Factors associated with poor short-term pharmacotherapy response in self-limited epilepsy with centrotemporal spikes / 中华实用儿科临床杂志

Objective:To explore risk factors for clinical onset in children with uncontrolled self-limited epilepsy with centrotemporal spikes (SeLECTS) managed by 2 anti-seizure medications (ASMs).Methods:A total of 112 children with SeLECTS who were diagnosed at the Department of Pediatric Neurology of the Third Affiliated Hospital of Zhengzhou University from January 2018 to May 2021 were retrospectively reviewed.All of them were treated with conventional ASMs, and regularly followed up for 1-2 years.Types of therapeutic drugs, clinical seizure control status, presence of new seizure forms, electroencephalogram (EEG) were reviewed at follow-up visits.According to whether the seizures were controlled after the use of no more than 2 ASMs, patients were divided into poor response group (43 cases) and good response group (69 cases), and their clinical data and EEG characteristics were compared.Multivariate Logistic regression analysis was used to explore the risk factors for seizures that were uncontrolled by 2 ASMs. Results:There were significant differences in the age of onset ( χ2=8.919, P=0.003), seizure form ( χ2=4.218, P=0.040), seizure frequency ( Z=-7.664, P<0.001), EEG background slowing ( χ2=10.284, P=0.001), emergence of electrical status epilepticus during slow-wave sleep (ESES)( χ2=11.921, P=0.001), discharge generalization ( χ2=25.377, P<0.001), and presence of epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS)( χ2=54.334, P<0.001) between groups.Multivariate Logistic regression analysis showed that seizure frequency ( P<0.001, OR=0.086, 95% CI: 0.022-0.329), discharge generalization ( P=0.006, OR=9.942, 95% CI: 1.918-51.527) and EEG background slowing ( P=0.041, OR=6.648, 95% CI: 1.077-41.038) were the 3 main risk factors associated with poor response to short-term medications of ASMs. Conclusions:Seizures are easily controlled in most SeLECTS patients medicated with ASMs with a favorable prognosis.Seizure frequency, discharge generalization and EEG background slowing are risk factors for the poor response to short-term pharmacotherapy in children with SeLECTS.

Cognitive impairment in children with benign childhood epilepsy with centrotemporal spikes and attention deficit hyperactivity disorder: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To study the difference in cognitive impairment between the children with benign childhood epilepsy with centrotemporal spikes (BECT) and attention deficit hyperactivity disorder (ADHD) and those with BECT or ADHD alone.@*METHODS@#A prospective study was performed on 80 children with BECT and ADHD, 91 children with BECT, and 70 children with ADHD , who were diagnosed with the diseases for the first time. Seventy children of the same age who underwent physical examination were enrolled as the healthy control group. Event-related potential P300, Wechsler Intelligence Scale for Children, and integrated visual and auditory continuous performance test were used to measure and compare each index between groups.@*RESULTS@#Compared with the healthy control group, the BECT+ADHD group, the BECT group, and the ADHD group had a significantly prolonged P300 latency, a significant reduction in the amplitude of P300, and significant reductions in the scores of verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), processing speed index (PSI), full scale intelligence quotient (FSIQ), auditory response control quotient (ARCQ), visual response control quotient, full response control quotient (FRCQ), auditory attention quotient (AAQ), visual attention quotient, and full attention quotient (@*CONCLUSIONS@#Compared with the children with BECT or ADHD alone, the children with both BECT and ADHD have basically the same fields of cognitive impairment but a higher degree of cognitive impairment in some fields.

