Prevalence of epileptiform activity in healthy children during sleep
Oscar Sans Capdevila1, Ehab Dayyat, Leila Kheirandish-Gozal
1Kosair Children's Hospital Sleep Medicine and Apnea Center, Department of Pediatrics, University of Louisville, 570 South Preston Street, Suite 204, Louisville, KY 40202, USA.
Insights
Epileptiform discharges, a type of brain activity not related to seizures, were found in 1.45% of healthy children during sleep studies. This finding suggests a potential link between these discharges and later cognitive or behavioral issues.
Area of Science:
- Neurology
- Pediatrics
- Sleep Medicine
Background:
- Epileptiform discharges are interictal paroxysmal activities, distinct from seizure-related electroencephalogram (EEG) activity.
- The prevalence of epileptiform activity in the general pediatric population remains largely unknown.
- Such activity is more commonly observed during sleep.
Purpose of the Study:
- To determine the prevalence of epileptiform activity in otherwise healthy children.
- To investigate potential associations between epileptiform activity and neurocognitive function in pediatric populations.
Main Methods:
- Polysomnographic (PSG) studies, including an eight-lead EEG montage, were performed on healthy children without prior seizure history.
- Epileptiform activity was defined as spike and/or sharp waves, with or without slow waves, in bursts lasting less than 5 seconds.
- Neurocognitive testing was conducted on a subset of children identified with epileptiform activity.
Main Results:
- Of 970 children studied, 14 (1.45%) exhibited epileptiform activity without other PSG abnormalities.
- The observed epileptiform patterns were primarily spike or spike-and-wave, predominantly in centro-temporal regions during non-rapid eye movement (NREM) sleep.
- Four of six children who underwent neurocognitive testing showed abnormalities in behavior, attention, hyperactivity, or learning.
Conclusions:
- Epileptiform activity appears relatively frequent in healthy community children.
- This activity may be associated with suboptimal cognitive and behavioral outcomes, warranting further investigation.
- Enhanced awareness and specific EEG montages during PSG can improve detection rates in children.
Background:
The term epileptiform discharge typically refers to interictal paroxysmal activity that occurs more commonly during sleep. This type of paroxysmal activity does not include the electroencephalographic (EEG) activity observed during a seizure. The prevalence of epileptiform activity in the general pediatric population is unknown.
Methods:
Polysomnographic (PSG) studies were conducted in otherwise healthy children recruited from the general population and with no previous history of seizures or any other medical conditions. All sleep studies included an eight-lead EEG montage. Spike and sharp waves, either alone or accompanied by slow waves, occurring singly or in bursts lasting <5s were considered as representing epileptiform activity.
Results:
Nine hundred seventy children underwent overnight PSG. In 14 children, evidence of epileptiform activity, in the absence of any additional abnormality in the PSG, occurred. Thus, the prevalence of epileptiform activity was 1.45%. Epileptiform patterns found were either spike or spike and wave and were more prominent during non-rapid eye movement (NREM) sleep, with 11 patients presenting spike and spike and wave patterns in the centro-temporal regions. Four of the six children who underwent neurocognitive tests exhibited abnormal findings in areas of behavior, attention, hyperactivity, and learning.
Conclusion:
Epileptiform activity in otherwise healthy children from the community is relatively frequent and, if confirmed by prospective studies, could be associated with suboptimal cognitive and behavioral functions. Increased awareness by sleep professionals and use of PSG montage that includes temporal leads and >2 standard EEG leads should facilitate the detection of epileptiform activity in children.
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