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Türkyılmaz A, Sağer SG, Tekin E, Teralı K, Düzkalır H, Eser M, Akın Y. Expanding the clinical and genetic landscape of (developmental) epileptic encephalopathy with spike-and-wave activation in sleep: results from studies of a Turkish cohort. Neurogenetics 2024; 25:119-130. [PMID: 38388889 DOI: 10.1007/s10048-024-00751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
The terms developmental epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS) and epileptic encephalopathy with spike-and-wave activation in sleep (EE-SWAS) designate a spectrum of conditions that are typified by different combinations of motor, cognitive, language, and behavioral regression linked to robust spike-and-wave activity during sleep. In this study, we aimed at describing the clinical and molecular findings in "(developmental) epileptic encephalopathy with spike-and-wave activation in sleep" (D)EE-SWAS) patients as well as at contributing to the genetic etiologic spectrum of (D)EE-SWAS. Single nucleotide polymorphism (SNP) array and whole-exome sequencing (WES) techniques were used to determine the underlying genetic etiologies. Of the 24 patients included in the study, 8 (33%) were female and 16 (67%) were male. The median age at onset of the first seizure was 4 years and the median age at diagnosis of (D)EE-SWAS was 5 years. Of the 24 cases included in the study, 13 were compatible with the clinical diagnosis of DEE-SWAS and 11 were compatible with the clinical diagnosis of EE-SWAS. Abnormal perinatal history was present in four cases (17%), and two cases (8%) had a family history of epilepsy. Approximately two-thirds (63%) of all patients had abnormalities detected on brain computerized tomography/magnetic resonance (CT/MR) imaging. After SNP array and WES analysis, the genetic etiology was revealed in 7 out of 24 (29%) cases. Three of the variants detected were novel (SLC12A5, DLG4, SLC9A6). This study revealed for the first time that Smith-Magenis syndrome, SCN8A-related DEE type 13 and SLC12A5 gene variation are involved in the genetic etiology of (D)EE-SWAS. (D)EE-SWAS is a genetically diverse disorder with underlying copy number variations and single-gene abnormalities. In the current investigation, rare novel variations in genes known to be related to (D)EE-SWAS and not previously reported genes to be related to (D)EE-SWAS were discovered, adding to the molecular genetic spectrum. Molecular etiology enables the patient and family to receive thorough and accurate genetic counseling as well as a personalized medicine approach.
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Affiliation(s)
- Ayberk Türkyılmaz
- Department of Medical Genetics, Karadeniz Technical University Faculty of Medicine, Ortahisar, 61100, Trabzon, Türkiye.
| | - Safiye Güneş Sağer
- Department of Pediatric Neurology, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Türkiye
| | - Emine Tekin
- Department of Pediatric Neurology, Giresun University Maternity and Children Hospital, Giresun, Türkiye
| | - Kerem Teralı
- Department of Medical Biochemistry, Cyprus International University Faculty of Medicine, Nicosia, Cyprus
| | - Hanife Düzkalır
- Department of Radiology, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Türkiye
| | - Metin Eser
- Department of Medical Genetics, Ümraniye Research and Training Hospital, Istanbul, Türkiye
| | - Yasemin Akın
- Department of Pediatrics, Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Türkiye
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Jellinek ER, Duda TA, Fein RH. The RUBI Parent Training for Disruptive Behavior in a Child with Electrical Status Epilepticus in Sleep (ESES): A Case Report. J Clin Psychol Med Settings 2023; 30:770-779. [PMID: 36840783 PMCID: PMC9959946 DOI: 10.1007/s10880-023-09949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
Children with electrical status epilepticus in sleep (ESES) often present with cognitive deficits and behavioral difficulties. Children that present with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), intellectual disability, and ESES would be expected to manifest more complex symptoms and increased behavioral difficulties given the nature of these disorders. Despite the complex presentation, there is little research to support effective treatments that manage behavior challenges and associated symptoms of ASD in such patients. In the present case report, the authors implemented a validated parent management training intervention, The Research Unit on Behavioral Interventions (RUBI) Autism Network Parent Training program (RUBI-PT) via telemedicine to manage symptoms of ADHD, ASD, and disruptive behaviors in an 8-year-old South-Asian boy with ESES and associated mild intellectual disability. The family participated in 15 RUBI-PT sessions over 22 weeks. Parent report and ratings using the clinical global impression, improvement scale (CGI-I) indicated reductions in challenging behavior and improvement in adaptive skills. The current case report demonstrates the utility of RUBI-PT in the treatment of behavioral difficulties in a patient with ASD, ADHD, and ESES. Further, the present study explores future directions for the use of RUBI-PT to address behavioral challenges associated with ESES and commonly co-occurring conditions and highlights the importance of cultural responsive practice in the context of parent management training.
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Affiliation(s)
- Emily R Jellinek
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, 491 Farish Hall, Houston, TX, 77204-5023, USA.
| | - Thomas A Duda
- Psychology Service, Texas Children's Hospital, 6701 Fannin Street, CCC 1630, Houston, TX, 77030-2399, USA
| | - Rachel H Fein
- Psychology Service, Texas Children's Hospital, 6701 Fannin Street, CCC 1630, Houston, TX, 77030-2399, USA
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3
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Freibauer AE, RamachandranNair R, Jain P, Jones KC, Whitney R. The genetic landscape of developmental and epileptic encephalopathy with spike-and-wave activation in sleep. Seizure 2023; 110:119-125. [PMID: 37352690 DOI: 10.1016/j.seizure.2023.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Epileptic Encephalopathy / Developmental Epileptic Encephalopathy with spike-and-wave activation in sleep (EE/DEE-SWAS) is defined as an epilepsy syndrome characterized by neurodevelopmental regression temporally related to the emergence of significant activation of spike-wave discharges in EEG during sleep. The availability of genetic testing has made it evident that monogenic and chromosomal abnormalities play an aetiological role in the development of EE/DEE-SWAS. We sought to review the literature to better understand the genetic landscape of EE/DEE-SWAS. METHODS In this systematic review, we reviewed cases of EE/DEE-SWAS associated with a genetic aetiology, collecting information related to the underlying aetiology, onset, management, and EEG patterns. RESULTS One hundred and seventy-two cases of EE/DEE-SWAS were identified. Genetic causes of note included pathogenic variants in GRIN2A, ZEB2, CNKSR2 and chromosome 17q21.31 deletions, each of which demonstrated unique clinical characteristics, EEG patterns, and age of onset. Factors identified to raise suspicion of a potential genetic aetiology included the presentation of DEE-SWAS and onset of SWAS under the age of five years. Treatment of EE/DEE-SWAS due to genetic causes was diverse, including a combination of anti-seizure medications, steroids, and other clinical strategies, with no clear consensus on a preferred or superior treatment. Data collected was significantly heterogeneous, with a lack of consistent use of neuropsychology testing, EEG patterns, or use of established clinical definitions. CONCLUSIONS Uniformity concerning the new definition of EE/DEE-SWAS, guidelines for management and more frequent genetic screening will be needed to guide best practices for the treatment of patients with EE/DEE-SWAS.
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Affiliation(s)
- Alexander E Freibauer
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kevin C Jones
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Robyn Whitney
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
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Halász P, Szũcs A. Self-limited childhood epilepsies are disorders of the perisylvian communication system, carrying the risk of progress to epileptic encephalopathies-Critical review. Front Neurol 2023; 14:1092244. [PMID: 37388546 PMCID: PMC10301767 DOI: 10.3389/fneur.2023.1092244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
"Sleep plasticity is a double-edged sword: a powerful machinery of neural build-up, with a risk to epileptic derailment." We aimed to review the types of self-limited focal epilepsies..."i.e. keep as two separate paragraphs" We aimed to review the types of self-limited focal epilepsies: (1) self-limited focal childhood epilepsy with centrotemporal spikes, (2) atypical Rolandic epilepsy, and (3) electrical status epilepticus in sleep with mental consequences, including Landau-Kleffner-type acquired aphasia, showing their spectral relationship and discussing the debated topics. Our endeavor is to support the system epilepsy concept in this group of epilepsies, using them as models for epileptogenesis in general. The spectral continuity of the involved conditions is evidenced by several features: language impairment, the overarching presence of centrotemporal spikes and ripples (with changing electromorphology across the spectrum), the essential timely and spatial independence of interictal epileptic discharges from seizures, NREM sleep relatedness, and the existence of the intermediate-severity "atypical" forms. These epilepsies might be the consequences of a genetically determined transitory developmental failure, reflected by widespread neuropsychological symptoms originating from the perisylvian network that have distinct time and space relations from secondary epilepsy itself. The involved epilepsies carry the risk of progression to severe, potentially irreversible encephalopathic forms.
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Affiliation(s)
- Péter Halász
- Department of Neurology, University Medical School, Pécs, Hungary
| | - Anna Szũcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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Nath A, Whitworth E, Bretz D, Davila-Williams D, McIntosh L. Electrical Status Epilepticus in Sleep (ESES) in an Elderly Adult: A Case Report. Cureus 2022; 14:e26372. [PMID: 35911258 PMCID: PMC9329594 DOI: 10.7759/cureus.26372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Electrical status epilepticus in sleep (ESES) is a pattern of continuous spikes seen in electroencephalography (EEG) and may be associated with neuropsychological deficits in children. This EEG pattern has not previously been reported in older adults. In this case report, a 66-year-old woman with post-traumatic epilepsy presented to the emergency department following a breakthrough seizure. Her EEG exhibited a striking pattern of continuous spikes during sleep that stopped abruptly with wakefulness, which is characteristic of the ESES phenomenon. This patient had triggers for a breakthrough seizure including subtherapeutic seizure medication levels, exposure to flashing lights, and iatrogenic hyperthyroidism, but none of these triggers have been known to cause selectively continuous spikes during sleep on EEG. This finding suggests that the phenomenon of ESES may persist into older adulthood.
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Specchio N, Wirrell EC, Scheffer IE, Nabbout R, Riney K, Samia P, Guerreiro M, Gwer S, Zuberi SM, Wilmshurst JM, Yozawitz E, Pressler R, Hirsch E, Wiebe S, Cross HJ, Perucca E, Moshé SL, Tinuper P, Auvin S. International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: Position paper by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1398-1442. [PMID: 35503717 DOI: 10.1111/epi.17241] [Citation(s) in RCA: 220] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
The 2017 International League Against Epilepsy classification has defined a three-tier system with epilepsy syndrome identification at the third level. Although a syndrome cannot be determined in all children with epilepsy, identification of a specific syndrome provides guidance on management and prognosis. In this paper, we describe the childhood onset epilepsy syndromes, most of which have both mandatory seizure type(s) and interictal electroencephalographic (EEG) features. Based on the 2017 Classification of Seizures and Epilepsies, some syndrome names have been updated using terms directly describing the seizure semiology. Epilepsy syndromes beginning in childhood have been divided into three categories: (1) self-limited focal epilepsies, comprising four syndromes: self-limited epilepsy with centrotemporal spikes, self-limited epilepsy with autonomic seizures, childhood occipital visual epilepsy, and photosensitive occipital lobe epilepsy; (2) generalized epilepsies, comprising three syndromes: childhood absence epilepsy, epilepsy with myoclonic absence, and epilepsy with eyelid myoclonia; and (3) developmental and/or epileptic encephalopathies, comprising five syndromes: epilepsy with myoclonic-atonic seizures, Lennox-Gastaut syndrome, developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep, hemiconvulsion-hemiplegia-epilepsy syndrome, and febrile infection-related epilepsy syndrome. We define each, highlighting the mandatory seizure(s), EEG features, phenotypic variations, and findings from key investigations.
