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Camfield P, Camfield C. Regression in children with epilepsy. Neurosci Biobehav Rev 2019; 96:210-218. [DOI: 10.1016/j.neubiorev.2018.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/26/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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Tacke M, Rupp N, Gerstl L, Heinen F, Vill K, Bonfert M, Neubauer BA, Bast T, Borggraefe I. Benign epilepsy with centrotemporal spikes: Correlating spike frequency and neuropsychology. Acta Neurol Scand 2018; 138:475-481. [PMID: 30259965 DOI: 10.1111/ane.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/10/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Neuropsychological sequelae are a feature of benign epilepsy with centrotemporal spikes (BECTS) in children. A correlation between the frequency of interictal EEG discharges and the cognitive as well as behavioral profile of the patients has been suspected but not proven. MATERIALS AND METHODS Children with BECTS that had not yet been treated were included into a randomized controlled trial. In the initial visit, EEGs were recorded. The frequency of interictal discharges was quantified. Correlations between the discharge frequency and the performance in a neuropsychological test battery were examined. RESULTS The cognitive test results were within or slightly above normal range (Culture-free intelligence test: 99.4%-confidence interval [CI]: [50.3, 59.9], test standardized to a population mean of 50). Parent-reported behavioral abnormalities were statistically significantly increased (CBCL total score CI: [51.9, 61.9], population mean as above). Correlations between the frequency of interictal epileptic discharges and the test results could not be identified (lowest encountered P-value: 0.034, not significant after correction for multiple testing). CONCLUSION The data do not support the hypothesis that the frequency of the interictal EEG discharges influences the neurocognitive performance or behavioral parameters of children with BECTS.
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Affiliation(s)
- Moritz Tacke
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics; University of Munich; Munich Germany
| | - Nina Rupp
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics; University of Munich; Munich Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics; University of Munich; Munich Germany
| | - Florian Heinen
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics; University of Munich; Munich Germany
| | - Katharina Vill
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics; University of Munich; Munich Germany
| | - Michaela Bonfert
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics; University of Munich; Munich Germany
| | - Bernd Axel Neubauer
- Department of Neuropediatrics; Justus-Liebig-University of Giessen; Giessen Germany
- Children's Hospital; Rosenheim Germany
| | - Thomas Bast
- Kork Epilepsy Center; Kehl-Kork Germany
- Medical Faculty of the University of Freiburg; Freiburg Germany
| | - Ingo Borggraefe
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics; University of Munich; Munich Germany
- Epilepsy Center; University of Munich; Munich Germany
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Han MJ, Kim SJ. Effects of Antiepileptic Drugs on Language Abilities in Benign Epilepsy of Childhood with Centrotemporal Spikes. J Clin Neurol 2018; 14:523-529. [PMID: 30198231 PMCID: PMC6172516 DOI: 10.3988/jcn.2018.14.4.523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/28/2023] Open
Abstract
Background and Purpose This study is to assess the responsiveness of electroencephalography (EEG) abnormalities and their effects on language ability after initiating different types of antiepileptic therapy in children with newly diagnosed benign epilepsy of childhood with centrotemporal spikes (BECTS). Methods The records of patients newly diagnosed with BECTS (n=120; 69 males) were reviewed retrospectively. The patients were randomly treated with lamotrigine, oxcarbazepine, or topiramate monotherapy, and underwent at least two EEG and standardized language tests. Effects were compared using Pearson's chi-square tests and paired t-tests. Results The recurrence rates for seizures in the lamotrigine, topiramate, and oxcarbazepine groups were 19.4%, 21.7%, and 11.4%, respectively, while complete or partial recovery (as indicated by EEG) occurred in 32%, 39%, and 16% of the patients. Patients in the lamotrigine group showed significant improvements in all parameters assessed by the Test of Language Problem Solving Abilities, except for ‘determining cause.’ Patients in the oxcarbazepine group also showed improvements, except for ‘making inferences’ (p<0.05). Most linguistic index scores were worse in the topiramate group except for Mean Length of Utterance in Words. Patients in the lamotrigine and oxcarbazepine groups showed significant improvements in the receptive language test (p<0.05). EEG improvements were not related to language ability. Conclusions The improvements in language and problem-solving performance in children with BECTS were greater for lamotrigine and oxcarbazepine than for topiramate. However, EEG remission did not imply that language function would be improved after the treatments.
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Affiliation(s)
- Min Jeong Han
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Chonbuk National University Medical School, Jeonju, Korea.
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Tan G, Xiao F, Chen S, Wang H, Chen D, Zhu L, Xu D, Zhou D, Liu L. Frequency-specific alterations in the amplitude and synchronization of resting-state spontaneous low-frequency oscillations in benign childhood epilepsy with centrotemporal spikes. Epilepsy Res 2018; 145:178-184. [PMID: 30048931 DOI: 10.1016/j.eplepsyres.2018.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Spontaneous low-frequency oscillations in different frequency bands have diverse physiological meanings. The amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) in different frequency bands in Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) are unknown and worth exploring. METHOD Resting-state functional magnetic resonance imaging data were collected in 51 drug-naïve BECTS patients and 76 healthy controls. The ALFF was calculated for the typical (0.01 - 0.08 Hz), slow-5 (0.01-0.027 Hz), slow-4 (0.027-0.073 Hz), and slow-3 (0.073-0.198 Hz) frequency bands. The bilateral precuneus/posterior cingulate cortex (PCU/PCC) showed a common alteration of ALFF in different frequency bands, and was selected as the seed for calculating FC per voxel. RESULTS In the typical band, BECTS patients showed increased ALFF in the left rolandic operculum and the right pre/postcentral gyrus, and decreased ALFF in the bilateral PCU/PCC, some of which were shared by the slow-5, slow-4, and slow-3 bands. Decreased ALFF in the left angular gyrus was also found in the slow-3 band. Only the bilateral PCU/PCC showed a frequency-dependent correlation with the total seizure frequency and full-scale intelligence quotient. Regions having degenerated FC with the bilateral PCU/PCC in BECTS patients were mainly in the left prefrontal cortex and bilateral anterior cingulate cortex for the typical and slow-5 bands, and in the bilateral temporal limbic system and striatum for the slow-4 and slow-3 bands. CONCLUSION Alteration of the ALFF and FC differed with distinct frequency bands. Therefore, employing different frequency bands would provide more meaningful findings for BECTS patients.
