ABSTRACT
We prospectively examined whether changes in the frequency of benign focal spikes accompany changes in cognition. Twenty-six children with benign focal spikes (19 with Rolandic epilepsy) and learning difficulties were examined with repeated 24-hour EEG recordings, three cognitive tests on central information processing speed (CIPS), and questionnaires on cognition and behavior at baseline, 6months, and 2years. Antiepileptic drug changes were allowed when estimated necessary by the treating physician. At baseline, a lower CIPS was correlated with a higher frequency of diurnal interictal epileptiform discharges (IEDs) and with worse academic achievement. At follow-up, there was a significant correlation between changes in CIPS and EEG changes in wakefulness (in the same direction) when the EEG outcome was dichotomized in IED frequency "increased" or "not increased". Behavioral problems were more often observed in patients with higher frequency of IEDs in sleep at baseline and in those with ongoing IEDs compared with those with EEG remission (without or with sporadic IEDs in the recording) at the end of the study period. No changes were observed in the results of the questionnaires. A lower diurnal IED frequency at baseline, lack of serial IEDs, and occurrence of only unilateral IEDs were correlated with a higher chance of EEG remission at 2-year follow-up. Electroencephalography remission could not be predicted from other epilepsy variables except from seizure freedom in the last six months. Our results confirm the nonbenign character of 'benign' focal spikes. Whether an early and stable EEG remission can be achieved through antiepileptic treatment and whether this is of benefit for cognitive development should be examined in prospective placebo-controlled randomized trials.
Subject(s)
Electroencephalography , Epilepsy, Rolandic/physiopathology , Epilepsy, Rolandic/psychology , Mental Processes , Anticonvulsants/therapeutic use , Behavior , Child , Child, Preschool , Cognition , Educational Status , Female , Follow-Up Studies , Humans , Learning Disabilities/etiology , Learning Disabilities/psychology , Male , Neuropsychological Tests , Prospective Studies , Psychomotor Performance , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Frequent interictal epileptiform discharges (IEDs) may have effects on cognition. We analysed a group of 182 children with different epilepsy syndromes as well as children with IEDs without observed seizures [corrected], with 24-h ambulatory EEG and cognitive tests. The IED index was estimated, in wakefulness and in sleep, as percentage of time in five categories (0%, <1%, 1-10%, ≥10-50% and ≥50%). IEDs were defined as spikes or spike-wave complexes, isolated or occurring serially (in runs) without evident clinical signs of a seizure. The IED categories were correlated to cognitive test results and epilepsy characteristics. The group of patients with diurnal IEDs in ≥10% of the EEG record showed impaired central information processing speed, short-term verbal memory and visual-motor integration. This effect was seen independently from other EEG-related and epilepsy-related characteristics, and independently from epilepsy syndrome diagnosis. The impact of the nocturnal IEDs was of less importance; only contributing partially to the slowing of central information processing speed. We conclude that frequent IEDs (in more than 10% of the record) in the awake EEG can impair cognitive performance in children. Whether children with a high diurnal spike frequency and low seizure frequency can benefit from antiepileptic treatment should be examined in controlled trials.
Subject(s)
Cognition/physiology , Epilepsy/psychology , Seizures/psychology , Child , Cognition Disorders/etiology , Cognition Disorders/psychology , Educational Status , Electroencephalography , Female , Humans , Intelligence Tests , Male , Memory/physiology , Neuropsychological Tests , Psychomotor Performance/physiology , Regression Analysis , Sleep/physiology , Wakefulness/physiologyABSTRACT
OBJECTIVE: An association between language impairment and rolandic epilepsy is frequently reported. This impairment could be correlated with the amount of nocturnal epileptiform activity. METHODS: We retrospectively analyzed 26 children with rolandic epilepsy and/or rolandic spikes. All had undergone a 24-hour EEG and neuropsychological assessment within 2 weeks. Reading performance (reading words and sentences) and intelligence were measured. RESULTS: There was a significant negative correlation between amount of nocturnal epileptiform activity and reading sentences R=-0.525 (P=0.008). There was a trend in this correlation for reading words R=-0.398 (P=0.054). We found a negative correlation between amount of nocturnal epileptiform activity and Verbal IQ (R=-0.51 P=0.08). No correlation was found between reading performance or Verbal IQ and amount of diurnal epileptiform activity. CONCLUSIONS: Reading performance is impaired in children with rolandic epilepsy and is correlated with the amount of nocturnal epileptiform activity.
Subject(s)
Brain Waves/physiology , Circadian Rhythm/physiology , Dyslexia/etiology , Epilepsy, Rolandic/complications , Achievement , Child , Electroencephalography , Female , Humans , Intelligence , Male , Neuropsychological Tests , Retrospective Studies , Statistics, NonparametricABSTRACT
We evaluated whether spike-rates are useful as an outcome parameter following vagus nerve stimulation (VNS). Spikes/minute and spikebursts/minute were counted in serial electroencephalograms before and after implantation of a vagus nerve stimulator in n = 19 patients with severe childhood epilepsies. In the period of 2 years post VNS, spike-rate and reported seizure frequency were significantly correlated (Spearman's R = 0.61); spikebursts and seizures were correlated with R = 0.74. The response rate, counted after 6 months, was too small to detect differences in responders and non-responders as to spike-reduction. Larger samples and effect sizes are necessary to prove the hypothesis that spike reduction is useful as outcome parameter after VNS or other interventions.
Subject(s)
Electric Stimulation Therapy/methods , Epilepsy/therapy , Vagus Nerve/radiation effects , Adolescent , Child , Electric Stimulation/methods , Electroencephalography/methods , Electroencephalography/radiation effects , Epilepsy/physiopathology , Female , Follow-Up Studies , Humans , Male , Pilot Projects , Prospective Studies , Treatment OutcomeABSTRACT
STUDY DESIGN: A case report is presented. OBJECTIVE: To report and discuss a case of primary non-Hodgkin's lymphoma in 10 different vertebrae in the spine of a 25-year-old woman. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, a case of primary bone lymphoma in several vertebrae has not been reported previously. METHODS: Primary bone lymphoma was diagnosed using magnetic resonance images and biopsy of one spine lesion. There was no other localization of the lymphoma. RESULTS: With chemotherapeutic treatment, the lymphoma was in remission for 16 months. The patient then died of complications associated with acute lymphatic B-cell leukemia. CONCLUSIONS: The incidence of primary bone lymphoma in a population with non-Hodgkin's lymphoma is less than 1%. A case with multiple localizations of lymphoma in the spine has never been reported before.