Risk factor analysis of benign childhood epilepsy with centrotemporal spikes complicated by electrical status epilepticus in sleep / 中华实用儿科临床杂志

Objective To evaluate the risk factors for benign childhood epilepsy with centrotemporal spikes (BECT) complicated by electrical status epilepticus in sleep(ESES).Methods From January 2013 to January 2017,a total of 80 children diagnosed as BECT in pediatric neurology outpatient department of Provincial Clinical Medical College Affiliated to Fujian Medical University were enrolled.According to whether there was an attack of ESES or not,patients were divided into ESES group(38 cases) and non-ESES group(42 cases).In order to elucidate risk factors for BECT complicated by ESES,clinical data including age,gender,first seizure age,seizure frequency before treatment,types of seizure,therapeutic drug,recurrence of seizure after treatment,febrile seizure,status at birth,family history,brain MRI,discharge quantity,discharge location,and intelligence score were investigated by multivariate Logistic regression analysis.Results Compared with non-ESES patients,ESES patients were more likely to have recurrence of epilepsy after treatment (68.4％ vs 26.2％,P ＜ 0.001),and had worse intellectual development (＜ 90 scores;73.7％ vs 38.1％,P =0.001);while electroencephalogram showed more discharge in anterior location (47.4％ vs 21.4％,P =0.014) and bilateral distribution of brain (52.6％ vs 26.2％,P =0.015).However,the multivariate Logistic regression analysis showed that only recurrence of seizure after treatment was the risk factor for ESES in BECT patients(P=0.008,OR=4.039,95％CI:1.429-11.418).Conclusion Recurrence of seizure after treatment of BECT was a high risk factor for ESES.Controlling seizure and reducing ESES phenomenon could be beneficial to alleviate the intellectual impairment of patients with BECT.

Effects of sleep epileptiform discharge on aural pre-attentive processing of children with benign childhood epilepsy with central-temporal spikes / 中华实用儿科临床杂志

Objective To explore the relationship between aural pre-attentive processing and non-rapid eye movement(NREM) sleep interictal epileptiform discharge (IED) in children with benign childhood epilepsy with central-temporal spikes (BECTS),in order to provide objective electrophysiological basis for early assessment of cognitive function lesion of BECTS children and intervention.Methods Twenty-nine children diagnosed as BECTS in the Second Affiliated Hospital of Xinxiang Medical University from February 2012 to November 2015 were selected,including 17 males and 12 females,and they were 4-14 years old with average age of (9.17 ±2.42) years,and the course of disease was 0.5-4.0 years.Twenty healthy children who had hospital routine check-up were selected as healthy control group,containing 14 males and 6 females,and they were 5-13 years old with average age of (8.55 ±3.09) years.Mismatch negativity (MMN) test was carried out in both groups,and the MMN amplitudes and latencies were analyzed.The long-term video electroencephalogram (VEEG) monitoring was conducted in the BECTS group to analyze the discharge phases (waking,sleep),locations and the IED indexes.The intergroup MMN indexes and the correlation between MMN and VEEG in the BECTS group were compared.Results The VEEG showed that the sleep structure of BECTS children did not change obviously.All children's epileptiform discharges were located in the Rolandic area,including 11 cases on the left side,8 cases on the right side,and 10 cases on both sides.Epilepsy discharge time:17 patients showed epileptiform discharges in sleep stages only and 12 patients showed epileptiform discharge in both sleep and waking stages.Epileptiform discharges of the 12 patients increased more significantly in sleep stage than thatin waking stage [(40.24 ± 25.15) times/min vs.(1.92 ± 1.38) times/rmin],and the difference was statistically significant (t =5.270,P =0.000).The sample IED index in stage 1 and 2 of NREM was (40.73 ± 10.69) times/min,in which 2 cases had IED indexes ＜ 5 times/min,the IED indexes of 3 cases ＞ 80 times/min who reached electrical status epilepticus during sleep,and others were 17.2-64.6 times/min.Clinical seizures in sleep stages were monitored in only 4 cases,which showed an electro-clinical segregation phenomenon from large quantities of sleep IED.The MMN amplitude was lower in the BECTS group than that in the healthy control group [(6.06 ± 1.89) μV vs.(7.28 ±1.64) μV],and the difference was statistically significant (t =2.346,P =0.025).Latency of BECTS group was longer than that in the healthy control group [(191.37 ±40.13) ms vs.(179.35 ±39.80) ms],but the difference was not statistically significant(t =1.037,P =0.355).Correlation analysis showed that the MMN amplitude was negatively related to discharge phases (r =-0.407,P ＜ 0.05) and the IED indexes (r =-0.644,P ＜ 0.01),and latency was positively related to the IED indexes (r =0.386,P ＜ 0.05),while the other VEEG indexes were not correlated with MMN.Conclusions The BECTS children have aural pre-attentive processing disturbance,especially unconscious automatic processing ability impairment,which weakenattention switch action of automatic processing switching to focused attention processing and fail to filter irrelevant information effectively.Sleep IED is an important factor in impairing the formation and reinforcement of acoustic discrimination and memory trace,interfering the acquisition,processing,storage and matching of new information,which induces children pre-attentive processing disturbance.The MMN may discover the electrophysiological changes of children pre-attentive processing disturbance in early stage.