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Affiliation(s)
- Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, Full Member of EpiCARE, Rome, Italy
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Necker-Sick Children Hospital, Public Hospital Network of Paris, member of EpiCARE, Imagine Institute, National Institute of Health and Medical Research, Mixed Unit of Research 1163, University of Paris, Paris, France
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - Pauline Samia
- Department of Pediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | | | - Sam Gwer
- School of Medicine, Kenyatta University, and Afya Research Africa, Nairobi, Kenya
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children and Institute of Health & Wellbeing, member of EpiCARE, University of Glasgow, Glasgow, UK
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R. Korey Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Ronit Pressler
- Programme of Developmental Neurosciences, University College London National Institute for Health Research Biomedical Research Centre Great Ormond Street Institute of Child Health, Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, UK
| | - Edouard Hirsch
- Neurology Epilepsy Units "Francis Rohmer", INSERM 1258, FMTS, Strasbourg University, Strasbourg, France
| | - Sam Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Helen J Cross
- Programme of Developmental Neurosciences, University College London National Institute for Health Research Biomedical Research Centre Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, and Young Epilepsy Lingfield, London, UK
| | - Emilio Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences, Scientific Institute for Research and Health Care, Bologna, Italy
| | - Stéphane Auvin
- Robert Debré Hospital, Public Hospital Network of Paris, NeuroDiderot, National Institute of Health and Medical Research, Department Medico-Universitaire Innovation Robert-Debré, Pediatric Neurology, University of Paris, Paris, France
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Stoyell SM, Baxter BS, McLaren J, Kwon H, Chinappen DM, Ostrowski L, Zhu L, Grieco JA, Kramer MA, Morgan AK, Emerton BC, Manoach DS, Chu CJ. Diazepam induced sleep spindle increase correlates with cognitive recovery in a child with epileptic encephalopathy. BMC Neurol 2021; 21:355. [PMID: 34521381 PMCID: PMC8438890 DOI: 10.1186/s12883-021-02376-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Continuous spike and wave of sleep with encephalopathy (CSWS) is a rare and severe developmental electroclinical epileptic encephalopathy characterized by seizures, abundant sleep activated interictal epileptiform discharges, and cognitive regression or deceleration of expected cognitive growth. The cause of the cognitive symptoms is unknown, and efforts to link epileptiform activity to cognitive function have been unrevealing. Converging lines of evidence implicate thalamocortical circuits in these disorders. Sleep spindles are generated and propagated by the same thalamocortical circuits that can generate spikes and, in healthy sleep, support memory consolidation. As such, sleep spindle deficits may provide a physiologically relevant mechanistic biomarker for cognitive dysfunction in epileptic encephalopathies. CASE PRESENTATION We describe the longitudinal course of a child with CSWS with initial cognitive regression followed by dramatic cognitive improvement after treatment. Using validated automated detection algorithms, we analyzed electroencephalograms for epileptiform discharges and sleep spindles alongside contemporaneous neuropsychological evaluations over the course of the patient's disease. We found that sleep spindles increased dramatically with high-dose diazepam treatment, corresponding with marked improvements in cognitive performance. We also found that the sleep spindle rate was anticorrelated to spike rate, consistent with a competitively shared underlying thalamocortical circuitry. CONCLUSIONS Epileptic encephalopathies are challenging electroclinical syndromes characterized by combined seizures and a deceleration or regression in cognitive skills over childhood. This report identifies thalamocortical circuit dysfunction in a case of epileptic encephalopathy and motivates future investigations of sleep spindles as a biomarker of cognitive function and a potential therapeutic target in this challenging disease.
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Affiliation(s)
- S M Stoyell
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - B S Baxter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - J McLaren
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - H Kwon
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - D M Chinappen
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - L Ostrowski
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA
| | - L Zhu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J A Grieco
- Massachusetts General Hospital, Psychology Assessment Center, Boston, MA, 02114, USA
| | - M A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA, 02115, USA
| | - A K Morgan
- Massachusetts General Hospital, Psychology Assessment Center, Boston, MA, 02114, USA
| | - B C Emerton
- Massachusetts General Hospital, Psychology Assessment Center, Boston, MA, 02114, USA
| | - D S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - C J Chu
- Department of Neurology, Massachusetts General Hospital, 175 Cambridge St, Suite 340, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
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Sapuppo A, Portale L, Massimino CR, Presti S, Tardino L, Marino S, Polizzi A, Falsaperla R, Praticò AD. GRIN2A and GRIN2B and Their Related Phenotypes. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1727146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractGlutamate is the most relevant excitatory neurotransmitter of the central nervous system; it binds with several receptors, including N-methyl-D-aspartate receptors (NMDARs), a subtype of ionotropic glutamate receptor that displays voltage-dependent block by Mg2+ and a high permeability to Ca2+. GRIN2A and GRIN2B genes encode the GluN2A and GluN2B subunits of the NMDARs, which play important roles in synaptogenesis, synaptic transmission, and synaptic plasticity, as well as contributing to neuronal loss and dysfunction in several neurological disorders. Recently, individuals with a range of childhood-onset drug-resistant epilepsies, such as Landau–Kleffner or Lennox–Gastaut syndrome, intellectual disability (ID), and other neurodevelopmental abnormalities have been found to carry mutations in GRIN2A and GRIN2B, with high variable expressivity in phenotype. The first one is found mainly in epilepsy-aphasia syndromes, while the second one mainly in autism, schizophrenia, and ID, such as autism spectrum disorders. Brain magnetic resonance imaging alterations are found in some patients, even if without a clear clinical correlation. At the same time, increasing data on genotype–phenotype correlation have been found, but this is still not fully demonstrated. There are no specific therapies for the treatment of correlated NMDARs epilepsy, although some evidence with memantine, an antagonist of glutamate receptor, is reported in the literature in selected cases with mutation determining a gain of function.
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Affiliation(s)
- Annamaria Sapuppo
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura Portale
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carmela R. Massimino
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Santiago Presti
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Tardino
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Simona Marino
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Unit of Neonatal Intensive Care and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
| | - Andrea D. Praticò
- Unit of Rare Diseases of the Nervous Systemin Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Baumer FM, McNamara NA, Fine AL, Pestana-Knight E, Shellhaas RA, He Z, Arndt DH, Gaillard WD, Kelley SA, Nagan M, Ostendorf AP, Singhal NS, Speltz L, Chapman KE. Treatment Practices and Outcomes in Continuous Spike and Wave during Slow Wave Sleep: A Multicenter Collaboration. J Pediatr 2021; 232:220-228.e3. [PMID: 33484700 PMCID: PMC8934740 DOI: 10.1016/j.jpeds.2021.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/20/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine how continuous spike and wave during slow wave sleep (CSWS) is currently managed and to compare the effectiveness of current treatment strategies using a database from 11 pediatric epilepsy centers in the US. STUDY DESIGN This retrospective study gathered information on baseline clinical characteristics, CSWS etiology, and treatment(s) in consecutive patients seen between 2014 and 2016 at 11 epilepsy referral centers. Treatments were categorized as benzodiazepines, steroids, other antiseizure medications (ASMs), or other therapies. Two measures of treatment response (clinical improvement as noted by the treating physician; and electroencephalography improvement) were compared across therapies, controlling for baseline variables. RESULTS Eighty-one children underwent 153 treatment trials during the study period (68 trials of benzodiazepines, 25 of steroids, 45 of ASMs, 14 of other therapies). Children most frequently received benzodiazepines (62%) or ASMs (27%) as first line therapy. Treatment choice did not differ based on baseline clinical variables, nor did these variables correlate with outcome. After adjusting for baseline variables, children had a greater odds of clinical improvement with benzodiazepines (OR 3.32, 95%CI 1.57-7.04, P = .002) or steroids (OR 4.04, 95%CI 1.41-11.59, P = .01) than with ASMs and a greater odds of electroencephalography improvement after steroids (OR 3.36, 95% CI 1.09-10.33, P = .03) than after ASMs. CONCLUSIONS Benzodiazepines and ASMs are the most frequent initial therapy prescribed for CSWS in the US. Our data suggests that ASMs are inferior to benzodiazepines and steroids and support earlier use of these therapies. Multicenter prospective studies that rigorously assess treatment protocols and outcomes are needed.
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Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA.
| | - Nancy A McNamara
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Anthony L Fine
- Department of Neurology, Divisions of Epilepsy & Child Neurology, Mayo Clinic, Rochester, MN
| | - Elia Pestana-Knight
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Renée A Shellhaas
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Zihuai He
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Daniel H Arndt
- Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - William D Gaillard
- Center for Neuroscience, Children's National Hospital, George Washington University, Washington, DC
| | - Sarah A Kelley
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Margot Nagan
- Department of Pediatrics & Neurology, University of Colorado, Aurora, CO
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH
| | - Nilika S Singhal
- UCSF Weill Institute for Neurosciences, UCSF School of Medicine, San Francisco, CA
| | - Laura Speltz
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN
| | - Kevin E Chapman
- Department of Pediatrics & Neurology, University of Colorado, Aurora, CO
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10
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Abstract
PURPOSE The spike-wave index (SWI) is a key feature in the diagnosis of electrical status epilepticus during slow-wave sleep. Estimating the SWI manually is time-consuming and is subject to interrater and intrarater variability. Use of automated detection software would save time. Thereby, this software will consistently detect a certain EEG phenomenon as epileptiform and is not influenced by human factors. To determine noninferiority in calculating the SWI, we compared the performance of a commercially available spike detection algorithm (P13 software, Persyst Development Corporation, San Diego, CA) with human expert consensus. METHODS The authors identified all prolonged EEG recordings for the diagnosis or follow-up of electrical status epilepticus during slow-wave sleep carried out from January to December 2018 at an epilepsy tertiary referral center. The SWI during the first 10 minutes of sleep was estimated by consensus of two human experts. This was compared with the SWI calculated by the automated spike detection algorithm using the three available sensitivity settings: "low," "medium," and "high." In the software, these sensitivity settings are denoted as perception values. RESULTS Forty-eight EEG recordings from 44 individuals were analyzed. The SWIs estimated by human experts did not differ from the SWIs calculated by the automated spike detection algorithm in the "low" perception mode (P = 0.67). The SWIs calculated in the "medium" and "high" perception settings were, however, significantly higher than the human expert estimated SWIs (both P < 0.001). CONCLUSIONS Automated spike detection (P13) is a useful tool in determining SWI, especially when using the "low" sensitivity setting. Using such automated detection tools may save time, especially when reviewing larger epochs.
