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Dilber B, Serdaroğlu E, Kanmaz S, Kılıç B, İpek R, Menderes DK, Yıldız N, Topçu Y, Arhan EP, Serdaroğlu A, Okuyaz Ç, Aydın K, Tekgül H, Cansu A. A Multicenter Study of Self-Limited Epilepsy With Centrotemporal Spikes: Effectiveness of Antiseizure Medication With Respect to Spike-Wave Index. Pediatr Neurol 2024; 152:79-86. [PMID: 38237317 DOI: 10.1016/j.pediatrneurol.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/06/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND There is no certain validated electroencephalographic (EEG) parameters for outcome prediction in children with self-limited epilepsy with centrotemporal spikes. To assess the effectiveness of antiseizure medication (ASM) for seizure outcome with respect to the spike-wave index (SWI) on serial EEG recordings. METHODS In this multicenter study, the study cohort consisted of 604 children with self-limited epilepsy with centrotemporal spikes. A data set of epilepsy centers follow-up between 2010 and 2022. The cohort was divided into 4 groups as those receiving 3 different monotherapy (carbamazepine [CBZ]/valproic acid [VPA]/levetiracetam [LEV]) and dual therapy. SWI analysis was performed with the percent of spikes in the 2-minute epoch in the 5th 6th minutes of the nonrapid eye movement sleep EEG record. The study group were also categorized according to seizure burden with seizure frequency (I) >2 seizures and (II) >5 seizures. Seizure outcome was evaluated based on the reduction in seizure frequency over 6-month periods: (1) 50% reduction and (2) seizure-free (complete response). RESULTS ASM monotherapy was achieved in 74.5% children with VPA, CBZ, and LEV with similar rates of 85.8%, 85.7%, and 77.9%. Dual therapy was need in the 25.5% of children with SeLECT. More dual therapy was administered in children aged below 5 years with a rate of 46.2%. Earlier seizure-free achievement time was seen in children with LEV monotherapy with more complete-response rate (86.7%) compared the VPA and CBZ. CONCLUSIONS We also determined that the children on dual therapy had more SWI clearance in the subsequent EEG recordings. The ROC curve analyses were performed to predict initial drug selection with using the SWI% might be used for the prediction of ASM type and drug selection in children.
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Affiliation(s)
- Beril Dilber
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Esra Serdaroğlu
- Department of Pediatric Neurology, Gazi University, Ankara, Turkey
| | - Seda Kanmaz
- Department of Pediatric Neurology, Ege University, İzmir, Turkey
| | - Betül Kılıç
- Department of Pediatric Neurology, Medipol University, İstanbul Turkey
| | - Rojan İpek
- Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | | | - Nihal Yıldız
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Yasemin Topçu
- Department of Pediatric Neurology, Medipol University, İstanbul Turkey
| | - Ebru Petek Arhan
- Department of Pediatric Neurology, Gazi University, Ankara, Turkey
| | - Ayşe Serdaroğlu
- Department of Pediatric Neurology, Gazi University, Ankara, Turkey
| | - Çetin Okuyaz
- Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Kürşad Aydın
- Department of Pediatric Neurology, Medipol University, İstanbul Turkey
| | - Hasan Tekgül
- Department of Pediatric Neurology, Ege University, İzmir, Turkey
| | - Ali Cansu
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey.
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Ji Y, Zhang J, Lu H, Yang H, Zhang X, Liu H, Liu W, Zhou W, Zhang X, Sun W. Correlation between scalp high-frequency oscillations and prognosis in patients with benign epilepsy of childhood with centrotemporal spikes. CNS Neurosci Ther 2023; 29:3053-3061. [PMID: 37157892 PMCID: PMC10493670 DOI: 10.1111/cns.14246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/03/2023] [Accepted: 04/16/2023] [Indexed: 05/10/2023] Open
Abstract
AIMS The study aimed to explore whether high-frequency oscillations (HFOs) can predict seizure risk and atypical manifestations of benign epilepsy of childhood with centrotemporal spikes (BECTS). METHODS We recruited 60 patients and divided them into three groups: (1) seizure-free BECTS, (2) active typical BECTS, and (3) active atypical forms of BECTS. Electroencephalogram was used to record the number, location, average amplitude, and duration of spikes, and spike ripples were analyzed using time-frequency technology. Multivariable logistic regression analysis was used to investigate independent predictive factors for prognosis. RESULTS The number of sleep spike ripples, rather than spikes, was an independent risk factor for the active period of the disease (odds ratio [OR] = 4.714, p = 0.003) and atypical forms of BECTS (OR = 1.455, p = 0.049); the optimal thresholds for the spike ripple rate were >0 (area under the curve [AUC] = 0.885, sensitivity = 96.15%, specificity = 73.33%) and >0.6/min (AUC = 0.936, sensitivity = 84.21%, specificity = 96.15%), respectively. Furthermore, in typical BECTS, the spike ripple rate showed significant negative correlations with time since the last seizure (ρ = -0.409, p = 0.009) and age (ρ = -0.379, p = 0.016), while the spike rate did not. CONCLUSION Spike ripple was a marker for distinguishing typical and atypical forms of BECTS and reflected the risk of seizure recurrence better than the spike alone. The present findings might assist clinicians in BECTS treatment.