A comparative analysis of EEG and cognitive function in children with benign epilepsy associated with central temporal spikes / 国际儿科学杂志

Objective To study the EEG discharge index, intelligence test and event-related potential P300 in BECT, and to analyze the change of EEG discharge index and cognitive function before and after the treatment.Methods Sixty patients with BECT were enrolled in this study, they were treated with EEG, intelligence tests and P300 before and after the treatment.Results (1) The EEG discharge index were reduced remarkly after treatment in BECT with levetiracetam and lamotrigine, the difference was statistically significant (P ＜ 0.05).(2) Comparing before and after 3 or 6 months treatment, the latency of P300 had reduced with significant difference (P ＜ 0.05).(3) After 3 months treatment, VIQ and FIQ has no obvious improvement, but PIQ has improved.After 6 months treatment, VIQ、 PIQ and FIQ were improved.The difference was statistically significant (P ＜ 0.05).(4) There was a negative correlation of EEG P300 latency (r =0.175), as well as there was a negative correlation between EEG discharge index and intelligence test (r =0.044).Conclusion There is impaired cognitive function in BECT, especially the more frequently the EEG discharge, the more extended of P300 latency, as well as the more serious damage of intelligence and cognition after treatment.The intelligence were improved after treatment with Levetiracetam and lamotrigine, the longer the treatment time, the more obvious of intelligence levels improve.

Treatment of Night Large Dose of Sodium Valproate on Benign Childhood Epilepsy with Centrotemporal Spikes：A Report of 45 Cases / 医药导报

Objective To study the effect of night large dose of sodium valproate on epileptiform discharges,and cognitive function of benign childhood epilepsy with centrotemporal spikes. Methods Ninety cases of benign childhood epilepsy with centrotemporal spikes were randomly divided into treatment group and control group (n= 45), both groups received regular total doses of sodium valproate therapy 25-30 mg?kg-1 ?d-1 . Patients in the treatment group received treatment that night doses of sodium valproate was double of morning doses. Every night dose was (17.96±1.21) mg?kg-1 , and every morning dose was (8.92±0.62) mg?kg-1 . The control group received the same dose [(13.37±0.80) mg?kg-1 ] of sodium alproate therapy twice a day, morning and evening. The epileptiform discharges, cognitive function, therapy effect were compared between two groups. Results Total effective rate of treatment group was 82.22% which were was significantly higher than that of the control group 62.22%(P<0.05);Epileptiform discharges reduction of treatment group was significantly higher than that of the control group (P<0.05), the effective rate of EEG improvement (84.44%)in treatment group was significantly higher than that in the control group 66.67% (P<0.05); FIQ, VIQ, PIQ in treatment group were significantly higher than those in the control group (P<0.05); There were no statistical differences of adverse reactions between two groups. Conclusion Night large dose of sodium valproate treatment can help control epileptic discharge, increase the plasma concentration, improve cognitive function, and therapy effect.