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Affiliation(s)
- Ge Tan
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Sihan Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Lina Zhu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Da Xu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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Arhan E, Serdaroglu A, Ozturk Z, Aydın K, Hırfanoglu T. Serial changes in the paroxysmal discharges in rolandic epilepsy may predict seizure recurrence: A retrospective 3-year follow-up study. Epilepsy Behav 2018; 82:150-154. [PMID: 29625366 DOI: 10.1016/j.yebeh.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/24/2018] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess the electrographic criteria related to seizure recurrence and determine age-related seizure recurrence in children with rolandic epilepsy under long-term follow-up. METHODS We retrospectively analyzed the data belonging to 109 patients with rolandic epilepsy with sufficient information regarding disease course and follow-up duration longer than 3years. Patients were divided into two categories: Group A (n: 75), comprised of "patients having fewer than four seizures", and Group B (n: 34), the "recurrence group comprised of patients having more than four seizures in the first three months". The number of spikes per minute during both wakefulness and sleep, the localization of spikes other than centrotemporal region, and the duration of spike-wave activity were evaluated longitudinally, with repeated electroencephalogram (EEG) recordings every 6months. RESULTS The appearance of rolandic spikes in awake EEGs tended to be more prevalent in Group B than Group A. In Group B, spike rates significantly increased in the 12 and 18months after onset whereas spike rates increased significantly only 6months after onset in Group A. Seizure recurrence is mostly seen at 6-8years, and improvement becomes evident by age 12. The mean number of paroxysmal rolandic discharges during sleep was significantly higher in the younger age groups (3-5, 6-8), and the mean number of spikes per minute significantly decreased at ages 9-11 and over 12. CONCLUSION Our study demonstrates that extended periods of high frequency of paroxysmal discharges, initial frontal EEG focus, and persistence of awake interictal abnormalities are highly effective in predicting seizure recurrence in patients with rolandic epilepsy (RE).
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Affiliation(s)
- Ebru Arhan
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology, Turkey
| | - Ayse Serdaroglu
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology, Turkey
| | - Zeynep Ozturk
- Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Department of Pediatric Neurology, Turkey.
| | - Kursad Aydın
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology, Turkey
| | - Tugba Hırfanoglu
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology, Turkey
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Baumer FM, Cardon AL, Porter BE. Language Dysfunction in Pediatric Epilepsy. J Pediatr 2018; 194:13-21. [PMID: 29241678 PMCID: PMC5826845 DOI: 10.1016/j.jpeds.2017.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA.
| | - Aaron L Cardon
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Brenda E Porter
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
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Jiang L, Zhang T, Lv F, Li S, Liu H, Zhang Z, Luo T. Structural Covariance Network of Cortical Gyrification in Benign Childhood Epilepsy with Centrotemporal Spikes. Front Neurol 2018; 9:10. [PMID: 29467710 PMCID: PMC5807981 DOI: 10.3389/fneur.2018.00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/08/2018] [Indexed: 11/13/2022] Open
Abstract
Benign childhood epilepsy with centrotemporal spikes (BECTS) is associated with cognitive and language problems. According to recent studies, disruptions in brain structure and function in children with BECTS are beyond a Rolandic focus, suggesting atypical cortical development. However, previous studies utilizing surface-based metrics (e.g., cortical gyrification) and their structural covariance networks at high resolution in children with BECTS are limited. Twenty-six children with BECTS (15 males/11 females; 10.35 ± 2.91 years) and 26 demographically matched controls (15 males/11 females; 11.35 ± 2.51 years) were included in this study and subjected to high-resolution structural brain MRI scans. The gyrification index was calculated, and structural brain networks were reconstructed based on the covariance of the cortical folding. In the BECTS group, significantly increased gyrification was observed in the bilateral Sylvain fissures and the left pars triangularis, temporal, rostral middle frontal, lateral orbitofrontal, and supramarginal areas (cluster-corrected p < 0.05). Global brain network measures were not significantly different between the groups; however, the nodal alterations were most pronounced in the insular, frontal, temporal, and occipital lobes (FDR corrected, p < 0.05). In children with BECTS, brain hubs increased in number and tended to shift to sensorimotor and temporal areas. Furthermore, we observed significantly positive relationships between the gyrification index and age (vertex p < 0.001, cluster-level correction) as well as duration of epilepsy (vertex p < 0.001, cluster-level correction). Our results suggest that BECTS may be a condition that features abnormal over-folding of the Sylvian fissures and uncoordinated development of structural wiring, disrupted nodal profiles of centrality, and shifted hub distribution, which potentially represents a neuroanatomical hallmark of BECTS in the developing brain.
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Affiliation(s)
- Lin Jiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Radiology, The Third Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | - Tijiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical College, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiguang Li
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical College, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Zhiwei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Shakeri M, Datta AN, Malfait D, Oser N, Létourneau-Guillon L, Major P, Srour M, Tucholka A, Kadoury S, Lippé S. Sub-cortical brain morphometry and its relationship with cognition in rolandic epilepsy. Epilepsy Res 2017; 138:39-45. [DOI: 10.1016/j.eplepsyres.2017.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/29/2017] [Accepted: 09/16/2017] [Indexed: 02/02/2023]
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Camfield C, Camfield P. Cognitive Disabilities and Long-term Outcomes in Children with Epilepsy: A Tangled Tail. Semin Pediatr Neurol 2017; 24:243-250. [PMID: 29249504 DOI: 10.1016/j.spen.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cognitive problems ranging from mild specific learning problems to profound intellectual disability (ID) are very common in children with epilepsy. For most affected patients there is good evidence that the cognitive problems are present at the onset of seizures and do not deteriorate over time. There is no evidence that a few seizures lead to cognitive deterioration. An exception may occur in children with epileptic encephalopathies, although this contention is not always easy to prove. ID is a strong predictor of intractable epilepsy, and the greater the degree of the ID the greater the risk of medication resistant epilepsy. It is not known if specific learning disorders are associated with more severe epilepsy. Rolandic epilepsy is unusual because possibly one-third of patients have transient cognitive and behavioral difficulties during the active phase but later have normal adult social outcome. More longitudinal studies with baseline and repeated cognitive assessments are needed to fully understand the relationship of cognitive problems to childhood onset epilepsy.