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Gong P, Xue J, Jiao X, Zhang Y, Yang Z. Genetic Etiologies in Developmental and/or Epileptic Encephalopathy With Electrical Status Epilepticus During Sleep: Cohort Study. Front Genet 2021; 12:607965. [PMID: 33897753 PMCID: PMC8060571 DOI: 10.3389/fgene.2021.607965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Recently, the electroencephalogram pattern of electrical status epilepticus during sleep (ESES) had been reported in some genetic disorders, and most of them were noted with developmental and epileptic encephalopathy (DEE) or epileptic encephalopathy (EE). This study aimed to determine the genetic etiologies and clinical characteristics of ESES in DEE/EE. Methods We performed a cohort study in cases of DEE or EE with ESES. Tio-based genetic testing was performed in 74 cases and was analyzed to identify underlying variants. Results Pathogenic or likely pathogenic variants were identified in 17/74 cases, including KCNQ2 (n = 6), KCNA2 (n = 5), GRIN2A (n = 3), SLC9A6 (n = 1), HIVEP2 (n = 1), and RARS2 (n = 1). Eleven were boys. The median age at seizure onset was 6 months. ESES occurred at the mean age of 2.0 ± 1.2 years, predominant in the Rolandic region in 14 years. Twelve of 17 cases had the first stage of different epilepsy preceding ESES: 2/12 were diagnosed as Ohtahara syndrome, 2/12 were diagnosed as infantile spasms, 3/12 were diagnosed as DEE, and 5/12 were diagnosed as EE without the epileptic syndrome. Conclusion Monogenic variants explained over 20% of DEE/EE with ESES. ESES could be an age-related feature in genetic disorders and occurred after the first stage of different epilepsy. Both age-related factors and genetic etiology were suggested to play a role in the occurrence of ESES in genetic DEE/EE.
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Affiliation(s)
- Pan Gong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiao Xue
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xianru Jiao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Reduced thalamic volume is strongly associated with electrical status epilepticus in sleep. Acta Neurol Belg 2021; 121:211-217. [PMID: 31456121 DOI: 10.1007/s13760-019-01202-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 08/20/2019] [Indexed: 01/19/2023]
Abstract
To identify the relationship between thalamic volume and electrical status epilepticus in sleep (ESES). We analyzed subcortical gray matter volumes in patients with an ESES pattern on their electroencephalographs. All magnetic resonance imaging scans were considered within normal limits. The patients were not receiving antiepileptic drug at the time of the MRI study. High resolution T1-weighted 3-dimensional MPRAGE scans were assessed for segmentation and quantitative volumetric analysis of the brain by using the "volBrain" method. After correcting for total brain volume, volumes were compared with a group of healthy controls (HCs) and patients with benign childhood epilepsy with centrotemporal spikes (BECTS). Fifteen patients with ESES, 15 patients with BECTS, and 30 HCs were included. The median age of the patients with ESES was 8.5 (range, 5.8-13) years, 8 (range, 5-14) years for the HCs, and 7.8 (range, 4-13.5) years for the patients with BECTS. The total relative thalamic volume was significantly lower in patients with ESES than in the healthy controls (0.87 ± 0.07 vs. 0.93 ± 0.03, p = 0.002), and in patients with ESES than in those with BECTS (0.87 ± 0.07 vs. 0.93 ± 0.03, p = 0.006). There was no significant difference the HCs and patients with BECTS (0.93 ± 0.03 vs. 0.93 ± 0.03, p = 0.999). Both right and left relative thalamic volumes were lower in patients with ESES than in HCs (right thalamus: 0.43 ± 0.04 vs. 0.46 ± 0.02, p = 0.003, left thalamus: 0.44 ± 0.03 vs. 0.47 ± 0.02, p = 0.002), in patients with ESES than in patients with BECTS (right thalamus: 0.43 ± 0.04 vs. 0.46 ± 0.01, p = 0.01, left thalamus: 0.43 ± 0.04 vs. 0.47 ± 0.01, p = 0.007); however, there was no significant difference between the HCs and patients with BECTS (right thalamus: 0.46 ± 0.02 vs. 0.46 ± 0.01, p = 0.999, left thalamus: 0.47 ± 0.02 vs. 0.47 ± 0.01, p = 0.999). This study highlights the association between thalamic involvement and ESES, even when not severe enough to cause a detectable lesion on visual interpretation of MRI.
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Öztoprak Ü, Yayici Köken Ö, Aksoy E, Yüksel D. Spike-Wave Index Assessment and Electro-Clinical Correlation in Patients with Encephalopathy Associated with Epileptic State During Slow Sleep (ESES / CSWS); Single-Center Experience. Epilepsy Res 2021; 170:106549. [PMID: 33450525 DOI: 10.1016/j.eplepsyres.2021.106549] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to describe the electroclinical spectrum and neurocognitive outcome in children with epileptic encephalopathy with status epilepticus during sleep (ESES) according to the EEG patterns. METHODS Records of 48 (19 males, 29 females) patients with ESES/CSWS syndrome were retrospectively evaluated for data on sleep and awake EEGs, psychometric tests, and brain MRI. Patients with a spike-wave index (SWI) of at least 50 % in the NREM sleep EEG were included in the study. Electrophysiologic findings were separated into two groups based on SWI: SWI>85-100 % (typical ESES) and SWI < 85 % (atypical ESES). The neurocognitive prognosis was also evaluated in two groups; favorable and unfavorable. RESULTS The median age at the onset of ESES was 6 years and 5 months and ranged from 3 to 13 years. The median duration of follow-up after the ESES diagnosis was 57 months (range 24-150 months). Etiology was evaluated in three groups: symptomatic/structural, idiopathic, and unknown (cryptogenic). Twenty-seven (56.25 %) patients had atypical ESES patterns and 21 patients (43.75 %) had typical ESES patterns. Twenty-eight patients (58.3 %) had cognitive deterioration. Long term neurocognitive outcome was unfavorable in half of the patients. Symptomatic/structural etiology was more common in patients with unfavorable (p < 0.001) outcomes. The median age at the diagnosis of ESES (p < 0.001) was significantly earlier in the patients with unfavorable neurocognitive outcomes. The longer duration of ESES(p < 0.001), and the longer time between the onset of epilepsy and ESES (p = 0.039) was significantly associated with unfavorable outcomes. We found that patients with typical ESES had a higher risk for poor neurocognitive outcomes than patients with atypical ESES (OR: 31.096 [1.565-617.696]). CONCLUSION The long-term outcome of ESES is exceedingly variable. An unfavorable neurocognitive outcome seems to be related to ESES with a long-duration and early-onset epileptic activity, SWI ≥ 85 %, and etiology.
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Affiliation(s)
- Ülkühan Öztoprak
- University of Health Sciences, Dr. Sami Ulus Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey.
| | - Özlem Yayici Köken
- Ankara City Hospital, Children's Hospital, Department of Pediatric Neurology, Ankara, Turkey.
| | - Erhan Aksoy
- University of Health Sciences, Dr. Sami Ulus Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey.
| | - Deniz Yüksel
- University of Health Sciences, Dr. Sami Ulus Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey.
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RamachandranNair R. Encephalopathy Associated with Electrical Status Epilepticus of Sleep (ESES): A Practical Approach. Indian J Pediatr 2020; 87:1057-1061. [PMID: 32632569 DOI: 10.1007/s12098-020-03422-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
Encephalopathy associated with electrical status epilepticus of sleep (ESES) is an underdiagnosed epileptic encephalopathy syndrome. Though there is considerable controversy regarding the terminology of this condition, there is increasing acceptance of the term, 'encephalopathy associated with electrical status epilepticus of sleep,' as it implies a clinical component as well as EEG feature. Core EEG feature of sleep activation of epileptiform discharges temporarily associated with cognitive or behavioral regression in a child with epilepsy is sufficient to make a diagnosis of ESES. It is important to quantify the spike wave index (SWI) during awake state and sleep to assess for sleep activation. Since focal spikes are also included in the counting of SWI, some grading to assess the distribution of epileptiform discharges is suggested to obtain the complete sleep EEG picture. MRI of the brain does not show abnormality in a number of patients. But common structural lesions include perinatal vascular insults and cortical malformations. Response to treatment is usually variable, but highest success rate is reported with the steroids. Prognosis usually depends on the duration of ESES.
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Affiliation(s)
- Rajesh RamachandranNair
- Department of Pediatrics, Comprehensive Epilepsy Program, McMaster Children's Hospital, McMaster University, 1280 Main St W, Hamilton, ON, L8S4K1, Canada.
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Abstract
We aimed to explore the link between NREM sleep and epilepsy. Based on human and experimental data we propose that a sleep-related epileptic transformation of normal neurological networks underlies epileptogenesis. Major childhood epilepsies as medial temporal lobe epilepsy (MTLE), absence epilepsy (AE) and human perisylvian network (PN) epilepsies - made us good models to study. These conditions come from an epileptic transformation of the affected functional systems. This approach allows a system-based taxonomy instead of the outworn generalized-focal classification. MTLE links to the memory-system, where epileptic transformation results in a switch of normal sharp wave-ripples to epileptic spikes and pathological high frequency oscillations, compromising sleep-related memory consolidation. Absence epilepsy (AE) and juvenile myoclonic epilepsy (JME) belong to the corticothalamic system. The burst-firing mode of NREM sleep normally producing sleep-spindles turns to an epileptic working mode ejecting bilateral synchronous spike-waves. There seems to be a progressive transition from AE to JME. Shared absences and similar bilateral synchronous discharges show the belonging of the two conditions, while the continuous age windows - AE affecting schoolchildren, JME the adolescents - and the increased excitability in JME compared to AE supports the notion of progression. In perisylvian network epilepsies - idiopathic focal childhood epilepsies and electrical status epilepticus in sleep including Landau-Kleffner syndrome - centrotemporal spikes turn epileptic, with the potential to cause cognitive impairment. Postinjury epilepsies modeled by the isolated cortex model highlight the shared way of epileptogenesis suggesting the derailment of NREM sleep-related homeostatic plasticity as a common step. NREM sleep provides templates for plasticity derailing to epileptic variants under proper conditions. This sleep-origin explains epileptiform discharges' link and similarity with NREM sleep slow oscillations, spindles and ripples. Normal synaptic plasticity erroneously overgrowing homeostatic processes may derail toward an epileptic working-mode manifesting the involved system's features. The impact of NREM sleep is unclear in epileptogenesis occurring in adolescence and adulthood, when plasticity is lower. The epileptic process interferes with homeostatic synaptic plasticity and may cause cognitive impairment. Its type and degree depends on the affected network's function. We hypothesize a vicious circle between sleep end epilepsy. The epileptic derailment of normal plasticity interferes with sleep cognitive functions. Sleep and epilepsy interconnect by the pathology of plasticity.