Clinical features of the variants of benign childhood epilepsy with central temporal spikes: 12 cases report / 临床儿科杂志

Objective To study the clinical features of the variants of benign childhood epilepsy with central temporal spikes (BECT).Methods The clinical data of 12 hospitalized pediatric patients with BECT from Jan 2007 to Jan 2014 were retrospectively reviewed. Results There were 7 boys and 5 girls in 12 patients. The age of onset was from 3 to 9 years old. Two cases were dizygotic twins. The atypical symptoms included atypical absence of 10 cases, negative myoclonic seizure of 8 cases, speech expression disorders and oral-pharynx apraxia of 4 cases. The electroencephalography (EEG) of all 12 patients showed abundance of spike and waves (SW) in rolandic areas during wake-up and sleep. The SW index was 50%-85% during slow sleep in all patients.Conclusions The variants of BECT are often associated with EEG deterioration. Understanding the clinical featuress and EEG characteristics can help the diagnosis of BECT variants.

Effect of levetiracetam on electrical status epilepticus during sleep in benign childhood epilepsy with centro-temporal spikes / 中国小儿急救医学

Objective To investigate the effect of levetiracetam on benign childhood epilepsy with centro-temporal spikes(BECT) with early-electrical status epilepticus during sleep(ESES).Methods Since June 2010 to June 2013,35 cases of BECT with ESES were treated in our hospital.They were divided into two groups:early-ESES group and ESES group.The seizure rate and spike-wave index in different groups were observed before and after treatment.Intelligence quotient(IQ),response control quotient,attention quotient in different groups were compared before and after treatment.Results The seizure-free rate in earlyESES group was 55.00％,the total effective rate was 85.00％,EEG improvement rate was 60.00％.The seizure-free rate in ESES group was 26.67％,the total effective rate was 73.33％,EEG improvement rate was 46.67％.The seizure-free rate,total effective rate and EEG improvement rate in early-ESES group were higher than that in ESES group,but there were no statistically significant differences between two groups.The cognitive function (verbal IQ:90.29 ± 13.47 vs.83.97 ± 10.20; performance IQ:93.83 ± 11.12 vs.87.03 ± 11.15; full IQ:94.26 ± 10.96 vs.86.71 ± 11.29) and visual attention in both groups (response control quotient:100.77 ± 7.91 vs.87.40 ± 9.68 ; attention quotient:94.66 ± 7.22 vs.79.46 ± 12.52) were significantly improved after treatment(P ＜ 0.05,respectively).Conclusion Levetiracetarn is effective on BECT with ESES and early-ESES,especially on early-ESES.Levetiracetam maybe have a preventive effect on ESES.

Análisis espectral del electroencefalograma en pacientes con epilepsia rolándica / Spectral analysis of the electroencephalogram in patients with rolandic epilepsy

Objetivo: Describir la presencia de alteraciones de la actividad de base a través del análisis cuantitativo del EEG (QEEG) en pacientes portadores de Epilepsia Rolándica. Material y Método: Se realizó el análisis visual del EEG (29 pacientes) y el QEEG (26 pacientes). Los valores de poder absoluto y poder relativo obtenidos para cada paciente fueron comparados con una base de datos normativos mediante el estadígrafo transformada Z. Resultados: Se encontraron variaciones estadísticamente significativas de energía en 73,08 % de los casos: 73,68 % en las bandas lentas y 26,31 % para las rápidas. La topografía de la actividad lenta fue en regiones centro-temporales y/o centro-parietales 64,28 %, en las regiones anteriores y extratemporales 21,43 % y 14,28 % presentaron actividad lenta aislada extratemporal. Conclusiones: Las alteraciones significativas en la actividad de base electroencefalográfica antes descritas en los pacientes portadores de Epilepsia Rolándica, sugieren una posible relación con un disturbio maduracional o a la presencia de las descargas epileptiformes interictales.