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Affiliation(s)
- Carol Camfield
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Peter Camfield
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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"Atypical forms" of benign epilepsy with centrotemporal spikes (BECTS): How to diagnose and guide these children. A practical/scientific approach. Epilepsy Behav 2017; 75:165-169. [PMID: 28866336 DOI: 10.1016/j.yebeh.2017.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/20/2022]
Abstract
Benign epilepsy with centrotemporal spikes (BECTS) epilepsy, also known as rolandic epilepsy, is the most common childhood type of epilepsy. There is debate on its "benign" definition given the numerous literature data on its correlation to cognitive morbidity. Although its prognosis is often favorable, BECTS can present or evolve however to an atypical form, characterized by a worse prognosis and negative impact on cognitive development. It is possible that abnormal electrical activity, marker of neurological dysfunction, has the potential to disrupt neural network function and development. Numerous studies tried to identify clinical or electroencephalographic criteria for atypical forms and atypical evolution of BECTS in order to guide follow-up and treatment of patients and to predict their outcome. This review provides a compact summery of literature data with a focus on predictive features of future cognitive decline.
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Shinnar RC, Shinnar S, Cnaan A, Clark P, Dlugos D, Hirtz DG, Hu F, Liu C, Masur D, Weiss EF, Glauser TA. Pretreatment behavior and subsequent medication effects in childhood absence epilepsy. Neurology 2017; 89:1698-1706. [PMID: 28916534 DOI: 10.1212/wnl.0000000000004514] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/26/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To characterize pretreatment behavioral problems and differential effects of initial therapy in children with childhood absence epilepsy (CAE). METHODS The Child Behavior Checklist (CBCL) was administered at baseline, week 16-20, and month 12 visits of a randomized double-blind trial of ethosuximide, lamotrigine, and valproate. Total problems score was the primary outcome measure. RESULTS A total of 382 participants at baseline, 310 participants at the week 16-20 visit, and 168 participants at the month 12 visit had CBCL data. At baseline, 8% (95% confidence interval [CI] 6%-11%) of children with CAE had elevated total problems scores (mean 52.9 ± 10.91). At week 16-20, participants taking valproic acid had significantly higher total problems (51.7 [98.3% CI 48.6-54.7]), externalizing problems (51.4 [98.3% CI 48.5-54.3]), attention problems (57.8 [98.3% CI 55.6-60.0]), and attention-deficit/hyperactivity problems (55.8 [98.3% CI 54.1-57.6]) scores compared to participants taking ethosuximide (46.5 [98.3% CI 43.4-49.6]; 45.8 [98.3% CI 42.9-48.7]; 54.6 [98.3% CI 52.4-56.9]; 53.0 [98.3% CI 51.3-54.8]). Lack of seizure freedom and elevated week 16-20 Conner Continuous Performance Test confidence index were associated with worse total problems scores. At month 12, participants taking valproic acid had significantly higher attention problems scores (57.9 [98.3% CI 55.6-60.3]) compared to participants taking ethosuximide (54.5 [95% CI 52.1-56.9]). CONCLUSIONS Pretreatment and ongoing behavioral problems exist in CAE. Valproic acid is associated with worse behavioral outcomes than ethosuximide or lamotrigine, further reinforcing ethosuximide as the preferred initial therapy for CAE. CLINICALTRIALSGOV IDENTIFIER NCT00088452. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for children with CAE, valproic acid is associated with worse behavioral outcomes than ethosuximide or lamotrigine.
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Affiliation(s)
- Ruth C Shinnar
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD.
| | - Shlomo Shinnar
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Avital Cnaan
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Peggy Clark
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Dennis Dlugos
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Deborah G Hirtz
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Fengming Hu
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Chunyan Liu
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - David Masur
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Erica F Weiss
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Tracy A Glauser
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
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Wickens S, Bowden SC, D'Souza W. Cognitive functioning in children with self-limited epilepsy with centrotemporal spikes: A systematic review and meta-analysis. Epilepsia 2017; 58:1673-1685. [DOI: 10.1111/epi.13865] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Steven Wickens
- Melbourne School of Psychological Sciences; University of Melbourne; Parkville Victoria Australia
| | - Stephen C. Bowden
- Department of Clinical Neurosciences; St. Vincent's Hospital Melbourne; Fitzroy Victoria Australia
| | - Wendyl D'Souza
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Fitzroy Victoria Australia
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Doumlele K, Friedman D, Buchhalter J, Donner EJ, Louik J, Devinsky O. Sudden Unexpected Death in Epilepsy Among Patients With Benign Childhood Epilepsy With Centrotemporal Spikes. JAMA Neurol 2017; 74:645-649. [PMID: 28384699 DOI: 10.1001/jamaneurol.2016.6126] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Children with benign epilepsy with centrotemporal spikes (BECTS) have traditionally been considered to have a uniformly good prognosis. However, benign may be a misnomer because BECTS is linked to cognitive deficits, a more severe phenotype with intractable seizures, and the potential for sudden unexpected death in epilepsy (SUDEP). Objective To determine if cases of BECTS are present in the North American SUDEP Registry (NASR). Design, Setting, and Participants The NASR is a clinical and biospecimen repository established in 2011 to promote SUDEP research. The NASR database, which includes medical records, results of electroencephalographic tests, and interviews with family members of patients with epilepsy who died suddenly without other identifiable causes of death, was queried from June 3, 2011, to June 3, 2016, for cases of BECTS. The patients with epilepsy had died suddenly without other identifiable causes of death (eg, drowning, trauma, exposure to toxic substances, or suicide); SUDEP classification was determined by the consensus of 2 epileptologists. Main Outcomes and Measures Cases of SUDEP among children who received a diagnosis of BECTS among patients reported in the NASR. Results Three boys (median age at death, 12 years; range, 9-13 years) who received a diagnosis of BECTS by their pediatric epileptologist or neurologists were identified among 189 cases reported in the NASR. The median age of epilepsy onset was 5 years (range, 3-11 years), and the median duration of epilepsy was 4 years (range, 1-10 years). Two deaths were definite SUDEP, and 1 was probable SUDEP. Independent review of clinical and electroencephalographic data supported the diagnosis of BECTS in all 3 patients. None of the patients was prescribed antiseizure drugs, either owing to physician recommendation or mutual decision by the physician and parents. All 3 patients were found dead in circumstances typical of SUDEP. The 3 patients spanned the spectrum of BECTS severity: 1 had only a few seizures, 1 had more than 30 focal motor seizures, and 1 had 4 witnessed generalized tonic-clonic seizures and approximately 30 suspected generalized tonic-clonic seizures. Conclusions and Relevance Sudden unexpected death in epilepsy is a very rare outcome in BECTS that clinicians should consider discussing in appropriate circumstances and possibly factoring into treatment decisions.
