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Influence of epileptic activity during sleep on cognitive performance in benign childhood epilepsy with
Andreea Nissenkorn1, Adi Pappo2, Yael Feldmann3
1Service for Rare Disorders, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel; Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel Ha Shomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Abundant epileptiform activity in benign childhood epilepsy with centrotemporal spikes did not negatively impact neurocognitive performance, except for fine motor skills. This finding suggests that aggressive treatment may not be necessary for all cases.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurodevelopmental Disorders
Background:
- Benign childhood epilepsy with centrotemporal spikes (BCECTS) typically presents between ages 4-10 with excellent prognosis.
- While generally benign, BCECTS can be associated with mild cognitive, language, fine motor, and behavioral issues.
- An atypical form, electrical status epilepticus during slow wave sleep, can cause severe neurocognitive decline.
Purpose of the Study:
- To investigate the impact of significant, but not status epilepticus, epileptiform activity during sleep on neurocognitive function in children with BCECTS.
- To determine if randomly discovered abundant sleep epileptiform activity influences cognitive outcomes in children without pre-existing intellectual impairment.
Main Methods:
- Retrospective review of 34 children with BCECTS who underwent neurocognitive evaluation.
- Neurocognitive assessment included attention, memory, language, fine motor skills, and behavior.
- Patients were divided into two groups based on spike-wave index during sleep EEG (>50% vs. <50%) and compared.
Main Results:
- Children with >50% epileptiform activity were diagnosed younger, had less controlled seizures, and received more antiepileptic drugs.
- No significant differences in overall neurocognitive performance were observed between groups.
- A significant deficit in fine motor tasks (Pegboard) was noted in children with higher epileptiform activity.
Conclusions:
- Abundant sleep epileptiform activity in BCECTS, not meeting criteria for ESES, did not demonstrate a negative cognitive effect.
- The findings do not support the need for aggressive treatment solely based on the amount of epileptiform activity during sleep.
- Further research may be warranted to explore the specific impact on fine motor skills.
Background:
Benign childhood epilepsy with centrotemporal spikes is benign childhood epilepsy, presenting between 4 and 10 years of age, characterized by typical clinical and EEG findings. Despite excellent prognosis, there are reports of mild cognitive, language, fine motor and behavioral difficulties. In its atypical form - electrical status epilepticus during slow wave sleep, continuous epileptiform activity during sleep lead to severe neurocognitive deterioration. Our objective was to investigate the influence of abundant sleep epileptiform activity, not fulfilling the criteria for electrical status epilepticus during Slow Wave Sleep, discovered randomly in children without overt intellectual impairment.
Methods:
We retrospectively reviewed the charts and EEG's of 34 children with benign childhood epilepsy with centrotemporal spikes, who underwent neurocognitive evaluation. The neurocognitive battery included items in the following domains: attention span, memory, language, fine motor and behavior. Patients were divided into two groups according to the spike wave index on sleep EEG, with a cut-off point of 50%. The groups were compared regarding to neurocognitive performance.
Outcomes:
Children with epileptiform activity of more than 50%, were diagnosed at a significantly younger age (5.13 ± 1.94 years vs. 7.17 ± 2.45, p = 0.014 T test), had less controlled seizures and received more antiepileptic drugs. However, there was no difference in neurocognitive performance, except in fine motor tasks (Pegboard), where children with more abundant activity were scored lower (-0.79 ± 0.96 vs. 0.20 ± 1.05, p = 0.011, T test).
Conclusion:
Our study did not show negative cognitive effect of abundant epileptiform activity discovered randomly in children with benign childhood epilepsy with centrotemporal spikes, warranting aggressive treatment.
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