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Refractory Epilepsy Screening Tool for Lennox-Gastaut Syndrome (REST-LGS)
Screens adults with drug-resistant epilepsy for possible Lennox-Gastaut syndrome.
Refractory Epilepsy Screening Tool for Lennox-Gastaut Syndrome (REST-LGS)
Two or more seizure types
Seizure onset at or before 12 years of age
History of EEG with generalized slow spike-wave discharges <=2.5 Hz
Cognitive impairment present since childhood
Persistent seizures despite trial of >=2 antiseizure medications
History of vagus nerve stimulation, ketogenic diet, or epilepsy surgery
Evidence of seizure-related helmet use, or head/face injury
Other EEG abnormalities (e.g. multifocal spikes, generalized discharges, paroxysmal fast activity)
Result0 points
Unlikely LGS - consider further evaluation for Lennox-Gastaut syndrome when "possible" or "likely".
- Category
- Unlikely LGS
When to use
- Screening adults or adolescents with drug-resistant epilepsy and intellectual/developmental disability who may have unrecognized Lennox-Gastaut syndrome.
Formula
4 major criteria worth 3 points each (>=2 seizure types; onset <=12 years; generalized slow spike-wave EEG <=2.5 Hz; childhood-onset cognitive impairment) plus 4 minor criteria worth 1 point each (persistent seizures on >=2 AEDs; history of VNS/ketogenic diet/epilepsy surgery; seizure-related injury; other EEG abnormalities). Total 0-16: <8 unlikely, 8-11 possible, >11 likely LGS.
Pearls and pitfalls
- Developed by modified Delphi consensus among epilepsy experts; the point-based scoring system was added and evaluated in a later real-world validation study.
- Missing EEG or seizure-onset-age data are common in adult charts and can bias the score toward "unlikely" - interpret low scores cautiously when major-criteria data are missing.
References
- Pina-Garza JE, Boyce D, Tworek DM, et al. The refractory epilepsy screening tool for Lennox-Gastaut syndrome (REST-LGS). Epilepsy Behav. 2019;90:148-153.
- Wolf SM, Boyce D, Pena P, et al. Real-world use of the updated refractory epilepsy screening tool for Lennox-Gastaut syndrome. Epilepsia Open. 2024;9(4):1277-1286.