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Functional partial epilepsies in childhood
Insights
Functional partial epilepsies (FPE) in children are not always benign, even with EEG findings similar to Rolandic spikes. Differentiating FPE from typical benign epilepsy of children with centro-temporal EEG foci (BECCT) is crucial for accurate seizure prognosis.
Area of Science:
- Pediatric Neurology
- Clinical Electrophysiology
- