The neurological examination is most likely to be abnormal in patients with which condition?

In patients with Lennox-Gastaut syndrome, the neurological examination is often abnormal due to the characteristic pattern of global cognitive impairment and significant seizure activity that affects various regions of the brain. This syndrome is marked by a spectrum of different types of seizures, including tonic, atonic, and atypical absence seizures, which can lead to developmental delays and intellectual disability. The combination of these seizures and cognitive deficits generally results in noticeable abnormalities in the neurological examination, reflecting the widespread effects of the condition on brain function.

In contrast, conditions like Rolandic epilepsy, juvenile myoclonic epilepsy, and absence seizures typically present with normal neurological examinations between seizure episodes. While these conditions involve seizures, they usually do not lead to significant cognitive impairment or neurological deficits, making the examination findings remain within normal limits when patients are not actively seizing. Thus, Lennox-Gastaut syndrome stands out due to its profound impact on both cognitive and neurological functioning.