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Affiliation(s)
- Kyra Doumlele
- Department of Neurology, New York University School of Medicine, New York
| | - Daniel Friedman
- Department of Neurology, New York University School of Medicine, New York
| | - Jeffrey Buchhalter
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada3Department of Clinical Neurosciences, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth J Donner
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Jay Louik
- Department of Neurology, New York University School of Medicine, New York
| | - Orrin Devinsky
- Department of Neurology, New York University School of Medicine, New York
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Zhao X, Wang A, Wang S, Zhang T, Chi Z, Liu Y. Atypical features of benign rolandic epilepsy in Chinese children: Retrospective study. Pediatr Int 2017; 59:793-797. [PMID: 28258599 DOI: 10.1111/ped.13274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 12/31/2016] [Accepted: 02/27/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Benign rolandic epilepsy (BRE) is one of the most common focal epilepsies in childhood, but less typical clinical presentations may lead to misdiagnosis and incorrect treatment. The focus of this study was therefore to retrospectively investigate the less typical features of BRE in Chinese children. METHODS Data on 316 Chinese children with BRE were collected and analyzed. RESULTS A total of 7.3% of children complained of tension, fear and terror at the onset of a seizure, and 5.4% had been misdiagnosed with mesial temporal lobe epilepsy. Approximately 12.3% had post-ictal Todd's paresis, with 6.6% having been misdiagnosed and given incorrect treatment. Nineteen children (6%) had neuroradiologic abnormalities, which could lead to a diagnosis of symptomatic epilepsy. Twenty-five patients (8.0%) had cognitive deficits. CONCLUSIONS Greater recognition of, and further investigation into, the spectrum of BRE are needed.
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Affiliation(s)
- Xiuhe Zhao
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Aiqin Wang
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Shengjun Wang
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Tongxia Zhang
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Zhaofu Chi
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yiming Liu
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong, China
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Verly M, Gerrits R, Lagae L, Sunaert S, Rommel N, Zink I. Evaluation of the language profile in children with rolandic epilepsy and developmental dysphasia: Evidence for distinct strengths and weaknesses. BRAIN AND LANGUAGE 2017; 170:18-28. [PMID: 28391031 DOI: 10.1016/j.bandl.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 06/07/2023]
Abstract
Although benign, rolandic epilepsy (RE) or benign childhood epilepsy with centro-temporal spikes is often associated with language impairment. Recently, fronto-rolandic EEG abnormalities have been described in children with developmental dysphasia (DD), suggesting an interaction between language impairment and interictal epileptiform discharges. To investigate if a behavioral-linguistic continuum between RE and DD exists, a clinical prospective study was carried out to evaluate the language profile of 15 children with RE and 22 children with DD. Language skills were assessed using an extensive, standardized test battery. Language was found to be impaired in both study groups, however RE and DD were associated with distinct language impairment profiles. Children with RE had difficulties with sentence comprehension, semantic verbal fluency and auditory short-term memory, which are unrelated to age of epilepsy onset and laterality of epileptic focus. In children with DD, sentence comprehension and verbal fluency were among their relative strengths, whereas sentence and lexical production constituted relative weaknesses.
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Affiliation(s)
- M Verly
- Dept. Neurosciences, ExpORL, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - R Gerrits
- Dept. Neurosciences, ExpORL, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - L Lagae
- Dept. Pediatrics, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - S Sunaert
- Dept. Radiology, Translational MRI, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Dept. Radiology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - N Rommel
- Dept. Neurosciences, ExpORL, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - I Zink
- Dept. Neurosciences, ExpORL, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Kirby A, Williams N, Koelewijn L, Brindley LM, Muthukumaraswamy SD, Te Water Naudé J, Thomas M, Gibbon F, Singh KD, Hamandi K. Benign childhood epilepsy with centrotemporal spikes (BECTS) and developmental co-ordination disorder. Epilepsy Behav 2017; 72:122-126. [PMID: 28575760 DOI: 10.1016/j.yebeh.2017.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Benign epilepsy with centro-temporal spikes (BECTS) is a common childhood epilepsy syndrome also known as Rolandic Epilepsy (RE). Neurocognitive phenotypes have been described with greater focus on attention, reading and language domains but there have been far fewer studies focusing on motor functioning. This study included measures of motor, language and cognition in order to investigate the range, degree and pattern of difficulties associated with BECTS in a case series of children, but with a particular emphasis on motor skills. METHOD Twenty-one children aged between 8 and 16years with a diagnosis of BECTS were asked to complete standardized assessments for language, cognition, motor functioning and handwriting. RESULTS When measuring across language, cognitive and motor domains, 19 (90.48%) of the twenty-one children with a diagnosis of BECTS showed some difficulties on at least one area of functioning using standardized assessment tests. Of particular note nearly half (47.62%) of the children had some difficulties in one or more areas of motor functioning. DISCUSSION Children with BECTS have a heterogeneous pattern of neurocognitive impairments. The presence of motor difficulties (DCD) should be considered in all children routinely seen in clinical settings with BECTS and included in any screening processes.
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Affiliation(s)
- Amanda Kirby
- Dyscovery Centre, University of South Wales, Newport, UK.
| | | | - Loes Koelewijn
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK.
| | - Lisa M Brindley
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK.
| | | | | | - Marie Thomas
- Department of Child Health, University Hospital of Wales, Cardiff, UK
| | - Frances Gibbon
- CUBRIC, School of Psychology, Cardiff University, Cardiff, UK.
| | - Krish D Singh
- Welsh Epilepsy Centre, University Hospital of Wales, Cardiff, UK.
| | - Khalid Hamandi
- Welsh Epilepsy Centre, University Hospital of Wales, Cardiff, UK.
