Ripples on rolandic spikes: A marker of epilepsy severity
Nicole E C van Klink1, Maryse A van 't Klooster1, Frans S S Leijten1
1Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
Insights
Ripples on electroencephalography (EEG) rolandic spikes can help differentiate epilepsy types in children. The absence of ripples suggests a benign condition, while their presence indicates a higher likelihood of seizures and potential need for treatment.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Epileptology
Background:
- Rolandic spikes in children's EEG can present with or without seizures, ranging from benign to severe epilepsy.
- Differentiating between these clinical entities is crucial for appropriate management.
Purpose of the Study:
- To investigate if high-frequency ripples (80-250 Hz) superimposed on rolandic spikes in surface EEG can distinguish between different clinical presentations of rolandic spikes in children.
Main Methods:
- A cohort study analyzed EEG data from children with rolandic spikes and no other abnormalities.
- Children were grouped into: no epilepsy, typical epilepsy, and atypical/symptomatic epilepsy.
- Ripples on rolandic spikes were quantified and correlated with seizure frequency; ROC curves assessed predictive value.
Main Results:
- Ripples were detected in 13 of 22 children; their presence correlated significantly with seizure frequency.
- More than two ripples predicted seizures (AUC 0.84), while spikes did not (AUC 0.53).
- Over five ripples accurately differentiated benign from atypical epilepsy (AUC 0.91).
Conclusions:
- The absence of ripples on rolandic spikes suggests a benign clinical course.
- The presence of multiple ripples indicates a higher seizure burden and may necessitate pharmacologic treatment.
Objective:
Children with rolandic spikes may or may not have seizures, ranging from benign rolandic epilepsy to severe atypical rolandic epilepsy. We investigated whether ripples (80-250 Hz), superimposed on rolandic spikes in surface electroencephalography (EEG), can differentiate between different entities.
Methods:
In this cohort study we analyzed the EEG studies of children with rolandic spikes without other EEG or magnetic resonance imaging (MRI) abnormalities. They were divided into the following three groups: (1) rolandic spikes but no epilepsy, (2) typical rolandic epilepsy, and (3) atypical and symptomatic rolandic epilepsy. Ripples superimposed on rolandic spikes were marked in 10 minutes of EEG, and compared to the number of seizures before the EEG. Receiver operating characteristic (ROC) curves were constructed to determine the predictive value of ripples and spikes for having epilepsy (groups 2 and 3) and for differentiating benign courses (groups 1 or 2) from atypical and symptomatic epilepsy (group 3). Ripples were also marked in the time frequency spectrum of averaged rolandic spikes.
Results:
Ripples were found in 13 of 22 children. Children without epilepsy showed no ripples, except for a single child with only one ripple. The number of ripples showed a significant positive correlation with the number of seizures (ρ = 0.70, p = 0.001), whereas spikes had a borderline significant correlation (ρ = 0.43, p = 0.05). Presence of more than two ripples was a predictor for having seizures (area under the curve [AUC] 0.84), whereas spikes could not predict having seizures (AUC 0.53). More than five ripples predicted the difference between benign courses and atypical and symptomatic epilepsy (AUC 0.91, sensitivity 63%, specificity 100%). Ripples in the time frequency spectra appeared in all children and were not related to seizures.
Significance:
Absence of ripples on top of rolandic spikes predicts a relative benign clinical entity, whereas in the presence of several ripples, the child is likely to have more seizures than classical rolandic epilepsy, and pharmacologic treatment might be needed.
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