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Generalized spike-and-wave patterns in children: clinical correlates
B Martínez-Menéndez1, A P Sempere, P P Mayor
1Pediatric Neurology Unit, Section of Neurology, H.U. de Getafe, Hospital 12 de Octubre, Madrid, Spain.
Insights
This study analyzed electroencephalograms (EEGs) in 154 children with epilepsy, classifying generalized spike-and-wave (SW) patterns by frequency. Different SW patterns correlate with distinct epilepsy types, seizure characteristics, and prognoses, aiding in diagnosis and treatment strategies.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Electroencephalograms (EEGs) are crucial for diagnosing epilepsy in children.
- Generalized spike-and-wave (SW) patterns on EEGs are common in pediatric epilepsy.
- Classifying SW patterns by frequency may offer prognostic insights.
Purpose of the Study:
- To analyze the clinical characteristics of children with epilepsy exhibiting generalized SW patterns.
- To classify SW patterns based on their frequency and correlate them with clinical features.
- To determine the prognostic implications of different SW pattern frequencies in pediatric epilepsy.
Main Methods:
- Retrospective review of 154 pediatric EEGs performed between 1980 and 1990.
- Classification of generalized SW patterns according to their frequency (typical, slow, fast).
- Analysis of clinical data including seizure types, epilepsy syndromes, neurological examination, and neuroimaging (CT scans).
Main Results:
- Typical SW patterns were associated with absence seizures, normal findings, idiopathic generalized epilepsies, monotherapy, and seizure freedom.
- Slow SW patterns correlated with West syndrome, younger onset, various seizure types, abnormal findings, cryptogenic/symptomatic epilepsies, polytherapy, and poor seizure control.
- Fast SW patterns were linked to secondary generalized and partial seizures, normal CT scans, cryptogenic partial epilepsy, and seizure recurrence.
Conclusions:
- Epilepsy with typical SW patterns can be considered benign.
- Epilepsy with slow SW patterns suggests a malignant course.
- Epilepsy with fast SW patterns indicates a treacherous prognosis, necessitating careful management.
Abstract:
All electroencephalograms performed in our institution between 1980 and 1990 were reviewed. The clinical characteristics of children with epilepsy and generalized spike-and-wave (SW) patterns were analyzed. The SW patterns were classified according to their frequency. Electroencephalograms of 154 children with epilepsy revealed SW patterns. Absence seizures were the most common first seizure, but partial seizures were frequent. More than 40% had several types of seizures. Sixty percent of the epileptic syndromes were generalized, but almost 25% were partial. The typical SW pattern was associated with absence seizures, a normal examination and computed tomographic scan, idiopathic generalized epilepsies, monotherapy, freedom from seizures, and lack of recurrence. The slow SW pattern was associated with West syndrome; a younger age at seizure onset; atonic, myoclonic, tonic, and partial simple seizures; an abnormal examination and computed tomographic scan; cryptogenic or symptomatic generalized epilepsy or symptomatic partial epilepsy; polytherapy; and poor seizure control. The fast SW pattern was associated with secondary generalized, partial, tonic-clonic, and complex partial seizures; a normal computed tomographic scan; cryptogenic partial epilepsy; isolated seizures; and seizure recurrence. Epilepsy with a typical SW pattern should be considered benign, epilepsy with a slow SW pattern malignant, and epilepsy with a fast SW pattern treacherous.