Objective: To describe abnormalities of the background activity by quantitative analysis in patients with Rolandic Epilepsy. Methods: Visual (29 patients) and quantitative EEG (QEEG) (26 patients) analyses were done. Absolute and Relative Power values obtained in the patients were compared with those from a normative database (Z-Maps). Results: Q-EEG results showed a significative changes in a 73,08 % of the patients: 73,68 % in slow frequency and 26,31 % in rapid frequency. A focal significative increase in slow frequency in centro-temporal and/or centro-parietal regions was observed in 64,28 %, in the same regions and extratemporal regions in 21,43 % and only slow activity extratemporal in 14,28 % of the patients. Conclusions: Significative variations in background activity in patients with Rolandic Epilepsy, suggests a possible relation with the presence of interictal epileptiform discharges or a certain age-related functional immaturity.

Analysis of Interictal Epileptiform Discharges in the Benign Childhood Epilepsy with Centrotemporal Spikes: Prediction of Seizure Outcome

PURPOSE: The benign childhood epilepsy with centrotemporal spikes (BECTS), commonly affecting children between 3 and 13 years of age, is focal epilepsy with the presence of centrotemporal spikes on electroencephalography (EEG). The aim of our study was to assess the relationship between EEG findings and clinical prognosis in patients with BECTS. METHODS: From 2005 to 2010, patients with a diagnosis of BECTS with a follow-up period of over one year after the diagnosis were included in our study. We analyzed their first interictal EEG: frequency of interictal discharges and average voltage in each waking and sleep phase. In addition, multiple factors were reviewed from the medical records: the age at the time of seizure onset, frequency of seizures, use of antiepileptic drugs (AEDs), duration of AED therapy, age at the time of EEG normalization and age at the time of last seizure. RESULTS: Seventy-four patients were included in our study. Frequent interictal epileptiform discharges during sleep correlated with younger age of seizure onset (P=0.040), earlier onset of AED therapy (P=0.022), younger age at the time of seizure cessation (P=0.027), greater frequency of interictal epileptiform discharges during wakefulness (P=0.006), higher average voltage (P=0.001) and higher frequency of seizures after AED initiation (P=0.043). CONCLUSION: In BECTS patients, frequent interictal epileptiform discharges during sleep could be correlated with higher seizure frequency, even after cessation of AED. These findings would be helpful in predicting the prognosis of children with BECTS.

Benign childhood epilepsy with centro-temporal spikes: evolutive clinical, cognitive and EEG aspects / Epilepsia benigna da infância com pontas centrotemporais: aspectos evolutivos clínicos, cognitivos e do EEG

Thirty-two children with benign childhood epilepsy with centrotemporal spikes (BECTS) were studied for a mean period of 27.6 months. The characteristics of the seizures, electroencephalogram (EEG), WISC-III and School Performance Test were compared at the start and end of the study. Nine (28.1 percent) children continued having seizures. Epileptiform activity (EA) on the EEG reduced in number and was no longer recorded in 6 (18.7 percent) children. There was a significant improvement in the performance and perceptual organization IQ values. The improvement in reading performance failed to reach statistical significance. The performance in arithmetic worsened in 43.7 percent of the children, and this was associated with the persistence of epileptic seizures. There were no significant correlations between changes in cognitive aspects and characteristics of EA. There is a need to continue this study, and also search for other factors influencing the evolution of cognitive abilities in children with BECTS.

Foram estudados aspectos evolutivos clínicos, cognitivos e eletrencefalográficos (EEG) de 32 crianças com epilepsia benigna da infância com pontas centrotemporais (EBICT) acompanhadas por 27,6 meses. Foram comparadas as características das crises, do EEG, do WISC-III e do Teste de Desempenho Escolar ao início e ao final do estudo. Nove (28,1 por cento) crianças continuaram apresentando crises. A atividade epileptiforme (AE) ao EEG reduziu-se em número e não mais foi registrada em 6 (18,7 por cento) crianças. Houve melhora significativa nos QI de execução e de organização perceptual. A melhora do desempenho em leitura não alcançou significância estatística, enquanto em 43,7 por cento das crianças houve piora em aritmética. Esta foi associada à persistência de crises epilépticas. Não houve correlações significativas entre aspectos cognitivos e características da AE. Há necessidade de estudar até a remissão total das crises e da AE, assim como procurar outros fatores que influenciem a evolução das habilidades cognitivas das crianças com EBICT.

