Prognostic significance of failure of the initial antiepileptic drug in children with benign childhood epilepsy with centrotemporal spikes

Alternations of neuromagnetic activity across neurocognitive core networks among benign childhood epilepsy with centrotemporal spikes: A multi-frequency MEG study

Objective

We aimed to investigate the alternations of neuromagnetic activity across neurocognitive core networks among early untreated children having benign childhood epilepsy with centrotemporal spikes (BECTS).

Methods

We recorded the Magnetoencephalography (MEG) resting-state data from 48 untreated children having BECTS and 24 healthy children. The fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV) was utilized to divide the children with BECTS into two groups: the cognitive impairment (CI) group with a full-scale intelligence quotient (FSIQ) of < 90 and the cognitive non-impairment (CNI) group with an FSIQ of > 90. We selected 26 bilateral cognitive-related regions of interest based on the triple network model. The neurocognitive core network spectral power was estimated using a minimum norm estimate (MNE).

Results

In the CNI group, the spectral power inside the bilateral anterior cingulate cortex (ACC) and the bilateral caudal middle frontal cortex (CMF) enhanced within the delta band and reduced within the alpha band. Both the CI and the CNI group demonstrated enhanced spectral power inside the bilateral posterior cingulate cortex (PCC), bilateral precuneus (PCu) region, bilateral superior and middle temporal cortex, bilateral inferior parietal lobe (IPL), and bilateral supramarginal cortex (SM) region in the delta band. Moreover, there was decreased spectral power in the alpha band. In addition, there were consistent changes in the high-frequency spectrum (> 90 Hz). The spectral power density within the insula cortex (IC), superior temporal cortex (ST), middle temporal cortex (MT), and parahippocampal cortex (PaH) also decreased. Therefore, studying high-frequency activity could lead to a new understanding of the pathogenesis of BECTS.

Conclusion

The alternations of spectral power among neurocognitive core networks could account for CI among early untreated children having BECTS. The dynamic properties of spectral power in different frequency bands could behave as biomarkers for diagnosing new BECTS.

Outcome analysis of children with rolandic discharges on EEG: A real-world study

OBJECTIVE

To evaluate the efficacy of drugs for patients with central mid-temporal (rolandic) discharges detected by electroencephalogram (EEG).

METHODS

This retrospective study enrolled 430 patients with rolandic discharges, who were treated at the Neuroelectrophysiology Center of the Children's Hospital of Nanjing Medical University from February 2015 to February 2018. Patients were divided into three groups according to medication: levetiracetam (LEV), oxcarbazepine (OXC) and sodium valproate (VPA). All patients were followed up for at least 2 years, and the seizure frequency, EEG results and side effects of drugs were recorded.

RESULTS

Rolandic epilepsy (RE) occurred in 398/430 patients. Rolandic discharges were also found in those with febrile seizures, tic disorders, and attention deficit hyperactivity disorder. Thirty-one patients experienced only one seizure and no relapse, while 367 patients experienced more than two seizures (including 364 receiving drug treatment). The failure rate of LEV as initial therapy was significantly higher than those of OXC and VPA. The overall efficacy of OXC was higher than that of LEV. However, none of the three medications could control rolandic discharges. Moreover, the side effects of the three drugs were mild.

CONCLUSIONS

Rolandic discharges are common in children with RE and other diseases, such as febrile seizures, tic disorders, and attention deficit hyperactivity disorder. Patients with only one seizure need no treatment. Those with multiple seizures can be treated with OXC, LEV, and VPA. OXC serves as the initial antiepileptic drug with a lower failure rate and significant efficacy.

Factors associated with electroencephalographic and clinical remission of benign childhood epilepsy with centrotemporal spikes

PURPOSE

Benign childhood epilepsy with centrotemporal spikes (BECTS) is strongly related to age, both to age at the time of seizure onset and to age at remission. However, the age of remission varies. The present study analyzed factors associated with remission of BECTS.

METHODS

Sixty-nine children with BECTS were retrospectively analyzed. Thirty-eight (55.1%) were boys and 31 (44.9%) were girls. Mean age at seizure onset was 86.36 ± 24.55 months (range: 41-151 months).

RESULTS

The mean age at the time of EEG improvement or remission was 138.31 ± 19.71 months. Of the 69 patients, 36 (52.2%) exhibited electroencephalography (EEG) improvement or remission before age 11.5 years, whereas 33 (47.8%) showed later improvement or remission. The two groups differed significantly in age at seizure onset. When patients were divided into groups using an age cutoff for last seizure of 9 years, the two groups differed significantly in age at seizure onset.