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Affiliation(s)
- Péter Halász
- Szentágothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szűcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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van der Linden H, van der Linden V, Pessoa A, D Valente K. Continuous epileptiform discharges during sleep as an evolutionary pattern in patients with congenital Zika virus syndrome. Epilepsia 2020; 61:e107-e115. [PMID: 32820832 DOI: 10.1111/epi.16631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/28/2022]
Abstract
Congenital Zika virus syndrome (CZVS) is associated with severe neurological deficits. Clinical characteristics of epilepsy and the electroencephalographic (EEG) pattern in CZVS were documented in infancy. In this study, we aimed to describe the EEG findings observed during the follow-up of children with CZVS. Seventy-six EEGs of 55 children (60% female; mean age = 50 months) with confirmed CZVS were analyzed, considering the background, interictal, and ictal epileptiform discharges. Continuous (or almost continuous) epileptiform discharges during non-rapid eye movement sleep were identified in 22 (40%) patients. In 20 (90.1%) patients, the pattern was symmetrical, with an anterior predominance of the epileptiform activity. All patients with this pattern had epilepsy, which was severe in 15 (68.2%) and demanded polytherapy in 19 (86.4%). Subcortical calcifications (77.3%) and multifocal EEGs (72.8%) in earlier ages occurred more often in patients with this pattern. Other unspecific interictal EEG patterns were focal epileptiform discharges in 23 (41.8%) and multifocal activity in six (10.9%). In CZVS, continuous (or almost continuous) epileptiform discharges during sleep emerge as a pattern after the second year of life. This was associated with severe and drug-resistant epilepsy, but not necessarily with an apparent regression. Subcortical calcifications and multifocal epileptiform discharges in infancy are associated with this pattern.
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Affiliation(s)
- Hélio van der Linden
- Dr Henrique Santillo Rehabilitation Center, Goiânia, Brazil.,Department of Neurophysiology, Neurology Institute, Goiânia, Brazil
| | | | - André Pessoa
- Albert Sabin Children's Hospital, Fortaleza, Brazil.,State University of Ceará, Fortaleza, Brazil
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Sao Paulo, Brazil
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Sulthiame add-on treatment in children with epileptic encephalopathy with status epilepticus: an efficacy analysis in etiologic subgroups. Neurol Sci 2020; 42:183-191. [PMID: 32592101 DOI: 10.1007/s10072-020-04526-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Sulthiame (STM) has been recommended as an effective antiepileptic drug (AED) in children with epileptic encephalopathy with status epilepticus in sleep (ESES). The aim of this study is to evaluate the efficacy of STM add-on treatment in children with pattern of ESES with respect to the etiologic subgroup. METHODS Twenty-nine children with ESES pattern with three different etiologic subgroups (epileptic syndromes: 14, structural/infectious: 9, unknown: 6) who were given STM as add-on treatment were included into the study. The efficacy of STM was evaluated in terms of seizure control, electroencephalography (EEG) findings, need of the new AEDs after add-on STM, and behavioral and cognitive improvement. RESULTS The range of the follow-up duration after add-on STM treatment was between 5 and 51 months. At the end of 1 year of STM treatment, the most successful electrophysiologic improvement was identified in the well-defined epileptic syndrome group; epileptic syndrome, 71.4% (10/14); structural/infectious, 33.3% (3/9); and unknown, 0% (0/6). Patients who had complete response or persistent ESES pattern at the 3rd month were still in the same condition at the 6th and 12th months. However, the ESES pattern reappeared in 35.2% of the patients who had partial electrophysiological improvement at the 3rd month. In the epilepsy syndrome group, eight out of ten patients who had either complete or partial EEG response after 1 year of STM treatment displayed behavioral and cognitive improvement. CONCLUSION Sulthiame might be a valid add-on treatment of ESES especially in children with epilepsy syndromes.
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Marashly A, Koop J, Loman M, Lee YW, Lew SM. Examining the Utility of Resective Epilepsy Surgery in Children With Electrical Status Epilepticus in Sleep: Long Term Clinical and Electrophysiological Outcomes. Front Neurol 2020; 10:1397. [PMID: 32010050 PMCID: PMC6974623 DOI: 10.3389/fneur.2019.01397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Electrical Status Epilepticus in Sleep (ESES) is an epileptic encephalopathy syndrome characterized by infrequent clinical seizures and prominent interictal burden during slow wave sleep associated with cognitive deficits and behavioral dysfunction. Medical treatment with anti-epileptic drugs is often unsuccessful. Resective surgery may be a valuable option in carefully selected patients. This case series aims to describe the indications, long term results and utility of resective surgery for ESES. Methods: Information on 14 patients who underwent surgery for epilepsy and ESES at the Children's Hospital of Wisconsin between 2007 and 2017 is included. Clinical, electrographic and neuropsychological features and outcomes are described in detail. Results: The most common pathology was encephalomalacia due to perinatal middle cerebral artery stoke (5/14). Twelve patients had imaging findings of perinatal pathologies; however, two patients had normal magnetic resonance imaging. Surgery was performed to control refractory epilepsy in eight patients. Six patients had no clinical seizures for 1–6 years prior to surgery, one of which had no known clinical seizures at all. All showed cognitive declines (6/14) or impairment (8/14) on neuropsychological assessments, and surgery was suggested to minimize further cognitive declines. The most common surgical procedure was hemispherotomy (10/14). Temporo-parieto-occipital disconnection, frontal lobectomy, parieto-occipital resection, and limited corticectomy were also used, with good outcomes for the first three procedures. Clinical follow up mean was 4.4 years and 12 patients had excellent seizure outcome. Electroencephalography (EEG) follow up mean was 3 years and ESES resolved in 12/14 patients. All patients completed post-surgical neuropsychological evaluation with mean follow-up of 17.46 months. Conclusions: Resective surgery is an effective treatment for selected cases of ESES, producing long term seizure freedom, resolution of ESES and stabilization of cognitive and behavioral functioning in most patients. Our case series is the largest single center cohort description addressing resective surgery for ESES. Outcomes in this sample suggest that good long-term seizure, EEG and cognitive/behavioral outcomes can be achieved in patients with normal brain imaging and in limited lobar or multi-lobar resections. Moreover, patients with ESES and very infrequent clinical seizures can benefit from surgery with stabilization of cognitive and behavioral functioning.
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Affiliation(s)
- Ahmad Marashly
- Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jennifer Koop
- Division of Pediatric Neuropsychology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michelle Loman
- Division of Pediatric Neuropsychology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yu-Wen Lee
- Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sean M Lew
- Division of Pediatric Neurosurgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
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GRIN2D/GluN2D NMDA receptor: Unique features and its contribution to pediatric developmental and epileptic encephalopathy. Eur J Paediatr Neurol 2020; 24:89-99. [PMID: 31918992 PMCID: PMC7035963 DOI: 10.1016/j.ejpn.2019.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022]
Abstract
N-methyl-d-aspartate receptors (NMDARs), a subset of ligand-gated ionotropic glutamate receptors, are critical for learning, memory, and neuronal development. However, when NMDAR subunits are mutated, a host of neuropathological conditions can occur, including epilepsy. Recently, genetic variation within the GRIN2D gene, which encodes the GluN2D subunit of the NMDAR, has been associated with a set of early-onset neurological diseases, notably developmental and epileptic encephalopathy (DEE). Importantly, patients with GRIN2D variants are largely refractory to conventional anti-epileptic drug (AED) treatment, highlighting the need to further understand the distinctive characteristics of GluN2D in neurological and pathological functions. In this review, we first summarize GluN2D's unique spatial and temporal expression patterns, electrophysiological profiles, and contributions to both pre- and postsynaptic signaling. Next, we review thirteen unique case studies from DEE patients harboring ten different causal GRIN2D variants. These patients are highly heterogenous, manifesting multiple seizure types, electroencephalographic recordings, and neurological and developmental outcomes. Lastly, this review concludes by highlighting the difficulty in treating patients with DEE-associated GRIN2D variants, and stresses the need for selective therapeutic agents delivered within a precise time window.
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Kozhokaru AB. [Epileptiform activity index for the evaluation of treatment efficacy in patients with epileptic encephalopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:121-126. [PMID: 31793553 DOI: 10.17116/jnevro2019119101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Continuous spike and waves during sleep (CSWS) may lead to different cognitive, motor and behavioral symptoms. CSWS is characterized by an electroencephalography (EEG) pattern of electrical status epilepticus during sleep (ESES). The article reviews the main criteria of ESES, localization of EEG-changes and main EEG-patterns. An analysis of abnormal neuroimaging findings in patients with ESES was performed. The main pathophysiologic theories of ESES pattern formation are reviewed. ESES diagnosis is usually based on rough visual assessment of the number of spikes and waves, but other methods of assessment are also utilized, including spike-wave index (SWI), which is widely used in clinical practice. SWI reflects the percentage of sleep covered with spikes and waves. Two different strategies of SWI calculation are used, but none of them is officially validated. Moreover, there is no consensus on the period of sleep to be used for the calculation of SWI. The article presents a detailed review of calculation and utilization of SWI. It is concluded that further research is needed to develop an optimal algorithm of SWI calculation.
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Affiliation(s)
- A B Kozhokaru
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia, State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
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Hempel A, Frost M, Agarwal N. Language and behavioral outcomes of treatment with pulse-dose prednisone for electrical status epilepticus in sleep (ESES). Epilepsy Behav 2019; 94:93-99. [PMID: 30897536 DOI: 10.1016/j.yebeh.2019.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/17/2019] [Accepted: 02/17/2019] [Indexed: 12/29/2022]
Abstract
Few studies have examined treatment response in electrical status epilepticus in sleep (ESES), and fewer still have evaluated the effect of corticosteroid treatment employing a pulse-dose regimen. The aim of this study was to examine the effectiveness of pulse-dose prednisone in treating language and behavioral disturbances that often accompany ESES. The sample included 17 patients age 5 to 10 years at time of baseline electroencephalogram (EEG) and neuropsychological assessments. For all patients, focal, multifocal, or generalized spike and wave activity occupied greater than 50% of the nonrapid eye movement (REM) sleep record. Patients were seen for follow-up EEG recording and neuropsychological testing with an average of 10 months following initiation of pulse-dose prednisone. Improvement in language or behavior was examined in relation to resolution of ESES on EEG, age at seizure onset and treatment, duration of ESES, duration of treatment, lesional versus nonlesional epilepsy, history of language or behavioral regression, seizure control at follow-up, and intelligence quotient (IQ). With the exception of a greater likelihood of patients with low IQ to demonstrate improvement in language or behavior, improvement was seen in most patients, irrespective of ESES or other factors.