Cognitive and Behavioral Problems and the Effectiveness of Topiramate Once per Day in the Control of Benign Childhood Epilepsy with Centrotemporal Spikes

PURPOSE: This study was aimed to evaluate cognitive and behavioral problems in benign childhood epilepsy with centrotemporal spikes (BECTS) using objective scales. In addition, we investigated the efficacy and cognitive effects of topiramate by introducing it once a day as a pilot study. METHODS: Seven patients were evaluated. They were diagnosed as BECTS based on clinical features and electroencephalography findings. We assessed cognitive and behavioral functions with several neuropsychological tests and followed up the seizure frequency, side effects, and cognitive dysfunction for six months after introducing topiramate once per day. RESULTS: The mean intelligence quotient, memory quotient, and social quotient of patients show the difference as compared to the general population. However, three patients showed attention deficit/hyperactivity disorder. Further, the seizure reduction rate was 100% after receiving topiramate once a day and there were no newly reported neuropsychological problems on questionnaires. CONCLUSION: This study demonstrated that a significant number of children with BECTS have behavioral problems and that topiramate monotherapy once a day is effective.

Benign childhood epilepsy with centrotemporal spikes: word and pseudoword discrimination / Epilepsia benigna da infância com pontas centro-temporais: discriminação entre palavras e pseudopalavras

In the active phase of benign childhood epilepsy with centro-temporal spikes (BCECTS) there may be a fall in scholastic performance. OBJECTIVE: To study lexical decision in children with BCECTS. METHOD: 42 children with BCECTS were compared with a control group with respect to their hits and response time in a visual discrimination of words and pseudowords task (DWPT). RESULTS: The children with BCECTS had a lower percentage of hits for words and pseudowords and showed longer response times for pseudowords. They also frequently showed inferior reading and writing performance in the school performance test. The percentage of hits for pseudowords was lower when there was bilateral, asynchronous epileptiform activity. CONCLUSIONS: The DWPT provided contributions for reading assessments in children with BCECTS. The results indicated the need for attention in detecting reading difficulties in children with BCECTS.

Na fase ativa da epilepsia benigna da infância com pontas centrotemporais (EBICT) pode ocorrer queda de desempenho escolar. OBJETIVO: Estudar a decisão lexical em crianças com EBICT. MÉTODO: 42 crianças com EBICT foram comparadas a grupo controle quanto a acertos e tempo de resposta em tarefa de discriminação visual entre palavras e pseudopalavras (DVPPS). RESULTADOS: As crianças com EBICT tiveram percentual menor de acertos para palavras e pseudopalavras e maior tempo de resposta para pseudopalavras e tiveram, mais frequentemente, desempenho inferior em escrita e leitura em teste de desempenho escolar. Houve relação significativa entre os resultados do DVPPS e o teste de desempenho escolar. A percentagem de acerto de pseudopalavras foi menor quando havia atividade epileptiforme bilateral e assíncronia no eletrencefalograma. CONCLUSÃO: O DVPPS mostrou contribuições na avaliação da leitura em crianças com EBICT. Os resultados apontam para a necessidade de atenção na detecção de dificuldades de leitura em crianças com EBICT.