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Affiliation(s)
- Yichen Ji
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Jun Zhang
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Hongjuan Lu
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Haoran Yang
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Xuan Zhang
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Huixin Liu
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Wenjian Liu
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Wei Zhou
- Department of NeurologyMine HospitalXuzhouChina
| | | | - Wei Sun
- Department of NeurologyXuanwu Hospital Capital Medical UniversityBeijingChina
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Günay Ç, Sarikaya Uzan G, Özsoy Ö, Hiz Kurul S, Yiş U. The fate of spikes in self-limited epilepsy with centrotemporal spikes: Are clinical and baseline EEG features effective? Epilepsy Res 2023; 193:107165. [PMID: 37201400 DOI: 10.1016/j.eplepsyres.2023.107165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of clinical and electroencephalographic features on spike reduction with a focus on the first EEG characteristics in self-limited epilepsy with centrotemporal spikes (SeLECTS). METHODS This retrospective study was conducted on SeLECTS patients of with at least five years follow-up and at least two EEG recordings in which spike wave indexes (SWI) were calculated. RESULTS 136 patients were enrolled. Median SWI in the first and last EEGs were 39% (7.6-89%) and 0 (0-112%). Gender, seizure onset age, psychiatric diseases, seizure characteristics (semiology, duration, and relationship to sleep), last EEG time, and spike lateralization in the first EEG did not have a statistically significant effect on the SWI change. Multinomial logistic regression analysis revealed that presence of phase reversal, interhemispheric generalization, and SWI percentage had a significant effect on spike reduction. The frequency of seizures was also significantly decreased in patients with a greater decrease in SWI. Both valproate and levetiracetam were statistically superior in suppressing SWI, with no significant difference between them. CONCLUSION Interhemispheric generalization and phase reversal in the first EEG in SeLECTS had negative effects on the spike reduction. The most effective ASMs in reducing spikes were valproate and levetiracetam.
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Affiliation(s)
- Çağatay Günay
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
| | - Gamze Sarikaya Uzan
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Özlem Özsoy
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Semra Hiz Kurul
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Uluç Yiş
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Oguri M, Okazaki T, Okanishi T, Nishiyama M, Kanai S, Yamada H, Ogo K, Himoto T, Maegaki Y, Fujimoto A. Phase Lag Analysis Scalp Electroencephalography May Predict Seizure Frequencies in Patients with Childhood Epilepsy with Centrotemporal Spikes. Yonago Acta Med 2023; 66:48-55. [PMID: 36820294 PMCID: PMC9937964 DOI: 10.33160/yam.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023]
Abstract
Background Childhood epilepsy with centrotemporal spikes (CECTS) is the most common epilepsy syndrome in school-aged children. However, predictors for seizure frequency are yet to be clarified using the phase lag index (PLI) analyses. We investigated PLI of scalp electroencephalography data at onset to identify potential predictive markers for seizure times. Methods We compared the PLIs of 13 patients with CECTS and 13 age- and sex-matched healthy controls. For the PLI analysis, we used resting-state electroencephalography data (excluding paroxysmal discharges), and analyzed the mean PLIs among all electrodes and between interest electrodes (C3, C4, P3, P4, T3, and T4) and other electrodes. Furthermore, we compared PLIs between CECTS and control data and analyzed the associations between PLIs and total seizure times in CECTS patients. Results No differences were detected in clinical profiles or visual electroencephalography examinations between patients with CECTS and control participants. In patients with CECTS, the mean PLIs among all electrodes and toward interest electrodes were higher at the theta and alpha bands and lower at the delta and gamma bands than those in control participants. Additionally, the mean PLIs toward interest electrodes in the beta frequency band were negatively associated with seizure times (P = 0.02). Conclusion The resting-state delta, theta, alpha, and gamma band PLIs might reflect an aberrant brain network in patients with CECTS. The resting-state PLI among the selected electrodes of interest in the beta frequency band may be a predictive marker of seizure times in patients with CECTS.