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Affiliation(s)
- Ann Hempel
- Minnesota Epilepsy Group, P.A., St. Paul, Minnesota, USA.
| | - Michael Frost
- Minnesota Epilepsy Group, P.A., St. Paul, Minnesota, USA; Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota, USA
| | - Nitin Agarwal
- Minnesota Epilepsy Group, P.A., St. Paul, Minnesota, USA; Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota, USA
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Halász P, Kelemen A, Rosdy B, Rásonyi G, Clemens B, Szűcs A. Perisylvian epileptic network revisited. Seizure 2019; 65:31-41. [DOI: 10.1016/j.seizure.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022] Open
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Bazil CW. Seizure modulation by sleep and sleep state. Brain Res 2019; 1703:13-17. [DOI: 10.1016/j.brainres.2018.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/29/2018] [Accepted: 05/01/2018] [Indexed: 11/26/2022]
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Mathieu ML, de Bellescize J, Till M, Flurin V, Labalme A, Chatron N, Sanlaville D, Chemaly N, des Portes V, Ostrowsky K, Arzimanoglou A, Lesca G. Electrical status epilepticus in sleep, a constitutive feature of Christianson syndrome? Eur J Paediatr Neurol 2018; 22:1124-1132. [PMID: 30126759 DOI: 10.1016/j.ejpn.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 06/25/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Christianson syndrome (CS) is a X-linked neurodevelopmental disorder, including severe intellectual disability (ID), progressive microcephaly, ataxia, autistic behaviour (ASD), near absent speech, and epilepsy. Electrical status epilepticus in sleep (ESES) has been reported in two patients. We describe five male patients from three unrelated families with Christianson syndrome caused by a pathogenic nucleotide variation or a copy-number variation involving SLC9A6. ESES was present in three out of the five patients in the critical age window between 4 and 8 years. All patients presented with severe intellectual disability, autistic features, and hyperactivity. Epilepsy onset occurred within the first two years of life. Seizures were of various types. In the two boys with a 20-years follow-up, epilepsy was drug-resistant during childhood, and became less active in early adolescence. Psychomotor regression was noted in two patients presenting with ESES. It was difficult to assess to what extent ESES could have contributed to the pathophysiological process, leading to regression of the already very limited communication skills. The two published case reports and our observation suggests that ESES could be a constitutive feature of Christianson syndrome, as it has already been shown for other Mendelian epileptic disorders, such as GRIN2A and CNKSR2-related developmental epileptic encephalopathies. Sleep EEG should be performed in patients with Christianson syndrome between 4 and 8 years of age. ESES occurring in the context of ID, ASD and severe speech delay, could be helpful to make a diagnosis of CS.
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Affiliation(s)
- Marie-Laure Mathieu
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Julitta de Bellescize
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Marianne Till
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Vincent Flurin
- Department of Paediatric Intensive Care, Le Mans Hospital, Le Mans, France
| | - Audrey Labalme
- Department of Medical Genetics, Lyon University Hospital, Lyon, France
| | - Nicolas Chatron
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Damien Sanlaville
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Imagine Institute, Paris, France; INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif sur Yvette, France
| | - Vincent des Portes
- Neuropaediatrics Department, Femme Mère Enfant Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Karine Ostrowsky
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of the European Reference Network EpiCARE, Hospices Civils de Lyon, Lyon, France; DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Gaëtan Lesca
- Department of Medical Genetics, Lyon University Hospital, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France; INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre (CRNL), Lyon, France.
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Kessi M, Peng J, Yang L, Xiong J, Duan H, Pang N, Yin F. Genetic etiologies of the electrical status epilepticus during slow wave sleep: systematic review. BMC Genet 2018; 19:40. [PMID: 29976148 PMCID: PMC6034250 DOI: 10.1186/s12863-018-0628-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 06/19/2018] [Indexed: 12/25/2022] Open
Abstract
Background Electrical status epilepticus during slow-wave sleep (ESESS) which is also known as continuous spike-wave of slow sleep (CSWSS) is type of electroencephalographic (EEG) pattern which is seen in ESESS/CSWSS/epilepsy aphasia spectrum. This EEG pattern can occur alone or with other syndromes. Its etiology is not clear, however, brain malformations, immune disorders, and genetic etiologies are suspected to contribute. We aimed to perform a systematic review of all genetic etiologies which have been reported to associate with ESESS/CSWSS/epilepsy-aphasia spectrum. We further aimed to identify the common underlying pathway which can explain it. To our knowledge, there is no available systematic review of genetic etiologies of ESESS/CSWSS/epilepsy-aphasia spectrum. MEDLINE, EMBASE, PubMed and Cochrane review database were searched, using terms specific to electrical status epilepticus during sleep or continuous spike–wave discharges during slow sleep or epilepsy-aphasia spectrum and of studies of genetic etiologies. These included monogenic mutations and copy number variations (CNVs). For each suspected dosage-sensitive gene, further studies were performed through OMIM and PubMed database. Results Twenty-six studies out of the 136 identified studies satisfied our inclusion criteria. I51 cases were identified among those 26 studies. 16 studies reported 11 monogenic mutations: SCN2A (N = 6), NHE6/SLC9A6 (N = 1), DRPLA/ ATN1 (N = 1), Neuroserpin/SRPX2 (N = 1), OPA3 (N = 1), KCNQ2 (N = 2), KCNA2 (N = 5), GRIN2A (N = 34), CNKSR2 (N = 2), SLC6A1 (N = 2) and KCNB1 (N = 5). 10 studies reported 89 CNVs including 9 recurrent ones: Xp22.12 deletion encompassing CNKSR2 (N = 6), 16p13 deletion encompassing GRIN2A (N = 4), 15q11.2–13.1 duplication (N = 15), 3q29 duplication (N = 11), 11p13 duplication (N = 2), 10q21.3 deletion (N = 2), 3q25 deletion (N = 2), 8p23.3 deletion (N = 2) and 9p24.2 (N = 2). 68 of the reported genetic etiologies including monogenic mutations and CNVs were detected in patients with ESESS/CSWSS/epilepsy aphasia spectrum solely. The most common underlying pathway was channelopathy (N = 56). Conclusions Our review suggests that genetic etiologies have a role to play in the occurrence of ESESS/CSWSS/epilepsy-aphasia spectrum. The common underlying pathway is channelopathy. Therefore we propose more genetic studies to be done for more discoveries which can pave a way for proper drug identification. We also suggest development of common cut-off value for spike-wave index to ensure common language among clinicians and researchers. Electronic supplementary material The online version of this article (10.1186/s12863-018-0628-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, 410008, Hunan Province, China. .,Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania.
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, 410008, Hunan Province, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, 410008, Hunan Province, China
| | - Juan Xiong
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, 410008, Hunan Province, China
| | - Haolin Duan
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, 410008, Hunan Province, China
| | - Nan Pang
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, 410008, Hunan Province, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, 410008, Hunan Province, China.
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Gong P, Xue J, Qian P, Yang H, Liu X, Cai L, Bian K, Yang Z. Scalp-recorded high-frequency oscillations in childhood epileptic encephalopathy with continuous spike-and-wave during sleep with different etiologies. Brain Dev 2018; 40:299-310. [PMID: 29307466 DOI: 10.1016/j.braindev.2017.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate high-frequency oscillations (HFOs) in epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) with different etiologies. METHODS Twenty-one CSWS patients treated with methylprednisolone were divided into structural group and genetic/unknown group. Comparisons were made between the two etiological groups: selected clinical variables including gender, age parameters, seizure frequencies and antiepileptic drugs; distribution of HFOs in pre-methylprednisolone electroencephalography (EEG) and percentage changes of HFOs and spikes after methylprednisolone treatment. RESULTS There were 7 patients (33%) in structural group and 14 patients (68%) in genetic/unknown group. No significant difference was found between the two groups regarding selected clinical variables. HFOs were found in 12 patients in pre-methylprednisolone EEG. The distribution of HFOs was focal and accordant with lesions in 5 of structural group, and it was also focal but in different brain regions in 7 of genetic/unknown group. The percentage reduction of total HFOs and spikes was 81% (158/195) and 19% (1956/10,037) in structural group, while 98% (315/323) and 55% (6658/12,258) in genetic/unknown group after methylprednisolone treatment. CONCLUSION The etiologies had no distinct correlation with some clinical characteristics in CSWS. HFOs recorded on scalp EEG might not only be used as makers of seizure-onset zone (SOZ), but also have association with functional disruption of brain networks. Both HFOs and spikes reduced more in genetic/unknown patients than that in structural patients after methylprednisolone treatment and HFOs were more sensitive to treatment than spikes.
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Affiliation(s)
- Pan Gong
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing 100034, China
| | - Jiao Xue
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing 100034, China
| | - Ping Qian
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing 100034, China
| | - Haipo Yang
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing 100034, China
| | - Xiaoyan Liu
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing 100034, China
| | - Lixin Cai
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing 100034, China
| | - Kaigui Bian
- Institude of Network Computing and Information Systems, Peking University, No.5, Yiheyuan Street, Haidian District, Beijing 100871, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing 100034, China.
