Which progression of seizures is considered rare?

The progression of seizures that is considered rare is the sequence from Rolandic seizures to absence seizures. Rolandic seizures, also known as benign rolandic epilepsy or centrotemporal spikes, typically occur in children and are characterized by focal motor symptoms, often affecting the face and mouth. These seizures are self-limiting and have a favorable prognosis.

Absence seizures, on the other hand, are characterized by brief episodes of impaired consciousness and are more generalized in nature. The two types of seizures have different underlying mechanisms and clinical presentations. While both involve different cortical areas, transitioning directly from Rolandic seizures to absence seizures is not a common occurrence in clinical practice.

In contrast, the other sequences mentioned in the question are more commonly observed. For example, the progression from focal to generalized seizures reflects the general phenomenon where focal seizures can lead to secondary generalization. Coupling tonic and clonic phases is the hallmark of tonic-clonic seizures and thus is a recognized and expected progression. Similarly, myoclonic seizures can precede tonic seizures, particularly in certain syndromes like juvenile myoclonic epilepsy.

Overall, the rarity of the transition from Rolandic to absence seizures identifies it as the least common progression, validating the choice of that option.