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Affiliation(s)
- Masayoshi Oguri
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Takamatsu 761-0123, Japan
| | - Tetsuya Okazaki
- Division of Clinical Genetics, Tottori University Hospital, Yonago 683-8503, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Masashi Nishiyama
- Department of Electrical Engineering and Computer Science, Tottori University, Tottori 680-8550, Japan
| | - Sotaro Kanai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Hiroyuki Yamada
- Division of Pediatrics, Public Toyooka Hospital Union Standing Toyooka Hospital, Toyooka 668-8501, Japan
| | - Kaoru Ogo
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Takamatsu 761-0123, Japan
| | - Takashi Himoto
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Takamatsu 761-0123, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu 430-8558, Japan
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Ashour M, Minato E, Alawadhi A, Berrahmoune S, Simard-Tremblay E, Poulin C, Myers KA. Diagnostic utility of specific abnormal EEG patterns in children for determining epilepsy phenotype and presence of structural brain abnormalities. Heliyon 2022; 8:e10172. [PMID: 36033323 PMCID: PMC9399955 DOI: 10.1016/j.heliyon.2022.e10172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EEG findings: centrotemporal spikes, photoparoxysmal response, asymmetric photic driving, and asymmetric sleep spindles, for epilepsy phenotype and presence of structural brain abnormalities. Methods In this case-control study we reviewed children referred for EEG over a 4-year period, with at least one of centrotemporal spikes, photoparoxysmal response, asymmetric photic driving, or asymmetric sleep spindles. This cohort was analyzed in combination with a research database of pediatric patients with seizures. Results Centrotemporal spikes had 100% sensitivity for childhood epilepsy with centrotemporal spikes or atypical childhood epilepsy with centrotemporal spikes, but lower specificity (70%) and PPV (58%). Photoparoxysmal response had high specificity (92%) and NPV (92%) for genetic generalized epilepsy. Asymmetric photic driving had low sensitivity for structural brain abnormalities (17%), with specificity 80%. In contrast, asymmetric sleep spindles had much higher sensitivity and specificity, 44% and 97%, respectively. Conclusions Although centrotemporal spikes are classically associated with childhood epilepsy with centrotemporal spikes, these discharges are seen in other conditions. Photoparoxysmal response is highly indicative of a genetic generalized epilepsy, though may be seen in other epilepsy phenotypes. Relative attenuation of sleep spindles is a more reliable indicator of structural brain malformation than asymmetric photic driving. Significance The quantitative diagnostic utility of EEG findings should be considered when incorporating these results into clinical decision-making.
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Affiliation(s)
- Mohammed Ashour
- Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
- Department of Pediatrics, University of Jeddah, Hamzah Ibn Al Qasim St, Al Sharafeyah, Jeddah, Saudi Arabia
| | - Erica Minato
- Research Institute of the McGill University Medical Centre, 5100 Blvd de Maisonneuve Montreal, Quebec H4A 3T2, Canada
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006 Australia
| | - Abdulla Alawadhi
- Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
- Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
- Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Saoussen Berrahmoune
- Research Institute of the McGill University Medical Centre, 5100 Blvd de Maisonneuve Montreal, Quebec H4A 3T2, Canada
| | - Elisabeth Simard-Tremblay
- Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
- Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
| | - Chantal Poulin
- Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
- Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
| | - Kenneth A. Myers
- Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
- Research Institute of the McGill University Medical Centre, 5100 Blvd de Maisonneuve Montreal, Quebec H4A 3T2, Canada
- Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
- Corresponding author.
