Typically, the following triad of attack types appears; while the three types usually appear simultaneously, they also can occur independently of each other:
Lightning attacks: Sudden, severe myoclonic convulsions of the entire body or several parts of the body in split seconds, and the legs in particular are bent (flexor muscle convulsions here are generally more severe than extensor ones). Nodding attacks: Convulsions of the throat and neck flexor muscles, during which the chin is fitfully jerked towards the breast or the head is drawn inward. Salaam or jackknife attacks: a flexor spasm with rapid bending of the head and torso forward and simultaneous raising and bending of the arms while partially drawing the hands together in front of the chest and/or flailing. If one imagined this act in slow motion, it would appear similar to the Muslim ceremonial greeting (Salaam), from which this type of attack derives its name. Cause
It is still unknown which bio-chemical mechanisms lead to the occurrence of West syndrome. It is known to be a malfunction of neurotransmitter function, or more precisely, a malfunction in the regulation of the GABA transmission process. Another possibility being researched is a hyper-production of the corticotropin-releasing hormone (CRH). It is possible that more than one factor is involved. Both hypotheses are supported by the effect of certain medications used to treat West syndrome.Cases of epilepsy have been historically divided into three different groups: symptomatic, cryptogenic, and unknown.
The International League Against Epilepsy (ILAE) in 2011 recommended abandoning these terms for reasons of clarity and instead trying to place individual cases into one of the following three groups: genetic, structural/metabolic, and unknown. The new terms are more immediately clear in their meaning, except that the structural and metabolic group includes cases that have a genetic component that does not always directly lead to the condition. Only the genetic grouping has a known direct genetic cause. "Unknown" cases may be of unknown genetic, structural, metabolic, or other unknown cause.The old terminology was defined by the ILAE as follows:
symptomatic:  the epilepsy is the consequence of a known or suspected disorder of the central nervous system. cryptogenic: this refers to a disorder whose cause is hidden or occult. Cryptogenic epilepsies are presumed to be symptomatic. idiopathic:  there is no underlying cause other than a possible hereditary predisposition.The remainder of this section will refer to the older terminology. Symptomatic
If a cause presents itself, the syndrome is referred to as symptomatic West syndrome, as the attacks manifest as a symptom of another problem. Almost any cause of brain damage could be associated, and these are divided into prenatal, perinatal, and post-natal. The following is a partial list:
In around one third of the children, there is evidence of a profound organic disorder of the brain. This includes:microcephaly
cortical dysplasia
cerebral atrophy
lissencephaly
bacterial meningitis
phakomatoses (e.g. tuberous sclerosis)
Aicardi syndrome
cephalhematoma and
vascular malformation. Furthermore, other causes increasingly being named in the literature are:
Incontinentia pigmenti
Foix–Chavany–Marie syndrome
Patau syndrome (trisomy 13)
Sturge–Weber syndrome
neurometabolic diseases
congential infections (e.g.