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Bourel-Ponchel E, Mahmoudzadeh M, Berquin P, Wallois F. Local and Distant Dysregulation of Synchronization Around Interictal Spikes in BECTS. Front Neurosci 2017; 11:59. [PMID: 28239337 PMCID: PMC5301021 DOI: 10.3389/fnins.2017.00059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 01/26/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: High Density electroencephalography (HD EEG) is the reference non-invasive technique to investigate the dynamics of neuronal networks in Benign Epilepsy with Centro-Temporal Spikes (BECTS). Analysis of local dynamic changes surrounding Interictal Epileptic Spikes (IES) might improve our knowledge of the mechanisms that propel neurons to the hypersynchronization of IES in BECTS. Transient distant changes in the dynamics of neurons populations may also interact with neuronal networks involved in various functions that are impaired in BECTS patients. Methods: HD EEG (64 electrodes) of eight well-characterized BECTS patients (8 males; mean age: 7.2 years, range: 5–9 years) were analyzed. Unilateral IES were selected in 6 patients. They were bilateral and independent in 2 other patients. This resulted in a total of 10 groups of IES. Time-frequency analysis was performed on HD EEG epochs around the peak of the IES (±1000 ms), including phase-locked and non-phase-locked activities to the IES. The time frequency analyses were calculated for the frequencies between 4 and 200 Hz. Results: Time-frequency analysis revealed two patterns of dysregulation of the synchronization between neuronal networks preceding and following hypersynchronization of interictal spikes (±400 ms) in the epileptogenic zone. Dysregulation consists of either desynchronization (n = 6) or oscillating synchronization (n = 4) (4–50 Hz) surrounding the IES. The 2 patients with bilateral IES exhibited only local desynchronization whatever the IES considered. Distant desynchronization in low frequencies within the same window occurs simultaneously in bilateral frontal, temporal and occipital areas (n = 7). Significance: Using time-frequency analysis of HD EEG data in a well-defined population of BECTS, we demonstrated repeated complex changes in the dynamics of neuronal networks not only during, but also, before and after the IES. In the epileptogenic zone, our results found more complex reorganization of the local network than initially thought. In line with previous results obtained at a microscopic or macroscopic level, these changes suggested the variability strategies of neuronal assemblies to raise IES. Distant changes from the epileptogenic zone in desynchronization observed in the same time window suggested interactions between larger embedded networks and opened new avenues about their possible role in the underlying mechanism leading to cognitive deficits.
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Affiliation(s)
- Emilie Bourel-Ponchel
- Institut National de la Santé et de la Recherche Médicale U 1105, GRAMFC, CURS, CHU Amiens Picardie - Site SudSalouël, Amiens, France; Fonctional Exploration of the Pediatric Nervous System, CHU Amiens Picardie - Site SudSalouël, Amiens, France
| | - Mahdi Mahmoudzadeh
- Institut National de la Santé et de la Recherche Médicale U 1105, GRAMFC, CURS, CHU Amiens Picardie - Site SudSalouël, Amiens, France; Fonctional Exploration of the Pediatric Nervous System, CHU Amiens Picardie - Site SudSalouël, Amiens, France
| | - Patrick Berquin
- Institut National de la Santé et de la Recherche Médicale U 1105, GRAMFC, CURS, CHU Amiens Picardie - Site SudSalouël, Amiens, France; Neuropediatry Unit, CHU Amiens Picardie - Site SudSalouël, Amiens, France
| | - Fabrice Wallois
- Institut National de la Santé et de la Recherche Médicale U 1105, GRAMFC, CURS, CHU Amiens Picardie - Site SudSalouël, Amiens, France; Fonctional Exploration of the Pediatric Nervous System, CHU Amiens Picardie - Site SudSalouël, Amiens, France
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Systad S, Bjørnvold M, Markhus R, Lyster SAH. Watch the language! Language and linguistic-cognitive abilities in children with nocturnal epileptiform activity. Epilepsy Behav 2017; 66:10-18. [PMID: 27984701 DOI: 10.1016/j.yebeh.2016.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/25/2022]
Abstract
We studied the language and linguistic-cognitive abilities of a group of children with nocturnal epileptiform activity (NEA; N=33) who were hospitalized at a tertiary epilepsy hospital. The children were compared with two groups: one age- and gender-matched group (N=33) and one group matched on language ability (vocabulary) and gender (N=66). We also examined how NEA-related variables affected language abilities. Overall, the children with NEA showed delayed language abilities and a trend for specific difficulties with phonology and naming speed. We did not find firm evidence that the amount of NEA, the use of antiepileptic drugs (AEDs), and the lateralization and localization of NEA had an effect on language. However, we found that children with right-lateralized epileptiform activity seemed to have specific difficulties with naming speed. Additionally, our results indicated that NEA located in the centrotemporal areas particularly affected phonology and orthographic skills.
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Affiliation(s)
| | - Marit Bjørnvold
- Department of Refractory Epilepsy- SSE, Oslo University Hospital, Norway
| | - Rune Markhus
- Department of Refractory Epilepsy- SSE, Oslo University Hospital, Norway
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Liu MJ, Su XJ, MD XYS, Wu GF, Zhang YQ, Gao L, Wang W, Liao JX, Wang H, Mai JN, Gao JY, Shu XM, Huang SP, Zhang L, Zou LP. Clinical features of benign epilepsy of childhood with centrotemporal spikes in chinese children. Medicine (Baltimore) 2017; 96:e5623. [PMID: 28121917 PMCID: PMC5287941 DOI: 10.1097/md.0000000000005623] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This multicenter clinical trial was conducted to examine current practice of benign epilepsy with centrotemporal spikes and especially address the question that in what circumstances 1 antiepileptic drug (AED) should be preferred.Twenty-five medical centers participate in this clinical trial. The general information, clinical information, and treatment status were collected under the guidance of clinicians and then analyzed. Difference between different treatment groups was compared, and usefulness of the most commonly used AEDs was evaluated.A total of 1817 subjects were collected. The average age of the subject was 8.81 years. The average age of onset is 6.85 years (1-14 years). Male-to-female ratio is 1.13:1. A total of 62.9% of the patients are receiving monotherapies, and 10.6% are receiving multidrug therapy. Both age and course of disease of treated rolandic epilepsy (RE) patients are significantly different from those of untreated patients. Bilateral findings on electroencephalography (EEG) are less seen in patients with monotherapy compared with patients with multidrug therapy. Except for 25.4% patients not taking any AEDs, oxcarbazepine (OXC), sodium valproate (VPA), and levetiracetam (LEV) are the most commonly used 3 AEDs. VPA and LEV are commonly used in add-on therapy. OXC and LEV are more effective as monotherapy than VPA.Age of onset of Chinese RE patients is 6.85 years. Bilateral findings on EEG could be a risk factor to require multidrug therapy. In Chinese patients, OXC, VPA, and LEV are most commonly used AEDs as monotherapy and OXC and LEV are more effective than VPA.