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Tekgul H, Kanmaz S, Serin HM, Yılmaz S. Spike wave characteristics and temporal spike evolution on serial EEG in childhood epilepsy with centrotemporal spikes. Seizure 2021; 87:75-80. [PMID: 33725524 DOI: 10.1016/j.seizure.2021.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the spike characteristics and temporal spike evolution on serial EEG of children with childhood epilepsy with centrotemporal spikes (CECTS) treated with anti-seizure medication. METHODS The study cohort consisted of 127 children with CECTS divided into three groups based on anti-seizure medication responsiveness: group I: seizure-free with monotherapy (n: 61, 48%), group II: seizure-controlled with monotherapy (n: 52, 41%) and group III: seizure-controlled with dual therapy (n: 14, 11%). The clinical profiles and sequential four-year follow-up visual EEG recordings of the children were evaluated. Each EEG was reanalyzed with three spike characteristics on the epochs: (1) spike-wave rate, (2) spike topography, and (3) spike localization. We calculated the spike clearance velocity, which is defined as a decrease in the spike-wave rate over time in four-year sequential follow-up EEGs. RESULTS There was no statistical significance across the study groups with respect to initial EEG spike characteristics (spike-wave rate, spike localization, and spike topography). Seizure recurrence occurred in 15 patients (12.8%) who discontinued anti-seizure medication. There was no statistically significant difference between the spike characteristics on EEG just before the discontinuation of anti-seizure medication and seizure recurrence. However, the spike clearance velocity was significantly slower in group III than in group I in four-year sequential follow-up EEGs (p = 0.002). A statistically significant decrease in the mean spike-wave rate was observed in group I in the first year of anti-seizure medication (p<0.001). The spike clearance velocity was also more prominent during the second year of treatment in group II and the third year of treatment in group III. However, the spike clearance velocity was not different across the anti-seizure medication groups (oxcarbazepine, valproic acid, and levetiracetam). CONCLUSION Spike clearance velocity might be a valuable EEG marker to guide anti-seizure medication in children with CECTS.
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Affiliation(s)
- Hasan Tekgul
- Department of Pediatrics, Division of Child Neurology, Ege University Medical Faculty, Turkey.
| | - Seda Kanmaz
- Department of Pediatrics, Division of Child Neurology, Ege University Medical Faculty, Turkey
| | - H Mine Serin
- Department of Pediatrics, Division of Child Neurology, Ege University Medical Faculty, Turkey
| | - Sanem Yılmaz
- Department of Pediatrics, Division of Child Neurology, Ege University Medical Faculty, Turkey.
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Han JY, Choi SA, Chung YG, Shim YK, Kim WJ, Kim SY, Kim H, Lim BC, Hwang H, Chae JH, Choi J, Kim KJ. Change of centrotemporal spikes from onset to remission in self-limited epilepsy with centrotemporal spikes (SLECTS). Brain Dev 2020; 42:270-276. [PMID: 31813543 DOI: 10.1016/j.braindev.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To reveal the changes of centrotemporal spikes that occur during the disease course of self-limited epilepsy with centrotemporal spikes (SLECTS). METHOD We retrospectively reviewed the serial EEGs of 63 patients with SLECTS from initial diagnosis to remission. There were 32 patients who did not undergo treatment and 31 patients who underwent treatment with oxcarbazepine (OXC). The change of occurrence or abundance, voltage, and location of centrotemporal spikes of serial EEGs were analyzed and compared between the two groups. Clinical seizure evidenced and reported was counted. The time gap between seizure remission and EEG remission was measured in the two groups. RESULT Changes of occurrence or abundance of the centrotemporal spikes were either abrupt (sudden disappearance of the frequent spikes on following EEG) or gradual (decline in number over 2 or more serial EEGs). Pattern of spike disappearance was not significantly different between the medication naïve group and OXC treated group. The spike voltage or the location of centrotemporal spikes did not change during the disease course in most cases. Delay between seizure remission and EEG normalization was 3.34 ± 1.75 (mean ± standard deviation, range: 0.77-7.97) years in untreated patients and 3.03 ± 1.41 (0.95-6.61) years in OXC-treated group. CONCLUSION Pattern of spike disappearance in SLECTS was either abrupt or gradual. Treatment with OXC had no effect in the disappearance pattern. Precise data regarding the pattern of disappearance and delay between seizure remission and EEG normalization can help to understand the evolution of spike in SLECTS and to predict the timing of normalization of EEG after seizure remission.
