Benign rolandic epilepsy: clinical and electroencephalographic correlates

Pediatric epilepsy syndromes with associated developmental impairment

In 2022, the International League Against Epilepsy revised their classification of epilepsy syndromes for clinicians to better understand the relationships between different epilepsy syndromes, their underlying causes, and their associated developmental and behavioral features. This review highlights portions of the current classification with an emphasis on epilepsy syndromes that readily present with developmental challenges and provides a unique framework, based on electroencephalography, to easily identify and understand these syndromes. Included in this review are a helpful categorization scheme with visual aid, descriptions of updated epilepsy syndromes, figures of relevant identifiers of syndrome and information regarding future directions toward treatment and research. Covered syndromes include developmental and epileptic encephalopathy, Dravet syndrome, Rasmussen syndrome, and infantile epileptic spasm syndrome, among others. WHAT THIS PAPER ADDS: The revised epilepsy syndrome classification by the International League Against Epilepsy aims to improve the outcomes for children with epilepsy. The electroencephalography features of epilepsy syndromes are grouped based on a categorization model. This model allows clinicians to understand overlapping phenotypes and aid with both identification and diagnosis.

Rolandic discharges: clinico-neurophysiological correlation

OBJECTIVE

The aim of this study was to analyze neurophysiologic aspects of rolandic discharges.

METHODS

We reviewed 45 electroencephalograms of patients divided into two groups: those with benign childhood epilepsy with centrotemporal spikes (BCECTS) and symptomatic partial epilepsy (SPE), following ILAE criteria (1989). The EEG data analyzed were: horizontal dipole discharges, double spike phenomenon, the extension of epileptiform discharges and background activity.

RESULTS

There was a predominance of horizontal dipole between patients with BCECTS compared with patients with SPE; however, this difference was not statistically significant. There was also no statistically significant difference between the two groups when the double spike phenomenon and the extension of discharges beyond the rolandic area were considered. The slower background activity in the SPE group was the only variable with statistical significance.

CONCLUSIONS

This study revealed similarities between rolandic discharges of two different epilepsy groups. The only reliable parameter to differentiate the groups was the background activity.

SIGNIFICANCE

Our findings suggest that most EEG rolandic features are not pathognomonic of BCECTS, as they are related to the area of the discharges and not to the epileptic syndrome itself.

Clinical and electroencephalographic follow-up after a first unprovoked seizure

We studied the role of clinical and electroencephalographic factors in the follow-up of children and adolescents after a first unprovoked seizure, and their correlation with recurrence and risk for epilepsy. We conducted a 24-month follow-up of 109 patients aged 1 month to 16 years who had a first unprovoked seizure. We analyzed the characteristics of the first seizure, perinatal history, family history of seizures, electroencephalographic patterns and their influence on seizure recurrence, and calculated risk for subsequent epilepsy. Fifty-six patients (51.4%) had recurrent seizures. The bivariate statistical analysis revealed that maternal prenatal disease (relative risk = 2.02, P = 0.03) and an abnormal electroencephalogram (relative risk = 2.89, P = 0.0003) were significantly associated with seizure recurrence. Other factors (male sex, partial first seizure, vaginal delivery, family history of seizures, and sleep state) approached statistical significance. Logistic regression revealed that the only variable significantly associated with recurrence was an abnormal electroencephalographic pattern on the first examination (relative risk = 2.48, P = 0.003). Cumulative risk ranged from 50-68% at 24 months when the first electroencephalogram was abnormal, and from 26-36% when it was normal. We concluded that the electroencephalogram may have an important diagnostic value in the prognosis of epileptic seizure recurrence in children and adolescents.