MDCalc

Refractory Epilepsy Screening Tool for Lennox–Gastaut Syndrome (REST-LGS)

Provides diagnostic criteria for Lennox-Gastaut Syndrome (LGS).

Major criteria

≥2 seizure types

Seizure onset before age of 12 years

History of EEG with generalized slow spike-and-wave (SSW) discharges (<2.5 Hz)

Cognitive impairment since childhood

May include past or current learning difficulties, history of special education, autism, intellectual disabilities, or developmental delays.

Minor criteria

Persistent seizures despite trial of ≥2 antiseizure medications

History of vagal nerve stimulator (VNS), ketogenic diet, or epilepsy surgery

Evidence of seizure-related helmet use, or head or face injuries

One of the following EEG abnormalities: multifocal spikes, symptomatic generalized discharges, generalized polyspikes, generalized periods of attenuation of background/electrodecrement, or paroxysmal fast activity

Result:

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Advice
  • This tool does not provide a definitive diagnosis of LGS; always interpret the score in the context of clinical judgment, patient history, and a full neurologic work‑up, with specialist input as needed.
  • LGS is a clinical diagnosis with diverse etiologies; the following investigations may aid in the evaluation:
    • EEG: To document characteristic interictal slow spike‑and‑wave or paroxysmal fast activity.
    • Brain MRI: To identify structural brain abnormalities.
    • Genetic testing, including epilepsy gene panel and chromosomal microarray: To detect pathogenic variants associated with LGS.
    • Metabolic testing: Consider when imaging and genetic testing are unrevealing to evaluate for neurometabolic disorders.
    • Referral to a comprehensive epilepsy center: For specialist evaluation and multidisciplinary management.
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