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Affiliation(s)
- Ji Yeon Han
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea; Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
| | - Yoon Gi Chung
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Young Kyu Shim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Woo Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jieun Choi
- Department of Pediatrics, SMG-SNU Boramae Hospital, Seoul, South Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, South Korea
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Tang H, Wang Y, Hua Y, Wang J, Jing M, Hu X. Analysis of serial electroencephalographic predictors of seizure recurrence in Rolandic epilepsy. Childs Nerv Syst 2019; 35:1579-1583. [PMID: 31267183 DOI: 10.1007/s00381-019-04275-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to assess the relationship between electroencephalography (EEG) markers and seizure recurrence in cases with benign epilepsy with centrotemporal spikes (BECT) in a long-term follow-up study. METHODS We analyzed the data of 52 children with BECT who were divided into 2 groups: the isolated group and recurrence group. The clinical profiles and initial/serial visual EEG recordings of both groups were evaluated. The entire follow-up period ranged from 12 to 65 months. RESULTS None of the clinical characteristics differed between the 2 groups. Serial EEGs showed that the appearance of Rolandic spikes in the frontal region was more prevalent in the recurrence group. Moreover, a significant correlation was found between bilateral asynchronous discharges and seizure recurrence. However, on initial EEG of these patients, neither of the EEG features exhibited statistical significance. CONCLUSION The presence of frontal focus and bilateral asynchrony appeared to be hallmarks of BECT patients with higher risk for seizure recurrence.
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Affiliation(s)
- Hongwei Tang
- Department of Neurology, Wuxi Children's Hospital, 299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Yanping Wang
- Department of Neurology, Wuxi Children's Hospital, 299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Ying Hua
- Department of Neurology, Wuxi Children's Hospital, 299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Jianbiao Wang
- Department of Neurology, Wuxi Children's Hospital, 299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Miao Jing
- Department of Neurology, Wuxi Children's Hospital, 299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Xiaoyue Hu
- Department of Neurology, Wuxi Children's Hospital, 299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China.
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Lu L, Xiong W, Zhang Y, Xiao Y, Zhou D. Propofol-induced refractory status epilepticus at remission age in benign epilepsy with centrotemporal spikes: A case report and literature review. Medicine (Baltimore) 2019; 98:e16257. [PMID: 31277145 PMCID: PMC6635254 DOI: 10.1097/md.0000000000016257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
RATIONALE Benign epilepsy with centrotemporal spikes (BECTS) is one of the most common forms of childhood epilepsy, which is expected to resolve before 16 years of age, with mild effects on the cognitive or behavioral functions in adulthood. This study aims to report the first propofol-induced refractory status epilepticus (SE) in patients with BECTS after 16 years of age, and to review SE in BECTS or induced by propofol. PATIENT CONCERN A 16-year-old Chinese girl, who was diagnosed with BECTS at the age of 2 years, developed refractory SE induced by propofol administered during the maintenance stage of general anesthesia during a plastic surgery procedure. DIAGNOSES Considering her medical history, EEG, and magnetic resonance images, and brain computed tomography, a diagnosis of refractory SE in BECTS was confirmed. INTERVENTIONS The patient had been seizure-free for 3 years from treatment with 2 anti-epileptic drugs (AEDs) valproate acid (VPA) and oxcarbazepine (OXC), and had started monotherapy with OXC for 3 months before the seizure incidence. She had undergone blepharoplasty under local anesthesia prior to receiving general anesthesia. During the maintenance state she developed convulsive SE, which was uncontrolled seizure and lasted for 14 hours. The treatment for which included midazolam, diazepam, propofol, VPA, OXC, and levetiracetam (LEV). OUTCOMES The prolonged seizure was controlled by diazepam (4 mg/h), propofol (6 mg/kg/h), VPA (2400 mg/d intravenous injection). Subsequently, she was administered VPA (800 mg/d po), OXC (600 mg/d po), and LEV (1000 mg/d po). Finally, on the 17th day she was discharged, and did not have any seizure recurrence and EEG results were normal as noted during the 3-month follow-up. LESSONS This was the first report of an SE in BECTS patient past the remission age. This report implied that interventions of sedation or analgesia in a patient after remission age of BECTS might still be at risk of refractory SE and therefore, should be carefully evaluated and monitored during such procedures, especially when an AED medication has been withdrawn or altered.
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