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Affiliation(s)
- Meng-Jia Liu
- Department of Pediatrics, Chinese PLA General Hospital
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing
| | - Xiao-jun Su
- Department of Pediatrics, Chinese PLA General Hospital
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing
| | - Xiu-Yu Shi MD
- Department of Pediatrics, Chinese PLA General Hospital
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing
| | - Ge-fei Wu
- Department of Neurology, Wuhan Children's Hospital Wuhan Shi, Hubei Sheng
| | - Yu-qin Zhang
- Department of Neurology, Tianjin Children's Hospital, Tianjin
| | - Li Gao
- Department of Pediatrics, Henan Province People's Hospital, Henan
| | - Wei Wang
- Department of Neurology, Harbin Children's Hospital, Heilongjiang Sheng
| | - Jian-xiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen Shi, Guangdong Sheng
| | - Hua Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang Shi, Liaoning Sheng
| | - Jian-ning Mai
- Department of Neurology, Guangzhou Women's and Children's Medical Center, Guangzhou
| | - Jing-yun Gao
- Department of Neurology, Tangshan Women's Children's Hospital, Tangshan Shi, Hebei Sheng
| | - Xiao-mei Shu
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical College, Zunyi
| | - Shao-ping Huang
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an
| | - Li Zhang
- Department of Pediatrics, Linyi People's Hospital, Linyi, China
| | - Li-Ping Zou
- Department of Pediatrics, Chinese PLA General Hospital
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing
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Ji GJ, Yu Y, Miao HH, Wang ZJ, Tang YL, Liao W. Decreased Network Efficiency in Benign Epilepsy with Centrotemporal Spikes. Radiology 2016; 283:186-194. [PMID: 27631414 DOI: 10.1148/radiol.2016160422] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the functional connectome alterations in benign epilepsy with centrotemporal spikes with respect to the occurrence of interictal epileptic discharges (IEDs) during functional magnetic resonance (MR) imaging. Materials and Methods This prospective study was approved by the local institutional review board and was HIPAA compliant. All participants were consecutively enrolled with written informed consent. Forty-three right-handed patients were classified into IED (n = 20, 13 girls and seven boys; mean age ± standard deviation, 9.00 years ± 1.95) and non-IED (n = 23, 11 girls and 12 boys; mean age, 10.22 years ± 2.13) groups on the basis of electroencephalographic data simultaneously recorded during resting-state functional MR imaging at 3.0 T. The functional connectome features (estimated with graph theoretical analysis) in patient groups and control subjects who were matched for sex, age, and education level (n = 28, all right-handed, 13 girls and 15 boys; mean age, 10.00 years ± 2.31) were compared by using one-way analysis of variance. Results Patients with IEDs and those without IEDs showed consistently abnormal global topology in their functional networks (ie, decreased global efficiency; P < .05) relative to that of control subjects, with no differences between the two patient groups (P > .05). Decreased regional efficiency and connectivity strength were observed in the patients with IEDs and those without (mainly in the perirolandic and frontal areas) relative to control subjects (P < .05). Moreover, the altered functional features significantly correlated with clinical characteristics (ie, disease duration and age at symptom onset, P < .05). Conclusion These findings suggest that decreased global and regional efficiency are prominent functional deficits in children with benign epilepsy with centrotemporal spikes and can be readily identified with resting-state functional MR imaging, irrespective of IEDs. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Gong-Jun Ji
- From the Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China (G.J.J.); Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, China (G.J.J.); Department of Psychology, School of Education (G.J.J., H.H.M., W.L.), and Center for Cognition and Brain Disorders and the Affiliated Hospital (G.J.J., H.H.M., W.L.), Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China (G.J.J., H.H.M., W.L.); Departments of Psychiatry (Y.Y.) and Neurology (Z.J.W., Y.L.T.), the Second Affiliated Hospital of Medial College, Zhejiang University, Zhejiang, China; and Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China (W.L.)
| | - Yang Yu
- From the Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China (G.J.J.); Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, China (G.J.J.); Department of Psychology, School of Education (G.J.J., H.H.M., W.L.), and Center for Cognition and Brain Disorders and the Affiliated Hospital (G.J.J., H.H.M., W.L.), Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China (G.J.J., H.H.M., W.L.); Departments of Psychiatry (Y.Y.) and Neurology (Z.J.W., Y.L.T.), the Second Affiliated Hospital of Medial College, Zhejiang University, Zhejiang, China; and Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China (W.L.)
| | - Huan-Huan Miao
- From the Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China (G.J.J.); Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, China (G.J.J.); Department of Psychology, School of Education (G.J.J., H.H.M., W.L.), and Center for Cognition and Brain Disorders and the Affiliated Hospital (G.J.J., H.H.M., W.L.), Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China (G.J.J., H.H.M., W.L.); Departments of Psychiatry (Y.Y.) and Neurology (Z.J.W., Y.L.T.), the Second Affiliated Hospital of Medial College, Zhejiang University, Zhejiang, China; and Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China (W.L.)
| | - Zhong-Jin Wang
- From the Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China (G.J.J.); Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, China (G.J.J.); Department of Psychology, School of Education (G.J.J., H.H.M., W.L.), and Center for Cognition and Brain Disorders and the Affiliated Hospital (G.J.J., H.H.M., W.L.), Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China (G.J.J., H.H.M., W.L.); Departments of Psychiatry (Y.Y.) and Neurology (Z.J.W., Y.L.T.), the Second Affiliated Hospital of Medial College, Zhejiang University, Zhejiang, China; and Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China (W.L.)
| | - Ye-Lei Tang
- From the Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China (G.J.J.); Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, China (G.J.J.); Department of Psychology, School of Education (G.J.J., H.H.M., W.L.), and Center for Cognition and Brain Disorders and the Affiliated Hospital (G.J.J., H.H.M., W.L.), Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China (G.J.J., H.H.M., W.L.); Departments of Psychiatry (Y.Y.) and Neurology (Z.J.W., Y.L.T.), the Second Affiliated Hospital of Medial College, Zhejiang University, Zhejiang, China; and Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China (W.L.)
| | - Wei Liao
- From the Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China (G.J.J.); Collaborative Innovation Centre of Neuropsychiatric Disorders and Mental Health, Anhui Province, China (G.J.J.); Department of Psychology, School of Education (G.J.J., H.H.M., W.L.), and Center for Cognition and Brain Disorders and the Affiliated Hospital (G.J.J., H.H.M., W.L.), Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China (G.J.J., H.H.M., W.L.); Departments of Psychiatry (Y.Y.) and Neurology (Z.J.W., Y.L.T.), the Second Affiliated Hospital of Medial College, Zhejiang University, Zhejiang, China; and Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China (W.L.)