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Varadkar S. Continuous spike-wave during sleep: treating an epilepsy without seizures. Dev Med Child Neurol 2018; 60:220. [PMID: 29283182 DOI: 10.1111/dmcn.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sophia Varadkar
- Neurosciences Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Japaridze N, Muthuraman M, Dierck C, von Spiczak S, Stephani U, Siniatchkin M. In response: Neuronal networks in epileptic encephalopathies with CSWS. Epilepsia 2018; 58:1297-1298. [PMID: 28677856 DOI: 10.1111/epi.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Natia Japaridze
- Department of Neuropediatrics, Christian-Albrechts-University, Kiel, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department Biomedical Statistics and Multimodal Signal Processing Unit, Johannes Gutenberg-University Mainz, Klinik und Poliklinik für Neurologie Germany, Mainz, Department of Nuerology, Germany, Mainz, Germany
| | - Carina Dierck
- Department of Neuropediatrics, Christian-Albrechts-University, Kiel, Germany
| | - Sarah von Spiczak
- Department of Neuropediatrics, Christian-Albrechts-University, Kiel, Germany.,Northern German Epilepsy Center for Children & Adolescents, Schwentinental/OT Raisdorf, Germany
| | - Ulrich Stephani
- Department of Neuropediatrics, Christian-Albrechts-University, Kiel, Germany
| | - Michael Siniatchkin
- Department of Medical Psychology and Medical Sociology, Christian-Albrechts-University, Kiel, Germany
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Electrical status epilepticus during sleep in Mowat-Wilson syndrome. Brain Dev 2017; 39:727-734. [PMID: 28501473 DOI: 10.1016/j.braindev.2017.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/14/2017] [Accepted: 04/20/2017] [Indexed: 11/22/2022]
Abstract
AIM Mowat-Wilson Syndrome (MWS) is a genetic rare disease. Epilepsy is present in 70-75% of Patients and an age-dependent electroclinical pattern has been described. Up to date, there are studies with overnight sleep EEGs, probably because of the severe intellectual disability (ID) and hyperactivity of these Patients. Our purpose was to verify the hypothesis that MWS Patients might have electrical status epilepticus in slow wave sleep (ESES pattern). METHODS A retrospective analysis of anamnestic and electrographic data was performed on 7 consecutive MWS Patients followed between 2007 and 2016. Only Patients with at least one overnight sleep EEG were included in the study. RESULTS Five out of 7 Patients had overnight sleep EEG studies and were included in this study. All of them had an anterior ESES pattern with spike-and-wave index>85%. The architecture of sleep was abnormal. An ESES related regression of cognitive and motor functions with impact on daily activities (ESES-related syndrome) was demonstrated in 3 out of 5 (60%) Patients. In two Patients marked improvement of cognitive and motor performances was observed when the epileptiform activity during sleep was successfully controlled or it was spontaneously reduced. CONCLUSIONS The clinical significance of the ESES pattern is hard to assess in MWS Patients due to severe ID, but changing in behaviour or in motor and cognitive functions should mandate sleep EEG investigation and, if ESES is present, an appropriate treatment should be tried. Furthermore, overnight sleep EEG recordings, if regularly performed in the follow up, might help to understand if ESES pattern hampers the cognitive and communicative profile in MWS.
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De Giorgis V, Filippini M, Macasaet JA, Masnada S, Veggiotti P. Neurobehavioral consequences of continuous spike and waves during slow sleep (CSWS) in a pediatric population: A pattern of developmental hindrance. Epilepsy Behav 2017; 74:1-9. [PMID: 28654799 DOI: 10.1016/j.yebeh.2017.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Continuous spike and waves during slow sleep (CSWS) is a typical EEG pattern defined as diffuse, bilateral and recently also unilateral or focal localization spike-wave occurring in slow sleep or non-rapid eye movement sleep. Literature results so far point out a progressive deterioration and decline of intellectual functioning in CSWS patients, i.e. a loss of previously normally acquired skills, as well as persistent neurobehavioral disorders, beyond seizure and EEG control. The objective of this study was to shed light on the neurobehavioral impact of CSWS and to identify the potential clinical risk factors for development. METHODS We conducted a retrospective study involving a series of 16 CSWS idiopathic patients age 3-16years, considering the entire duration of epilepsy from the onset to the outcome, i.e. remission of CSWS pattern. All patients were longitudinally assessed taking into account clinical (sex, age at onset, lateralization and localization of epileptiform abnormalities, spike wave index, number of antiepileptic drugs) and behavioral features. Intelligent Quotient (IQ) was measured in the whole sample, whereas visuo-spatial attention, visuo-motor skills, short term memory and academic abilities (reading and writing) were tested in 6 out of 16 patients. RESULTS Our results showed that the most vulnerable from an intellectual point of view were those children who had an early-onset of CSWS whereas those with later onset resulted less affected (p=0.004). Neuropsychological outcome was better than the behavioral one and the lexical-semantic route in reading and writing resulted more severely affected compared to the phonological route. CONCLUSIONS Cognitive deterioration is one but not the only consequence of CSWS. Especially with respect to verbal skills, CSWS is responsible of a pattern of consequences in terms of developmental hindrance, including slowing of development and stagnation, whereas deterioration is rare. Behavioral and academic problems tend to persist beyond epilepsy resolution.
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Affiliation(s)
- Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy; Brain and Behaviour Department, University of Pavia, Pavia, Italy.
| | - Melissa Filippini
- Child Neurology Unit, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Silvia Masnada
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy; Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy; Brain and Behaviour Department, University of Pavia, Pavia, Italy
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Altunel A, Altunel EÖ, Sever A. Response to adrenocorticotropic in attention deficit hyperactivity disorder-like symptoms in electrical status epilepticus in sleep syndrome is related to electroencephalographic improvement: A retrospective study. Epilepsy Behav 2017; 74:161-166. [PMID: 28778058 DOI: 10.1016/j.yebeh.2017.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/01/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Encephalopathy with electrical status epilepticus in sleep (ESES) syndrome is a rare epilepsy syndrome of childhood that is characterized by sleep-induced epileptiform discharges and problems with cognition or behavior. The neuropsychiatric symptoms in ESES syndrome, among which the ADHD-like symptoms are prominent, bear a close resemblance to symptoms in various developmental disorders. Positive response to adrenocorticotropic hormone (ACTH) is associated with the normalization of the EEG and improvement of neuropsychiatric function. This study aimed to determine the improvement in ADHD-like symptoms in response to ACTH and establish a relationship between improvement in clinical symptoms and EEG parameters. METHODS Seventy-five patients with ESES syndrome, who had clinically displayed ADHD-like symptoms, had been treated with ACTH for ESES, and their medical records were retrospectively reviewed. Sleep EEGs were recorded at referral and follow-up visits, and short courses of ACTH were administered when spike-wave index (SWI) was ≥15%. The assessment of treatment effectiveness was based on reduction in SWI and the clinician-reported improvement in ADHD-like symptoms. Statistical analyses were conducted in order to investigate the relationship between the clinical and EEG parameters. RESULTS Following treatment with ACTH, a reduction in SWI in all the patients was accompanied by a mean improvement of 67% in ADHD-like symptoms. Disappearance/reduction of foci and cessation/reduction of seizures were achieved in patients with formerly antiepileptic-resistant seizures. Multiple linear regressions established that pretreatment SWI and treatment delay predicted posttreatment SWI, while reduction in SWI, treatment delay, and the presence of foci predicted improvement in ADHD-like symptoms. DISCUSSION Improvement in ADHD-like symptoms showed high correlation and was timely with the resolution of ESES. It is suggested that ESES and ADHD may be the two different expressions of a common neurobiological abnormality. With enhanced interpretation of sleep EEG, a more thorough assessment and treatment of neurodevelopmental disorders is possible.
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Affiliation(s)
- Attila Altunel
- Suadiye Mah., Ulku Sok. No: 17/1, Kadikoy, Istanbul, Turkey; Mustafa Kemal Pasa Cad. Deniz Sarayi Apt 49/7 Aksaray Fatih, Istanbul, Turkey.
| | | | - Ali Sever
- Department of Radiology, Kadikoy Florence Nightingale Hospital, Bagdat Cad No:63, 34724 Kadikoy, Istanbul, Turkey.
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Halász P. Comment on Neuronal networks in epileptic encephalopathies with CSWS. Epilepsia 2017; 58:1296-1297. [DOI: 10.1111/epi.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Péter Halász
- National Institute of Clinical Neuroscience; Budapest Hungary
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Gröppel G, Dorfer C, Dressler A, Mühlebner A, Porsche B, Hainfellner JA, Czech T, Feucht M. Immediate termination of electrical status epilepticus in sleep after hemispherotomy is associated with significant progress in language development. Dev Med Child Neurol 2017; 59:89-97. [PMID: 27558205 DOI: 10.1111/dmcn.13233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 11/28/2022]
Abstract
AIM To study the effect of hemispherotomy on electrical status epilepticus in sleep (ESES) and language development. METHOD Children with a confirmed diagnosis of ESES prior to surgery and a minimum of 24 months of developmental follow-up data were compared with age-matched controls without ESES. Language quotients (LQs) were calculated before and after surgery. RESULTS Eleven patients (five females, six males) and 21 controls (11 females, 10 males) were included. Before surgery a significantly higher number of children in the study group (n=9) demonstrated severe developmental delay compared with children in the control group (n=13; p=0.015). In the study group ESES remitted immediately after surgery in 10 children, and a significant catch-up in LQs was observed in this group (preoperative mean 40.0 [standard deviation (SD) 22.2, interquartile range (IQR) 30.0-62.0]; postoperative mean 73.0 [SD 33.5, IQR 41.0-97.0]; p=0.037). There was no significant difference compared with controls at last follow-up after surgery (study group: five with severe impairment; control group: eight with severe impairment [p=0.971]). Overall, a favourable developmental outcome was associated with freedom from seizures (seizure-free group: median preoperative LQ 61.5, median postoperative LQ 78.0 [p=0.017]; seizure group: median preoperative LQ 35.5, median postoperative LQ 56.5 [p=0.273]) and antiepileptic drug withdrawal (off medication: median preoperative LQ 49.5, median postoperative LQ 78.0 [p=0.011]; on medication: median preoperative LQ 78.0, median postoperative LQ 83.5 [p=0.889]). INTERPRETATION Children with ESES showed significantly lower preoperative language abilities than children without ESES. In cases with remission of ESES after surgery, marked improvement in LQs was noticed. This improvement cannot be fully explained by seizure-freedom alone as seizure-free children without preoperative ESES showed less improvement.
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Affiliation(s)
- Gudrun Gröppel
- Epilepsy Monitoring Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
| | - Anastasia Dressler
- Epilepsy Monitoring Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
| | - Angelika Mühlebner
- Epilepsy Monitoring Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
| | - Barbara Porsche
- Epilepsy Monitoring Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
| | - Johann A Hainfellner
- Institute of Neurology, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
| | - Martha Feucht
- Epilepsy Monitoring Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna/General Hospital (AKH) Vienna, Vienna, Austria
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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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Kelley SA, Kossoff EH. How effective is the ketogenic diet for electrical status epilepticus of sleep? Epilepsy Res 2016; 127:339-343. [PMID: 27710878 DOI: 10.1016/j.eplepsyres.2016.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 02/07/2023]
Abstract
Electrical status epilepticus of sleep (ESES), with the activation of profuse amounts of epileptiform discharges in sleep, may lead to intractable epilepsy and neurocognitive decline in children. Numerous varied treatments including antiseizure medications, steroids, and surgery have been investigated as possible treatment options. The ketogenic diet (KD) is an additional treatment option which may add to our treatment armamentarium for ESES. The KD may theoretically improve ESES by affecting GABA systems and reducing inflammation. Clinical reports of the KD for ESES have been heterogeneous, but to date 38 children have been described in six publications. Overall, 53% had EEG improvement, 41% had>50% seizure reduction, 45% had cognitive improvement, but only 9% had EEG normalization. This review will assess the efficacy of the KD in the treatment of ESES based on known data as well as possible mechanisms of action and the need for future study.
