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Clinical manifestations in children with occipital spike-wave paroxysms
1Division of Pediatric Neurology, University of Minnesota Medical School, Minneapolis.
Insights
Occipital-posterotemporal spike-wave paroxysms (O-PT SWPs) are a nonspecific EEG finding in children. These patterns can indicate various epilepsies or even be present without seizures, highlighting their varied clinical significance.
Area of Science:
- Neurology
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Occipital-posterotemporal spike-wave paroxysms (O-PT SWPs) are a recognized EEG abnormality.
- This pattern is primarily associated with childhood occipital epilepsy and basilar artery migraine.
Purpose of the Study:
- To investigate the EEG and clinical characteristics of O-PT SWPs in children and young adults.
- To determine the association of O-PT SWPs with different epilepsy types and migraine.
Main Methods:
- Retrospective analysis of EEG and clinical data from 30 pediatric patients with O-PT SWPs.
- Correlation of O-PT SWP characteristics (duration, generalization) with clinical manifestations (seizures, migraine) and etiology.
Main Results:
- Prolonged O-PT SWPs (>6s) were exclusively observed in patients with seizures (p<0.001).
- Brief O-PT SWPs (1-6s) occurred post-eye closure; generalized SWPs and background abnormalities were common.
- 80% of patients had paroxysmal events (seizures or migraine); 20% had no paroxysmal events.
Conclusions:
- O-PT SWPs are a nonspecific EEG finding, not exclusive to epilepsy.
- The pattern can be associated with idiopathic partial, symptomatic partial, and absence epilepsies.
- O-PT SWPs may also be present in individuals without any seizure activity or migraine.
Abstract:
The pattern of occipital-posterotemporal spike-wave paroxysms (O-PT SWPs), is a distinctive EEG abnormality observed primarily with occipital epilepsy of childhood and basilar artery migraine. We studied EEG and clinical features in 30 children and young adults with this EEG pattern. Prolonged and brief O-PT SWPs were observed. Prolonged discharges (greater than 6 s) were observed only in children with seizures (p less than 0.001), and brief discharges (1-6 s) were observed immediately after eye closure. Generalized SWPs (11 patients, 37%) and background abnormalities (17 patients, 57%) were common. Photic activation of O-PT SWPs was not observed. Twenty-four patients (80%) manifested paroxysmal phenomena-seizures (20 patients, 67%) and migraine (12 patients, 40%, 4 alone and 8 with seizures). Fifteen patients (75%) had partial seizures, and 5 (25%) had absence seizures. In 7 patients with partial seizures, an etiology was evident. Neurologic examination was more often abnormal in patients with secondary partial seizures than in those with idiopathic partial seizures (p less than 0.05) and absence seizures. Conversely, migraine was more often associated with idiopathic partial seizures than with secondary partial seizures (p less than 0.05) and absence seizures. Six children (20%) had no paroxysmal events. Generalized SWPs were uncommon in patients with idiopathic partial seizures. We conclude that O-PT SWPs is a nonspecific epileptiform abnormality that may occur in children with (a) idiopathic partial, (b) symptomatic partial, and (c) absence epilepsies, but it may also occur in patients with no evidence of seizures.