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Grant AC, Chau L, Arya K, Schneider M. Prevalence of epileptiform discharges in healthy 11- and 12-year-old children. Epilepsy Behav 2016; 62:53-6. [PMID: 27450305 PMCID: PMC5014703 DOI: 10.1016/j.yebeh.2016.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
We sought to determine the prevalence of interictal epileptiform discharges (IEDs) in healthy 11- and 12-year-old children. Sixth grade students with no history of seizure, or neurologic or psychiatric disease, were enrolled in a longitudinal physical activity intervention study. Per study protocol, each student had two EEG recordings approximately 6months apart. Epileptiform discharges were present in 4 (2.9%) of 140 students: centrotemporal in three and generalized in one. In three children, the discharges were still present six months later. None of the children had developed seizures a minimum of one year after the second EEG. These results are consistent with those of two landmark European studies performed nearly a half century ago, before the modern era of digital EEG. Healthy 11- and 12-year-old children with no history of seizure may have centrotemporal or generalized epileptiform discharges on EEG, which can persist for at least 6months. Based on both our results and those of the two prior European studies, such discharges, if found incidentally in otherwise healthy children in this age group, should not prompt further evaluation or treatment.
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Affiliation(s)
- Arthur C. Grant
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA, To whom correspondence should be addressed at: SUNY Downstate Medical Center, Comprehensive Epilepsy Center, 450 Clarkson Ave. MSC 1275, Brooklyn, NY 11203, Phone #: (718) 270-2959, Fax #: (718) 270-4711,
| | - Larissa Chau
- Department of Social Ecology, University of California Irvine, Irvine, CA, USA.
| | - Kapil Arya
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Margaret Schneider
- Department of Social Ecology, University of California Irvine, Irvine, CA, USA.
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Liu X, Han Q. Depression and anxiety in children with benign childhood epilepsy with centrotemporal spikes (BCECTS). BMC Pediatr 2016; 16:128. [PMID: 27530338 PMCID: PMC4987983 DOI: 10.1186/s12887-016-0670-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Elevated rates of affective disturbance in children with benign childhood epilepsy with centrotemporal spikes (BCECTS) have been reported. However, it remains unclear how anxiety and depression are related to epilepsy, and it is unknown whether these mood disorders are influenced by the use of antiepileptic drugs. In the present report, we performed a prospective study designed to evaluate affective disorders (anxiety and depression) without the bias of antiepileptic drug treatment in 89 children with BCECTS, based on self-reporting. Furthermore, we sought to determine whether clinical factors, such as age, disease course, seizure frequency, and spike wave index (SWI), were related to the psychological profiles. Methods Patients with BCECTS (n = 89) and healthy matched controls (n = 75) were included in this study. The Depression Self-Rating Scale for Children (DSRSC) and the Screen for Child Anxiety-Related Emotional Disorders (SCARED) were completed by the children. Results None of the children met criteria for clinically significant anxiety or depression. However, the children with BCECTS had significantly higher depression and anxiety scores compared with children in the control group. We found no significant differences in depression or anxiety between the left, right, and bilateral lobe groups. The DSRSC scores were similar between the children with partial seizures and those with secondarily generalized seizures. Similarly, there were no significant differences in the SCARED scores between these two groups. However, the DSRSC and SCARED scores were positively correlated with age, seizure frequency, SWI, and disease course. Conclusions The children with BCECTS had an increased likelihood of depression and anxiety, and these higher rates were unrelated to seizure type or epileptic focus, but were positively correlated with age, seizure frequency, SWI, and disease course.
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Affiliation(s)
- Xinjie Liu
- Department of Pediatrics, Qilu Hospital, Shandong University, and Brain Science Research Institute, Shandong University, No. 107 Wen Hua Xi Road, Jinan, People's Republic of China.
| | - Qizheng Han
- Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, No. 4 Duan Xing Xi Road, Jinan, People's Republic of China
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van Dijkman SC, Alvarez-Jimenez R, Danhof M, Della Pasqua O. Pharmacotherapy in pediatric epilepsy: from trial and error to rational drug and dose selection - a long way to go. Expert Opin Drug Metab Toxicol 2016; 12:1143-56. [PMID: 27434782 DOI: 10.1080/17425255.2016.1203900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Whereas ongoing efforts in epilepsy research focus on the underlying disease processes, the lack of a physiologically based rationale for drug and dose selection contributes to inadequate treatment response in children. In fact, limited information on the interindividual variation in pharmacokinetics and pharmacodynamics of anti-epileptic drugs (AEDs) in children drive prescription practice, which relies primarily on dose regimens according to a mg/kg basis. Such practice has evolved despite advancements in pediatric pharmacology showing that growth and maturation processes do not correlate linearly with changes in body size. AREAS COVERED In this review we aim to provide 1) a comprehensive overview of the sources of variability in the response to AEDs, 2) insight into novel methodologies to characterise such variation and 3) recommendations for treatment personalisation. EXPERT OPINION The use of pharmacokinetic-pharmacodynamic principles in clinical practice is hindered by the lack of biomarkers and by practical constraints in the evaluation of polytherapy. The identification of biomarkers and their validation as tools for drug development and therapeutics will require some time. Meanwhile, one should not miss the opportunity to integrate the available pharmacokinetic data with modeling and simulation concepts to prevent further delays in the development of personalised treatments for pediatric patients.