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Affiliation(s)
- Sarah Aminoff Kelley
- Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD 21287, United States.
| | - Eric Heath Kossoff
- Johns Hopkins Hospital, 200 North Wolfe Street, Baltimore, MD 21287, United States.
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Long-term follow-up of cognitive functions in patients with continuous spike-waves during sleep (CSWS). Epilepsy Behav 2016; 60:211-217. [PMID: 27240307 DOI: 10.1016/j.yebeh.2016.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 11/21/2022]
Abstract
Continuous spike-waves during sleep (CSWS) are associated with several cognitive, neurological, and psychiatric disorders, which sometimes persist after CSWS disappearance. The purpose of this retrospective study was to investigate the correlation between general (clinical and instrumental) and neuropsychological findings in CSWS, to identify variables that predispose patients to a poorer long-term neuropsychological outcome. Patients with spikes and waves during sleep with a frequency ≥25/min (spikes and waves frequency index - SWFI) were enrolled. There were patients presenting abnormal EEG activity corresponding to the classic CSWS and patients with paroxysmal abnormalities during sleep <85% with SWFI ≥25/min that was defined as excessive spike-waves during sleep (ESWS). Clinical and instrumental features and neuropsychological findings during and after the spike and wave active phase period were considered. A statistical analysis was performed utilizing the Spearman correlation test and multivariate analysis. The study included 61 patients; the mean follow-up (i.e., the period between SWFI ≥25 first recording and last observation) was 7years and 4months. The SWFI correlated inversely with full and performance IQ during CSWS/ESWS. Longer-lasting SWFI ≥25 was related to worse results in verbal IQ and performance IQ after CSWS/ESWS disappearance. Other variables may influence the neuropsychological outcome, like age at SWFI ≥25 first recording, perinatal distress, pathologic neurologic examination, and antiepileptic drug resistance. This confirms that CSWS/ESWS are a complex pathology and that many variables contribute to its outcome. The SWFI value above all during CSWS/ESWS and long-lasting SWFI ≥25 after CSWS/ESWS disappearance are the most significant indexes that appear mostly to determine cognitive evolution. This finding underscores the importance of EEG recordings during sleep in children with a developmental disorder, even if seizures are not reported, as well as the importance of using therapy with an early efficacy.
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Japaridze N, Muthuraman M, Dierck C, von Spiczak S, Boor R, Mideksa KG, Anwar RA, Deuschl G, Stephani U, Siniatchkin M. Neuronal networks in epileptic encephalopathies with CSWS. Epilepsia 2016; 57:1245-55. [DOI: 10.1111/epi.13428] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Natia Japaridze
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
| | | | - Carina Dierck
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
| | - Sarah von Spiczak
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
- Northern German Epilepsy Center for Children & Adolescents; Raisdorf Germany
| | - Rainer Boor
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
- Northern German Epilepsy Center for Children & Adolescents; Raisdorf Germany
| | - Kidist G. Mideksa
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
- Digital Signal Processing and System Theory; Christian-Albrechts-University; Kiel Germany
| | - Rauf A. Anwar
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
- Digital Signal Processing and System Theory; Christian-Albrechts-University; Kiel Germany
| | - Günther Deuschl
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Ulrich Stephani
- Department of Neuropediatrics; Christian-Albrechts-University; Kiel Germany
- Northern German Epilepsy Center for Children & Adolescents; Raisdorf Germany
| | - Michael Siniatchkin
- Department of Medical Psychology and Medical Sociology; Christian-Albrechts-University; Kiel Germany
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Zhao X, Robinson PA. Generalized seizures in a neural field model with bursting dynamics. J Comput Neurosci 2015; 39:197-216. [PMID: 26282528 DOI: 10.1007/s10827-015-0571-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 07/02/2015] [Accepted: 07/26/2015] [Indexed: 11/27/2022]
Abstract
The mechanisms underlying generalized seizures are explored with neural field theory. A corticothalamic neural field model that has accounted for multiple brain activity phenomena and states is used to explore changes leading to pathological seizure states. It is found that absence seizures arise from instabilities in the system and replicate experimental studies in numerous animal models and clinical studies.
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Affiliation(s)
- X Zhao
- School of Physics, The University of Sydney, Sydney, New South Wales, 2006, Australia.
- Center for Integrative Brain Function, University of Sydney, NSW, 2006, Australia.
- Neurosleep, 431 Glebe Point Rd, Glebe, New South Wales, 2037, Australia.
- Cooperative Research Center for Alertness, Safety, and Productivity, University of Sydney, NSW, 2006, Australia.
| | - P A Robinson
- School of Physics, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Center for Integrative Brain Function, University of Sydney, NSW, 2006, Australia
- Neurosleep, 431 Glebe Point Rd, Glebe, New South Wales, 2037, Australia
- Cooperative Research Center for Alertness, Safety, and Productivity, University of Sydney, NSW, 2006, Australia
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Losito E, Battaglia D, Chieffo D, Raponi M, Ranalli D, Contaldo I, Giansanti C, De Clemente V, Quintiliani M, Antichi E, Verdolotti T, de Waure C, Tartaglione T, Mercuri E, Guzzetta F. Sleep-potentiated epileptiform activity in early thalamic injuries: Study in a large series (60 cases). Epilepsy Res 2015; 109:90-9. [DOI: 10.1016/j.eplepsyres.2014.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/18/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
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Halász P, Hegyi M, Siegler Z, Fogarasi A. Encephalopathy with Electrical Status Epilepticus in Slow Wave Sleep – a review with an emphasis on regional (perisylvian) aspects. JOURNAL OF EPILEPTOLOGY 2014. [DOI: 10.1515/joepi-2015-0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SUMMARYAim.The aim of this article is to review criticaly the Electrical Status Epilepticus in Slow Sleep (ESES) phenomenon from a neurophysiological mechanisms aspect as well as terminological and classification issues.Methods.The review includes all the relevant papers published during the last 43 years on the subject of ESES and Continous Spike – Wave in Sleep (CSWS).These papers were identified in various large databases via the internet.Rewiev and remarks.ESES/CSWS phenomena can be held as a common final pathway originating from different etiologies, including patients with early brain damage (probably involving thalamic structures), but also patients without structural pathology as in atypical evolution of idiopathic regional childhood hyperexcitability syndromes (with Rolandic epilepsy as a prototype). There are hints that genetic predisposition might be an important factor in the development of this process. The two large patient groups (lesional and non-lesional) show the same EEG evolution and encephalopathic cognitive consequences. The sleep EEG activation can be held as a common endophenotype. ESES represents an extreme sleep activation/potentiation of the local/regional interictal discharges, enhancing them in frequency, territorial extension, intra and trans-hemispherial propagation, synchrony and continuity. This process is most probably not identical with the development of bilateral spike-wave pattern in „generalized” epilepsies which involves primarily or secondarily the thalamocortical system as it had been explored by Gloor (1979) for idiopathic generalized rpilepsy and Steriade and Amzica (2003) for different types of generalized spike and wave discharges.Conclusions and syndromological embedding of ESES.In an overwhelming majority of the investigated cases, the maps of the single discharges constituting sleep activation are identical; with focal/regional interictal spikes followed by slow closing wave, as it is seen in childhood regional age dependent hyperexcitability syndromes (prototype of the centro-temporal spikes of Rolandic epilepsy). The main mechanism of the developing cognitive impairment is most probably the consequence of interference with plastic function of slow wave sleep by obliterating synaptic decline during sleep. Presently, the consensus and co-operative research is highly obstacled by the terminological chaos, the controversial definitions and views around this still striking and enigmatic phenomenon.
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Abstract
Epileptic encephalopathies represent a group of devastating epileptic disorders that occur early in life and are often characterized by pharmaco-resistant epilepsy, persistent severe electroencephalographic abnormalities, and cognitive dysfunction or decline. Next generation sequencing technologies have increased the speed of gene discovery tremendously. Whereas ion channel genes were long considered to be the only significant group of genes implicated in the genetic epilepsies, a growing number of non-ion-channel genes are now being identified. As a subgroup of the genetically mediated epilepsies, epileptic encephalopathies are complex and heterogeneous disorders, making diagnosis and treatment decisions difficult. Recent exome sequencing data suggest that mutations causing epileptic encephalopathies are often sporadic, typically resulting from de novo dominant mutations in a single autosomal gene, although inherited autosomal recessive and X-linked forms also exist. In this review we provide a summary of the key features of several early- and mid-childhood onset epileptic encephalopathies including Ohtahara syndrome, Dravet syndrome, Infantile spasms and Lennox Gastaut syndrome. We review the recent next generation sequencing findings that may impact treatment choices. We also describe the use of conventional and newer anti-epileptic and hormonal medications in the various syndromes based on their genetic profile. At a biological level, developments in cellular reprogramming and genome editing represent a new direction in modeling these pediatric epilepsies and could be used in the development of novel and repurposed therapies.
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Affiliation(s)
- Sahar Esmaeeli Nieh
- Departments of Neurology and Pediatrics, University of California, San Francisco, CA USA
| | - Elliott H. Sherr
- Departments of Neurology and Pediatrics, University of California, San Francisco, CA USA
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Neurobiology of continuous spike-wave in slow-wave sleep and Landau-Kleffner syndromes. Pediatr Neurol 2014; 51:287-96. [PMID: 25160535 DOI: 10.1016/j.pediatrneurol.2014.04.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several pediatric seizure disorders have common electrophysiological features during slow-wave sleep that produce different syndromes based on which part of the developing brain is involved. These disorders, of which continuous spike-wave in slow-wave sleep and Landau-Kleffner are the most common, are characterized by continuous spike-wave activity during slow-wave sleep, developmentally regulated onset and termination of abnormal electrical activity, and loss of previously acquired skills. Over the last 20 years, a variety of basic science findings suggest how spike-wave activity during sleep can cause the observed clinical outcomes. METHODS Literature review and analysis. RESULTS The role of slow-wave sleep in normal cortical plasticity during developmental critical periods, how disruption of slow-wave sleep by electrographic seizures could affect cortical maps and development, and the organization and functional connectivity of the thalamic structures that when damaged are thought to produce these seizure disorders are reviewed. CONCLUSIONS Potential therapeutic directions are proposed based on the mechanisms of plasticity and anatomical structures involved in cortical plasticity during slow-wave sleep.
