Significance of interictal occipital epileptiform discharges in children
Chunyang Wang1, Divya S Khurana, Sanjeev V Kothare
1Department of Neurology, Hahnemann University Hospital.
Insights
Interictal occipital epileptiform abnormalities in children may indicate encephalopathy. High or low amplitude spikes and background slowing are key indicators in pediatric epilepsy evaluations.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neurophysiology
Background:
- Interictal occipital epileptiform abnormalities are not well-characterized in pediatric populations.
- Understanding these abnormalities is crucial for diagnosing and managing childhood epilepsy.
Purpose of the Study:
- To assess the significance of interictal occipital epileptiform abnormalities in children.
- This pilot study aimed to characterize these findings in relation to specific clinical criteria.
Main Methods:
- EEG database search for "occipital", "spike", "sharp wave", and "epileptiform" terms.
- Patients categorized into two groups based on the presence or absence of neurological deficits, intellectual disability, or intractable epilepsy.
- Analysis focused on spike/sharp wave amplitude/duration and background slowing.
Main Results:
- 44 children (8 months–15 years) were studied, with 22 in each group.
- Background slowing was significantly more frequent in the group with neurological comorbidities (45% vs. 4.5%, p=0.002).
- Abnormal amplitude spikes/sharp waves (outside 50-150 microV) were more common in the comorbidity group, showing high positive predictive value (89%).
Conclusions:
- Very high or low-amplitude occipital epileptiform abnormalities can be indicative of underlying encephalopathy in children.
- Background slowing on EEG in conjunction with occipital abnormalities may suggest a more severe neurological condition.
Objective:
Interictal occipital epileptiform abnormalities have not been well characterized. The objective of this pilot study was to assess their significance in children.
Methods:
A search was performed on the EEG database for the keywords "occipital", "spike", "sharp wave" and "epileptiform". Patients were divided into two groups based on the absence of all (group 1) or presence of any (group 2) of the following criteria: mental retardation, cerebral palsy, neurological deficits, abnormal MRI and/or intractable epilepsy. Special attention was given to the spike/sharp wave amplitude/duration and background slowing.
Results:
A total of 44 children (eight months to 15 years) were studied. Groups 1 and 2 were each composed of 22 children. Background slowing was more frequent in group 2 (10/22, 45%) compared to group 1 (1/22, 4.5%; p = 0.002). In group 2, 8/22 (36%) had spikes or sharp waves with amplitudes below 50 microV or above 150 microV with a positive predictive value of 89%, and a negative predictive value of 39%. Only 1/22 (4.5%) in group 1 had epileptiform activity outside of the 50-150 microV range.
Conclusions:
The presence of very high or low-amplitude occipital epileptiform abnormalities or background slowing may be indicative of encephalopathy.
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