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Updated: Mar 29, 2026

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
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Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

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Characteristics and Management of Children with Continuous Spikes and Waves during Slow Sleep

K Fatema1, M M Rahman, S Begum

  • 1Dr Kanij Fatema, Assistant Professor, Pediatric Neurology Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Mymensingh Medical Journal : MMJ
|December 2, 2015
PubMed

Insights

Continuous spike and slow wave in sleep (CSWS) in children presents with diverse symptoms and often drug-resistant epilepsy. Midazolam drip showed significant efficacy in treating CSWS, offering a promising therapeutic option.

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Clinical Neurophysiology

Background:

  • Continuous spike and slow wave in sleep (CSWS) is an epilepsy syndrome characterized by continuous spike-and-wave discharges during sleep.
  • CSWS often presents with cognitive and behavioral regression, posing significant management challenges in children.
  • Previous treatment strategies have shown variable efficacy, necessitating exploration of alternative therapeutic options.

Purpose of the Study:

  • To delineate the clinical spectrum and EEG characteristics of CSWS in a pediatric cohort.
  • To evaluate the effectiveness of various treatment modalities for CSWS.
  • To identify potentially efficacious treatments, particularly in cases resistant to conventional antiepileptic drugs (AEDs).

Main Methods:

  • Retrospective analysis of ten pediatric patients diagnosed with CSWS treated between 2012 and 2013.
  • Detailed review of clinical presentations, including seizures, regression, and behavioral changes.
  • Assessment of EEG findings, specifically the percentage of sleep with spike-wave index (SWI), and evaluation of treatment responses to different AEDs and therapies.

Main Results:

  • The study included 10 patients with a mean age of 6.9 years, predominantly with epilepsy as the underlying etiology.
  • Presenting features included abnormal behavior, agitation, aggression, and regression (speech/motor).
  • Eighty percent of patients responded positively to midazolam drip, while pulse methylprednisolone showed partial response in one case and failure in two. Valproate was also found to be efficacious.

Conclusions:

  • Midazolam drip demonstrated significant efficacy in treating pediatric CSWS, even in cases resistant to multiple oral AEDs.
  • This study highlights midazolam drip as a potentially valuable therapeutic option for CSWS, contrasting with findings from previous studies emphasizing other treatments.
  • Further research is warranted to confirm these findings and establish optimal treatment protocols for CSWS.

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