The neurological examination is most likely to be abnormal in patients with which type of epilepsy?

In patients with Lennox-Gastaut syndrome, the neurological examination is often abnormal due to the complex and severe nature of this type of epilepsy. This syndrome typically presents in early childhood and is characterized by multiple seizure types, including atonic, tonic, and atypical absence seizures. In addition to seizures, patients frequently exhibit cognitive impairment, behavioral issues, and developmental delays. These factors contribute to a range of neurological abnormalities that can manifest during a clinical examination, such as differences in muscle tone, reflexes, and coordination.

Moreover, Lennox-Gastaut syndrome is often associated with underlying structural brain abnormalities or diffuse cerebral dysfunction, which further emphasizes the likelihood of an abnormal neurological exam. In contrast, the other types of epilepsy listed, such as juvenile myoclonic epilepsy, rolandic epilepsy, and focal epilepsy, typically do not present with such extensive neurological deficits, and patients may have relatively normal neurological examinations except during active seizure episodes.