Epileptiform activity in the electroencephalogram of 6-year-old children of women with epilepsy

Association of epileptiform brain activity and specific language impairment (SLI) in preschool children

Background

Epileptiform activities can cause transient or permanent deficits that affect the children during development and may be accompanied by neurodevelopmental disorders like specific language impairment.

Objectives

The objective of this study was to find if there is a possible association and the impact of epilepsy and epileptiform activity in children with specific language impairment.

Patients and methods

The study was conducted on 80 children suffering from specific language impairment and 80 age and sex match healthy control children. Computed tomography brain was performed and electroencephalography was recorded for children. Intelligence quotient level, cognitive age, social, and phoniatric assessment were done for all patients.

Results

Eighty children with specific language impairment (51 males and 29 females) with a mean age of 4.11 ± 1.93. Patients with specific language impairment showed significantly higher rates of abnormal electroencephalography (P = 0.006) and epilepsy (P < 0.001) compared to the control group. Spearman correlation demonstrated a highly negative significant relationship linking the language, intelligence quotient with abnormal electroencephalography and epilepsy (r = − 0.91, P < 0.01 and r = − 0.91, P < 0.01 respectively). Also, there was a moderately inverse significant relationship linking the cognitive age, social with abnormal electroencephalography, and epilepsy (r = − 0.70, P < 0.05 and r = − 0.65, P < 0.05 respectively).

Conclusion

Epileptiform activities even without epilepsy in preschool children may alter normal language function. Specific language impairment was associated with lower intelligence quotient levels, social, and cognitive age.

Trial registration

ClinicalTrials.gov ID: NCT04141332

Effectiveness of risk minimisation measures for valproate: A cross-sectional survey among physicians in Europe

Purpose

This study evaluated the effectiveness of risk minimisation measures (RMMs) implemented following the 2014 referral for valproate in Europe.

Methods

Cross‐sectional survey was conducted over 2‐month period in 2016 among physicians who prescribed valproate in France, Germany, the United Kingdom, Spain and Sweden. The web‐based questionnaire included five endpoints to evaluate physicians' knowledge on (a) prescribing valproate only for epilepsy and bipolar disorder in women if other treatments were ineffective or not tolerated; (b) ensuring supervision by experienced physicians while treating these conditions; (c) considering alternative treatments for women planning pregnancy, regular review of treatment needs and re‐assessing the benefit–risk balance in women and girls reaching puberty; (d) informing patients about the risks of taking valproate during pregnancy and (e) advising women on effective contraception during their treatment.

Results

Among 1153 physicians, 95.5% responded prescribing valproate for epilepsy and bipolar disorder in women only if other treatments are ineffective/not tolerated; 66.5% supervised while treatment; 76.6% considered alternative treatments for women planning pregnancy; 92.1% informed patients about the risks of taking valproate during pregnancy and 94.4% advised patients on the use of effective contraception during its treatment. Overall, 25.8% physicians recalled receiving both educational material (EM) and Dear Healthcare Professional Communication (DHPC). All endpoint rates were higher for physicians who acknowledged receipt of both DHPC and EM compared to physicians who did not receive them.

Conclusions

Although results varied across geography and physician speciality, majority of physicians had good knowledge about the indication and safety aspects of prescribing and using valproate.

Assessment of School-Aged Children of Mothers With Idiopathic Generalized Epilepsy

The aim is to examine the cognitive domains, behavioral domains, and electroencephalogram (EEG) findings in children of mothers with idiopathic generalized epilepsy who had been exposed to antiepileptic drugs (AEDs) in utero. Forty school-aged children born to 23 mothers with idiopathic generalized epilepsy were compared with 40 healthy children born to 34 healthy mothers. Stanford-Binet Intelligence Scale was applied to all children to assess their cognitive functions. Child Behavior Checklist was used to assess their behavioral characteristics. EEG was done for the epileptic mothers and their children. Children exposed to AEDs showed significantly lower scores in the verbal reasoning, visual reasoning, and global intelligence quotient (IQ). There was a significantly positive correlation between children's global IQ and maternal global IQ. Multiple regression analysis showed that in utero exposure to valproate and maternal IQ were the most independent factors affecting children's IQ. EEG findings of participating children were normal. Exposure to valproic acid during fetal life and maternal IQ represent confounding factors affecting the IQ of children with in utero exposure to AEDs.

Epileptiform discharges in EEG and seizure risk in adolescent children of women with epilepsy

We aimed to study the epileptiform discharges (ED) and seizure risk in EEG of 12-18-year-old children of women with epilepsy (WWE). Children of WWE who were prospectively followed up in the Kerala registry of epilepsy and pregnancy (KREP), aged 12-16years (n=92; males 48, females 44) underwent clinical evaluation and a 30-min digital 18-channel EEG. The EEG showed epileptiform discharges in 13 children (5 males and 8 females). The EDs were generalized in 9 and focal in 4 (occipital 2, frontal 1, and centroparietal 1). They had significantly higher risk of ED (odds ratio 4.02, 95% CI 1.04-15.51) when compared to published prevalence of ED in healthy children. There were 2 children with epilepsy (one with localization-related epilepsy and the other generalized epilepsy). The children under study had a trend towards higher prevalence of epilepsy (odds ratio 3.39, 95% CI 0.82-13.77) when compared to age specific prevalence of epilepsy from community surveys in same region. Children of WWE showed increased risk of ED in EEG and trend towards increased seizure risk when compared to healthy children.