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Benign focal epileptiform discharges of childhood and hippocampal sclerosis

Andrew Pan1, Ajay Gupta, Elaine Wyllie

  • 1Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Epilepsia
|March 11, 2004
PubMed

Insights

Benign focal epileptiform discharges of childhood (BFEDCs) can mimic true epilepsy. Careful evaluation is crucial for children with intractable seizures and unusual BFEDCs to identify underlying conditions like hippocampal sclerosis (HS).

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Neurophysiology

Background:

  • Benign focal epileptiform discharges of childhood (BFEDCs) are common EEG findings in children aged 4-14 years.
  • This age group overlaps with the presentation of temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS).

Observation:

  • Three preadolescent children with medically refractory TLE due to HS were initially misdiagnosed due to abundant, bilateral sharp waves suggestive of BFEDCs.
  • These sharp waves exhibited morphology, distribution, and sleep activation patterns typical of BFEDCs, but seizure symptoms and intractability were atypical for benign epilepsy.

Findings:

  • Unilateral HS on MRI and ipsilateral anteromesial temporal seizure onset on video-EEG clarified surgical candidacy.
  • Postoperative seizure freedom (2-4 years) confirmed HS as the primary epileptogenic cause, with BFEDCs being incidental or secondary manifestations.
  • Unusual bilateral occipitofrontal distribution of BFEDCs was noted in two cases, suggesting a potential link with HS.

Implications:

  • Highlights the importance of thorough investigation for children with BFEDCs exhibiting intractable seizures and atypical symptoms.
  • Suggests that BFEDCs in children with HS may not always be incidental and warrant further research.
  • Emphasizes the need to differentiate between benign EEG findings and underlying structural pathologies in pediatric epilepsy.
Abstract

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