Benign childhood epilepsy with Centro-Temporal spikes (BCECTSs), electrical status epilepticus in sleep (ESES), and...

Area of Science:

• Pediatric Neurology
• Epileptology
• Child Psychiatry

Background:

• Children with benign childhood epilepsy with centrotemporal spikes (BCECTS) often exhibit electrical status epilepticus during sleep (ESES).
• Comorbidities like ADHD and behavioral issues complicate treatment decisions regarding EEG normalization.
• Clinicians face challenges in determining the aggressiveness of interventions to normalize EEG in these pediatric patients.

Purpose of the Study:

• To evaluate the necessity of aggressive EEG normalization treatments in children with BCECTS, high spike-wave index (SWI), and ADHD.
• To identify critical parameters guiding the use of second-line antiepileptic agents in this patient population.

Main Methods:

• Retrospective study of 17 pediatric patients with BCECTS, SWI >30%, and ADHD/ADD.
• Exclusion of patients with documented neurocognitive deterioration.
• Follow-up for at least two years, with a mean follow-up of 5.5 years.

Main Results:

• Mean age at diagnosis was 6.9 years, mean SWI was 60%, and mean duration of electrical activity was 1.5 years.
• Six patients had learning disabilities; all received an average of three antiepileptic drugs for EEG normalization.
• No cognitive or behavioral deterioration was observed in any patient, and none received steroids or high-dose diazepam.

Conclusions:

• Formal psychological evaluation is crucial for identifying cognitive (IQ) decline, which is the primary indicator for considering aggressive treatments like steroids or high-dose diazepam.
• In the absence of documented cognitive decline, aggressive second-line treatments may be avoided in children with BCECTS, high SWI, and school difficulties.
• Current treatment approaches focusing on EEG normalization with standard antiepileptic drugs appear sufficient for managing BCECTS with ADHD without significant cognitive or behavioral deterioration.