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Affiliation(s)
- Sven C van Dijkman
- a Division of Pharmacology , Leiden Academic Centre for Drug Research , Leiden , The Netherlands
| | - Ricardo Alvarez-Jimenez
- a Division of Pharmacology , Leiden Academic Centre for Drug Research , Leiden , The Netherlands
| | - Meindert Danhof
- a Division of Pharmacology , Leiden Academic Centre for Drug Research , Leiden , The Netherlands
| | - Oscar Della Pasqua
- b Clinical Pharmacology and Discovery Medicine , GlaxoSmithKline , Stockley Park , UK.,c Clinical Pharmacology and Therapeutics , University College London , London , UK
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Vannest J, Tenney JR, Altaye M, Byars AW, Spencer C, Maloney TC, Szaflarski JP, Morita D, Glauser TA. Impact of frequency and lateralization of interictal discharges on neuropsychological and fine motor status in children with benign epilepsy with centrotemporal spikes. Epilepsia 2016; 57:e161-7. [PMID: 27350662 DOI: 10.1111/epi.13445] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
Despite a positive prognosis for seizure remission, children with benign epilepsy with centrotemporal spikes (BECTS) have been reported to exhibit subtle neuropsychological difficulties. We examined the relationship between patterns of centrotemporal spikes (the typical electroencephalography [EEG] finding in BECTS) and neuropsychological and motor outcomes in children with new-onset BECTS. Thirty-four patients with new-onset BECTS (not taking antiepileptic medication) and 48 typically developing children participated in the study. In BECTS patients, centrotemporal spikes (CTS) were evaluated in the first hour awake and first 2 h of sleep in a 24-h EEG recording and left or right-sided origin was noted. General intellectual function, language, visuospatial skill, processing speed, and fine motor skill were assessed in all participants. We found no significant difference between BECTS patients and controls on measures of general intellectual function, or visuospatial or language testing. There were significant differences in processing speed index and nondominant hand fine motor scores between groups. Significant negative relationships were observed between rates of left-sided CTS and right hand fine motor scores. This suggests that psychomotor and fine motor speed are affected in BECTS, but the extent of affected domains may be more limited than previously suggested, especially in untreated patients early in the course of their epilepsy.
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Affiliation(s)
- Jennifer Vannest
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Jeffrey R Tenney
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Mekibib Altaye
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Anna W Byars
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Caroline Spencer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Thomas C Maloney
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | | | - Diego Morita
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Tracy A Glauser
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Perry MS. Are We Winning the Battle But Losing the War? Sequelae of Surviving Epilepsy. Epilepsy Curr 2016; 16:139-40. [PMID: 27330433 PMCID: PMC4913840 DOI: 10.5698/1535-7511-16.3.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
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Tenney JR, Glauser T, Altaye M, Szaflarski JP, Spencer C, Morita D, Vannest J. Longitudinal stability of interictal spikes in benign epilepsy with centrotemporal spikes. Epilepsia 2016; 57:805-11. [PMID: 27012680 DOI: 10.1111/epi.13367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the natural history of electroencephalography (EEG) changes in patients with benign epilepsy with centrotemporal spikes (BECTS) over 1 year. METHODS Centrotemporal spikes were visually evaluated based on 24-h ambulatory EEG studies to determine the total, left, right, and bilateral centrotemporal spikes patients were awake and asleep. These spike rates were then used to compare the entire night of sleep to the first 2 h of sleep, the repeatability of spike frequency over two recordings (done within days to weeks), and longitudinal changes in spike rate over 6 and 12 months. RESULTS Nineteen children with newly diagnosed and untreated BECTS were included in this analysis. An excellent correlation was found between the centrotemporal spike rate during the entire duration of sleep and the first 2 h of sleep (intraclass correlation [ICC] 0.87, 95% confidence interval [CI] 0.67-0.95). In addition, an excellent correlation was found between two recordings completed an average of 23 days apart while patients were asleep (ICC 0.92, 95% CI 0.80-0.97) and good correlation while patients were awake (ICC 0.70, 95% CI 0.39-0.87). The average change in spike rate between recordings at baseline and at 6 months was a decrease of 64.7% (range -100% to +51.5%, p = 0.01) and the average change in rate between recordings at baseline and at 12 months was a decrease of 57.7% (range -100% to +29.1%, p = 0.01). In addition, within 6 months, most children had decreased centrotemporal rates, with 30% of children being spike-free. This absence of spikes did not continue in all children, since the majority (60%) had some spikes at 1 year following diagnosis. SIGNIFICANCE Centrotemporal spike rates during sleep are stable when compared over days to weeks; however, when comparing spike rates over months there is a larger degree of variability.
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Affiliation(s)
- Jeffrey R Tenney
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Tracy Glauser
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Caroline Spencer
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Diego Morita
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Jennifer Vannest
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Interictal epileptiform discharge effects on neuropsychological assessment and epilepsy surgical planning. Epilepsy Behav 2016; 56:131-8. [PMID: 26874864 PMCID: PMC4785026 DOI: 10.1016/j.yebeh.2016.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/31/2015] [Accepted: 01/02/2016] [Indexed: 01/14/2023]
Abstract
Both animal research and human research suggest that interictal epileptiform discharges (IEDs) may affect cognition, although the significance of such findings remains controversial. We review a wide range of literature with bearing on this topic and present relevant epilepsy surgery cases, which suggest that the effects of IEDs may be substantial and informative for surgical planning. In the first case, we present a patient with epilepsy with left anterior temporal lobe (TL) seizure onset who experienced frequent IEDs during preoperative neuropsychological assessment. Cognitive results strongly lateralized to the left TL. Because the patient failed performance validity tests and appeared amnestic for verbal materials inconsistent with his work history, selected neuropsychological tests were repeated 6 weeks later. Scores improved one to two standard deviations over the initial evaluation and because of this improvement, were only mildly suggestive of left TL impairment. The second case involves another patient with documented left TL epilepsy who experienced epileptiform activity while undergoing neurocognitive testing and simultaneous ambulatory EEG recording. This patient's verbal memory performance was impaired during the period that IEDs were present but near normal when such activity was absent. Overall, although the presence of IEDs may be helpful in confirming laterality of seizure onset, frequent IEDs might disrupt focal cognitive functions and distort accurate measurement of neuropsychological ability, interfering with accurate characterization of surgical risks and benefits. Such transient effects on daily performance may also contribute to significant functional compromise. We include a discussion of the manner in which IED effects during presurgical assessment can hinder individual patient presurgical planning as well as distort outcome research (e.g., IEDs occurring during presurgical assessment may lead to an underestimation of postoperative neuropsychological decline).
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Xiao F, An D, Lei D, Li L, Chen S, Wu X, Yang T, Ren J, Gong Q, Zhou D. Real-time effects of centrotemporal spikes on cognition in rolandic epilepsy. Neurology 2016; 86:544-51. [DOI: 10.1212/wnl.0000000000002358] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/12/2015] [Indexed: 11/15/2022] Open
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Datta AN. Language and literacy in children with benign epilepsy with centrotemporal spikes. Dev Med Child Neurol 2015; 57:986. [PMID: 26306569 DOI: 10.1111/dmcn.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland
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