatic focal epilepsy in infants and should be ruled out in
these patients.
3. If any metabolic or genetic work-up was
performed? Caution should be exercised to rule out inborn error of
metabolism and chromosomal disorders, especially if differentiation
between prolonged postictal state and underlying encephalopathy is
difficult.
4. If any of these patients have gastroenteritis?
The other entity with similar presentation is ‘Benign convulsion
with mild gastroenteritis’, first described in Japan [2]; though
rare in other countries, directed history of diarrhea should to
taken in infants with clusters of seizures.
5. Though I agree with the authors’ finding that
recognition of this syndrome helps in avoiding long term
anti-epileptic therapy and treatment with antiepileptic medication
is not mandatory, benign nature of the condition is extremely
difficult to ascertain during initial presentation; and rather than
non-initiation of antiepileptic drugs, treatment for shorter time
period may be justifiable. Though suspicion of this entity is
possible to some extent, definite diagnosis can only be possible at
age 5 years in presence of normal psychomotor development [3].