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Medical management with diazepam for electrical status epilepticus during slow wave sleep in children. Pediatr Neurol 2014; 50:238-42. [PMID: 24393416 DOI: 10.1016/j.pediatrneurol.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/25/2013] [Accepted: 11/05/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Oral diazepam, administered in varying doses, is among the few proposed treatment options for electrical status epilepticus during slow wave sleep in children. We sought to retrospectively evaluate the long-term efficacy of high-dose oral diazepam in reducing electrographic and clinical evidence of electrical status epilepticus during slow wave sleep in children. Additionally, we surveyed caregivers to assess safety and behavioral outcomes related to ongoing therapy. METHODS We collected demographic and clinical data on children treated for electrical status epilepticus during slow wave sleep between October 2010 and March 2013. We sought to identify the number of patients who achieved at least a 50% reduction in spike wave index on electroencephalograph after receiving high-dose oral diazepam. We also administered a questionnaire to caregivers to assess for behavioral problems and side effects. RESULTS We identified 42 evaluable patients who received high-dose diazepam (range 0.23-2.02 mg/kg per day) to treat electrical status epilepticus during slow wave sleep. Twenty-six patients had spike reduction data and 18/26 (69.2%) children achieved a greater than 50% reduction in spike wave count from an average of 15.54 to 5.05 (P = 0.001). We received 28 responses to the questionnaire. Some patients experienced new onset of difficulties with problem-solving and speech and writing development. Sleep disturbances (50%) and irritability (57.1%) were the most frequent side effects reported. There did not appear to be a dose-related effect with electroencephalograph changes, behavioral effects, or side effects. CONCLUSIONS High-dose oral diazepam significantly reduces the spike wave count on electroencephalograph in children with electrical status epilepticus during slow wave sleep. Although this therapy improves electroencephalograph-related findings, it can be associated with concerning neurological and behavioral side effects in some individuals, so further study is warranted.
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Continuous Spike-Wave during Slow Wave Sleep and Related Conditions. ISRN NEUROLOGY 2014; 2014:619079. [PMID: 24634784 PMCID: PMC3929187 DOI: 10.1155/2014/619079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022]
Abstract
Continuous spike and wave during slow wave sleep (CSWS) is an epileptic encephalopathy that presents with neurocognitive regression and clinical seizures, and that demonstrates an electroencephalogram (EEG) pattern of electrical status epilepticus during sleep, as defined by the Commission on Classification and Terminology of the International League Against Epilepsy 1989. CSWS is an age-related condition, typically presenting in children around 5 years of age, with clinical seizures which progress within 2 years to a severe epileptic encephalopathy. The pathophysiology of CSWS is not completely understood, but the corticothalamic neuronal network involved in sleep patterns is thought to be involved. Genetic predisposition and injury in early development are thought to play etiological roles. Treatment strategies have involved traditional anticonvulsants, hormonal therapies, and other newer techniques. Outcomes are fair, and the thought is that earlier diagnosis and intervention preserve neurocognitive development, as in the case of other epileptic encephalopathies. Further understanding of the mechanisms of CSWS may lead to improved therapeutic options and thus outcomes of children with CSWS.
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Peltola ME, Sairanen V, Gaily E, Vanhatalo S. Measuring spike strength in patients with continuous spikes and waves during sleep: comparison of methods for prospective use as a clinical index. Clin Neurophysiol 2014; 125:1639-46. [PMID: 24394692 DOI: 10.1016/j.clinph.2013.12.093] [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: 01/29/2013] [Revised: 11/06/2013] [Accepted: 12/04/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare methods of estimating spike strength as a potential index in the assessment of continuous spikes and waves during sleep (CSWS). METHODS Spikes were searched and averaged automatically from pre- and postoperative EEGs of ten patients with CSWS who underwent corpus callosotomy (eight) or resective epilepsy surgery (two). From the most prominent spike, we measured peak amplitude and root mean square (RMS) over ±150ms window around the peak. In order to compensate for spatiotemporal instability of spikes, the cumulative amplitude and RMS were computed from the highest quartile of electrodes (Ampl-Q and RMS-Q, respectively). The stability of parameters was studied by comparing two ten minute epochs during the first hour of NREM sleep, as well as by analyzing overnight variation of indices in further ten patients with CSWS. The Ampl-Q and RMS-Q were compared between pre- and postoperative recordings. RESULTS All four measures, amplitude, RMS, Ampl-Q and RMS-Q, were correlated with each other and highly dependent on NREM/REM-sleep stage and arousals. Expectedly, Ampl-Q and RMS-Q had the greatest intra-individual stability. The amplitude had up to 71% intra-individual variation making it unhelpful for clinical use. Ampl-Q and RMS-Q were comparable in assessing change following surgical treatment. CONCLUSIONS Computing an integrated RMS over multiple electrodes during steady NREM sleep offers a stable and reliable parameter for evaluating the strength of spikes in CSWS. SIGNIFICANCE Analyzing spike strength with RMS-Q may offer a clinically useful, supplementary index for EEG monitoring of CSWS where spike index has been of limited value.
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Affiliation(s)
- M E Peltola
- Department of Clinical Neurophysiology, Hospital for Children and Adolescents, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; Department of Clinical Neurophysiology, Turku University Hospital, University of Turku, Turku, Finland.
| | - V Sairanen
- Department of Clinical Neurophysiology, Hospital for Children and Adolescents, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; Department of Physics, 00014 University of Helsinki, Helsinki, Finland
| | - E Gaily
- Department of Pediatric Neurology, Hospital for Children and Adolescents, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - S Vanhatalo
- Department of Clinical Neurophysiology, Hospital for Children and Adolescents, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland; Department of Neurological Sciences, 00014 University of Helsinki, Helsinki, Finland
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Caraballo RH, Cejas N, Chamorro N, Kaltenmeier MC, Fortini S, Soprano AM. Landau-Kleffner syndrome: a study of 29 patients. Seizure 2013; 23:98-104. [PMID: 24315829 DOI: 10.1016/j.seizure.2013.09.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The aim of the study was to retrospectively analyze the electroclinical features, etiology, treatment, and prognosis of 29 patients with Landau-Kleffner syndrome (LKS) with a long-term follow-up. METHODS Inclusion criteria were a diagnosis of LKS with: (1) acquired aphasia or verbal auditory aphasia; (2) with or without focal seizures, secondarily generalized tonic-clonic seizures, absences, or atonic seizures. RESULTS Mean follow-up was 12 years. All cases except six had seizures. Before the onset of aphasia, developmental language and behavioral disturbances were present in 19 and 14 patients, respectively. All patients had verbal auditory agnosia. Aphasia was severe in 24 patients and moderate in five. Nonlinguistic cognitive dysfunctions were moderate in 14 patients. Behavioral disturbances were found in 16 patients. During the continuous spike-and-wave discharges during slow sleep phase, the spike-wave index was >85% in 15, 50-85% in eight, and 30-50% in four. In two patients, the EEG recording showed occasional bilateral spikes, without continuous spike-and-wave discharges during slow sleep. In this phase, the awake EEG recording showed more frequent interictal abnormalities, predominantly in the temporal regions. Eight patients recovered language completely, but the remaining patients continue to have language deficits of different degrees. CONCLUSION Landau-Kleffner syndrome is an epileptic encephalopathy characterized by acquired verbal auditory aphasia and seizures in most of the patients associated with continuous or almost continuous spike-and-wave discharges during slow wave sleep. The most commonly used treatments were clobazam, ethosuximide, sulthiame. High-dose steroids were also administered. Adequate and early management may avoid language and cognitive deterioration.
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Affiliation(s)
- Roberto Horacio Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.
| | - Natalia Cejas
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Noelia Chamorro
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María C Kaltenmeier
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Sebastian Fortini
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Ana María Soprano
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
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Long-term response to high-dose diazepam treatment in continuous spikes and waves during sleep. Pediatr Neurol 2013; 49:163-170.e4. [PMID: 23953953 PMCID: PMC6382391 DOI: 10.1016/j.pediatrneurol.2013.04.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/15/2013] [Accepted: 04/28/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study evaluated whether the reduction in epileptiform activity after treatment with high-dose diazepam in continuous spikes and waves during sleep persists over time. PATIENTS Patients aged 1 to 21 years with continuous spikes and waves during sleep who received high-dose nocturnal diazepam and who had electroencephalogram follow-up were included. Twenty-nine patients met the inclusion criteria and underwent a total of 48 high-dose diazepam treatment cycles. RESULTS An overnight reduction of the spike wave percentage of at least 25% (i.e., 75-50%) occurred in 29 cycles (20 patients), and persisted within 6 months in 16 of 29 cycles (12 patients), but returned to baseline in three of 29 cycles (three patients). An overnight reduction of at least 50% (i.e., 75-25%) occurred in 15 cycles (13 patients), and persisted within 6 months in eight of 15 cycles (eight patients), but returned to baseline in three cycles (three patients). Twenty of 29 cycles that responded in the short term had persistent response on follow-up. Thirteen cycles of treatment were associated with mild side effects that did not recur with repeated treatment cycles. CONCLUSIONS Treatment with high-dose diazepam reduced epileptiform activity in continuous spikes and waves during sleep in the short term, and improvement persisted for several months in most cycles. Short-term response predicted persistence of this effect on subsequent follow-up.
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Continuous Spikes and Waves during Sleep: Electroclinical Presentation and Suggestions for Management. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:583531. [PMID: 23991336 PMCID: PMC3748771 DOI: 10.1155/2013/583531] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/07/2013] [Indexed: 01/21/2023]
Abstract
Continuous spikes and waves during sleep (CSWS) is an epileptic encephalopathy characterized in most patients by (1) difficult to control seizures, (2) interictal epileptiform activity that becomes prominent during sleep leading to an electroencephalogram (EEG) pattern of electrical status epilepticus in sleep (ESES), and (3) neurocognitive regression. In this paper, we will summarize current epidemiological, clinical, and EEG knowledge on CSWS and will provide suggestions for treatment. CSWS typically presents with seizures around 2-4 years of age. Neurocognitive regression occurs around 5-6 years of age, and it is accompanied by subacute worsening of EEG abnormalities and seizures. At approximately 6-9 years of age, there is a gradual resolution of seizures and EEG abnormalities, but the neurocognitive deficits persist in most patients. The cause of CSWS is unknown, but early developmental lesions play a major role in approximately half of the patients, and genetic associations have recently been described. High-dose benzodiazepines and corticosteroids have been successfully used to treat clinical and electroencephalographic features. Corticosteroids are often reserved for refractory disease because of adverse events. Valproate, ethosuximide, levetiracetam, sulthiame, and lamotrigine have been also used with some success. Epilepsy surgery may be considered in a few selected patients.
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Diagnosis and management of epileptic encephalopathies in children. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:501981. [PMID: 23970964 PMCID: PMC3736403 DOI: 10.1155/2013/501981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/04/2013] [Accepted: 06/18/2013] [Indexed: 11/20/2022]
Abstract
Epileptic encephalopathies refer to a group of disorders in which the unremitting epileptic activity contributes to severe cognitive and behavioral impairments above and beyond what might be expected from the underlying pathology alone, and these can worsen over time leading to progressive cerebral dysfunction. Several syndromes have been described based on their electroclinical features (age of onset, seizure type, and EEG pattern). This review briefly describes the clinical evaluation and management of commonly encountered epileptic encephalopathies in children.
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