Benign childhood epilepsy with centro-temporal spikes: correlation between clinical, cognitive and EEG aspects

Benign childhood epilepsy with centro-temporal spikes (BECTS) is a form of epilepsy with no demonstrable anatomical lesion showing spontaneous seizure remission. During the active phase of the disease the children may show cognitive deficits. The objective of this study was to assess, in children with BECTS, the relationship between clinical-EEG aspects and performance in the school performance test (SPT), Raven's progressive matrixes test and the Wechsler Intelligence Scale for Children (WISC-III). Forty-two 7 to 11 year old children were included and the following tests carried out: anamnesis, neurological examination, electroencephalogram (EEG), SPT, Raven's test and WISC-III. The children with BECTS had normal IQ values but showed inferior performance in the SPT more frequently than "healthy" children, paired with respect to age and maternal scholastic level. There was moderate positive correlation between WISC-III results and the age when the seizures started and the educational level of the parents. On the other hand, aspects linked to the epileptic nature of BECTS, such as the number of seizures, time since last seizure and the number and lateralization of the centro-temporal spikes on the EEG, showed no correlation with the neuropsychological tests.

A epilepsia benigna da infância com pontas centrotemporais (EBICT) é uma forma de epilepsia na qual não existem lesões anatômicas demonstráveis e há remissão espontânea das crises. Na fase ativa da epilepsia as crianças podem apresentar déficits cognitivos. O objetivo deste estudo foi avaliar, em crianças com EBICT, a relação entre aspectos clínico-eletrencefalográficos e o desempenho no teste de desempenho escolar (TDE), no teste das matrizes progressivas de Raven e na Escala Wechsler de Inteligência para Crianças (WISC-III). Foram incluídas 42 crianças de 7 a 11 anos de idade. Foram realizados: anamnese, exame neurológico, eletrencefalograma (EEG), TDE, teste de Raven e WISC-III. As crianças com EBICT tiveram valores normais de QI e apresentaram desempenho inferior no TDE mais freqüentemente que crianças "sadias" pareadas quanto à idade e à escolaridade materna. Houve correlação positiva moderada entre idade de início das crises e escolaridade dos pais com resultados do WISC-III. Por outro lado, aspectos ligados à natureza epiléptica da EBICT como número de crises, tempo decorrido da última crise, número e lateralidade das pontas centrotemporais ao EEG não mostraram correlação com os resultados dos testes neuropsicológicos.

Quantitative EEG Analysis in Atypical Rolandic Epilepsies of Childhood / 대한간질학회지

PURPOSE: Benign childhood epilepsy with centrotemporal spikes (BCECT) or benign rolandic epilepsy (BRE) is not always benign in clinical or neuroimaging features. Recent studies have reported atypical forms of rolandic epilepsy with abnormal neurologic and/or neuroimaging findings, sometimes, also with poor seizure control. We investigated whether there are any differences in linear and nonlinear EEG analysis in typical and atypical rolandic epilepsies of childhood. METHODS: Ten patients with typical BRE group and seven patients with atypical BRE group were included in this study. We selected artifact-free 10-second epochs from 19 electrodes of 10-20 international EEG system from each patient. The power spectrum was calculated in delta, theta, alpha, beta, and gamma frequency ranges. The fractal dimension was analyzed as a nonlinear EEG analysis. We analyzed both EEGs with interictal spikes and without focal slowing or epileptiform activities. RESULTS: The spectral EEG analysis showed a significant increase of absolute and relative power of delta with decrease of alpha bands in atypical BRE group compared to typical group. There was no statistical difference in fractal dimension between the two groups. CONCLUSION: Atypical BRE group showed enhanced delta and decreased alpha power, suggesting a cortical dysfunction in this group with poor clinical outcome.

Efficacy of Antiepileptic Drug on the Benign Childhood Epilepsy with Centro-Temporal Spikes