CONCLUSIONS

The most important predictor of early BECTS remission is age at seizure onset.

"Atypical forms" of benign epilepsy with centrotemporal spikes (BECTS): How to diagnose and guide these children. A practical/scientific approach

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.

Nightly oral administration of topiramate for benign childhood epilepsy with centrotemporal spikes

OBJECTIVE

The objective of this study was to explore the feasibility of nightly oral administration of topiramate for treating benign childhood epilepsy with centrotemporal spikes (BECTS).

METHODS

Eighty-five children with BECTS receiving topiramate treatment were randomly divided into A group (44 patients) and B group (41 patients). In A group, topiramate was orally administrated once a night, with a final dose of 2 mg/kg/day. In B group, topiramate was orally administrated twice a day, with a final dose of 4 mg/kg/day. At the end of the 12-month follow-up period, clinical efficacy, changes in electroencephalographic (EEG) activity, and adverse reactions were analyzed.

RESULTS

There was no significant difference in overall efficacy rate, percentages of patients achieving seizure free, or changes in EEG activity between the two groups (P > 0.05). The rate of adverse reactions for A group was 9.1 %, which was significantly lower than the 29.3 % for B group (χ (2) = 4.262, P < 0.05).

CONCLUSION

Nightly oral administration of topiramate is a feasible strategy for the treatment of BECTS, with the advantages of comparable efficacy, convenience, and fewer adverse reactions.

Benign epilepsy with centrotemporal spikes: Relationship between type of seizures and response to medication in a Greek population

Purpose:

Benign epilepsy with centrotemporal spikes (BECTS) is considered to be the most common childhood epileptic syndrome. We studied the relationship between the type of seizures and response to medication in a Greek population.

Materials and Methods:

We studied 60 neurodevelopmentally normal children diagnosed with BECTS. Children were subdivided into three groups, based on type of seizures: Group A comprised 32 children with generalized tonic-clonic seizures, Group B 19 children with focal seizures and Group C 9 children with focal seizures with secondary generalization. All patients in the present study were started on an antiepileptic medication after the third seizure (sodium valproate, carbamazepine, and oxcarbazepine), and we studied the response to medication.

Results:

10 from 13 (76.92%) of patients in Group A, 13 from 15 (86.66%) patients in Group B, and all 6 patients (100%) in Group C started carbamazepine or oxcarbazepine had a favorable respond. Similarly, 16 from 19 (84.2%) of patients in Group A, 3 from 4 patients (75%) in Group B, and 1 from 3 patients (33.3%) in Group C, started sodium valproate responded well to medication.

Conclusions:

The majority of children responded well to the first antiepileptic treatment and had a favorable outcome, regardless of type of seizures. 88.3% of children became seizure free by 1 or 2 years after seizure onset. These findings are indicative that the type of seizures has no major effect neither in response to antiepileptic treatment or in the final outcome. Further research in a larger number of children is needed.

Factors Predicting Poor Response to Initial Therapy in Benign Childhood Epilepsy with Centrotemporal Spikes (BCECTS)

Background and Purpose:

Benign childhood epilepsy with centrotemporal spikes (BCECTS) is the most common pediatric focal epilepsy syndrome and typically has positive clinical outcomes. However, a few patients experience recurrent seizures, and therefore, require treatment with antiepileptic drugs (AEDs). This study aimed to identify risk factors associated with poor response to initial AED therapy in BCECTS patients.

Methods:

We retrospectively reviewed the files of 57 patients who were diagnosed with BCECTS between January 2008 and September 2013. Patients not being treated with AEDs have been excluded. We placed the patients into two groups: (1) patients using 1 AED, and (2) patients using 2 AEDs. Clinical characteristics were then collected from the medical records.

Results:

Of the 57 patients, 41 (72%) were successfully treated with 1 AED, and 16 (28%) required 2 AEDs to control seizures. Multiple logistic regression analysis indicated that seizure onset prior to age 5 (odds ratio [OR]: 5.65, 95% confidence interval [CI]: 1.41–22.68) and history of febrile seizures (OR: 4.97, 95% CI: 1.06–23.36) were independent risk factors for poor response to initial therapy (p<0.05). Response to AEDs was not associated with the presence of focal slowing or generalized epileptiform discharges on EEG, abnormalities on MRI of the brain, frequency of afebrile seizures before drug therapy, or family history of febrile seizures or epilepsy.

Conclusions:

This study revealed that 28% of patients with BCECTS experienced poor responses to initial AED therapy. Factors predicting poor response to the initial AED included onset of seizures prior to age 5 and history of febrile seizures.