PURPOSE: Benign childhood epilepsy with centrotemporal spikes(BECT) is characterized by an excellent prognosis. Therefore, the necessity for the use of antiepileptic drugs is controversial. The object of this study is to know about the long-term follow-up of BECT, comparing daily treatment with antiepileptic drug(AED) versus no medication. METHODS: We retrospectively studied 56 cases of BECTs, examined at Pediatric Neurology Clinic, Korea University Medical Center as reference study time, August 2002. Thirty-eight patients didn't have mediation(group I), while eighteen patients received one or two AED(group II). We evaluated demographics, clinical manifestations at diagnosis, EEG findings and clinical courses in groups I & II. RESULTS: There was no significant differences of sex, age, seizure frequency, seizure type, seizure onset time, family history and EEG findings between group I & II. The reasons to start AED were: parents' anxiety(three cases), frequent seizure(12 cases) and daytime seizure(three cases). There was no evolution of status epilepticus and no difficulty in school performance. CONCLUSION: AED treatment was of no advantage and long-term prognosis was good regardless of treatment strategy. So it is advisable not to choose AED as the first line of therapy, provided that the patient himself/herself or the family understands the benign nature of BECT.

Clinical Characteristics of Occipital Lobe Epilepsy in Children / 대한간질학회지

PURPOSE: To evaluate the differential clinical & electroencephalographic characteristics between benign childhood epilepsy with occipital paroxysm (BCEOP) and symptomatic occipital lobe epilepsy (SOLE). METHODS: Nine patients of BCEOP and seven patients of SOLE diagnosed at the department of pediatrics and epilepsy center in Inje University Sang-gye Paik Hospital from March 1992 to June 1998, were studied for the determination of differential characteristics between the two groups. Clinical features, EEG characteristics, MRI findings, associated conditions, and prognosis were investigated and compared between these groups. RESULT: 1) Male : female ratio was 1 : 2 in BCEOP and 1 : 2.5 in SOLE. 2) Seizure onset age was older in SOLE as compared with BCEOP. 3) There was no significant difference in seizure types between two groups. 4) Visual aura could be elicited in 5 patients (55.6%) in BCEOP, and 3 patients (42.9%) in SOLE. 5) Ictus emeticus was only noted in 4 patients (44.4%) of BCEOP. 6) Migraine was associated only in 3 patients of BCEOP. 7) Background EEG abnormality was more frequently associated in SOLE than BCEOP. 8) Seizure control was inefficient only in 3 patients (42.9%) of SOLE, and all patients with BCEOP were successfully treated with antiepileptic drugs. CONCLUSION: SOLE showed higher seizure onset age, less frequent association of ictus emeticus and migraine, more frequent background EEG abnormalities and more medical intractability to antiepileptic drugs than BCEOP.

Clinical Manifestations and Prognostic Factors of Occipital Lobe Epilepsy in Children

PURPOSE: The objective of this study is to review the clinical manifestations and acknowledge the prognostic factors in occipital lobe seizure and benign childhood epilepsy with occipital paroxysm (BEOP). METHODS: We reviewed retrospectively 253 cases who showed occipital epileptiform activity on EEG at the Pediatric Neurology Clinic, Yonsei University Medical Center from January 1997 to June 1999, and selected 72 cases who had been followed-up for over 2 years. According to the occurrence of seizure for recent 2 years, they were classified into 2 groups : favorable and unfavorable groups. Clinical manifestations were reviewed and analyzed in each group with chi-square and student t-test. RESULTS: 1) Symptomatic group was 16 out of 72 cases (22%), and cryptogenic group was 56 cases (78%). Seventeen out of 72 cases (24%) had the clinical manifestation of BEOP. 2) Early-onset variant is 9 out of 17 cases (52%), late-onset was 8 cases (48%) in BEOP patients. 3) Prognostic factors influencing unfavorable prognosis were prematurity, LBW, perinatal asphyxia and postictal headache in occipital lobe seizure. 4) Prognostic factors in BEOP were determined by age of onset, existence of visual symptom, oculomotor symptom, automatism, autonomic symptom, postictal headache, and diurnal or nocturnal seizure. CONCLUSION: Occipital lobe seizure manifests various clinical symptoms with various prognosis. Seventeen out of 72 cases were determined as BEOP: 9 cases of early variant and 8 cases of late onset. We acknowledge the prognostic factors in epilepsy with occipital lobe seizure as well as BEOP.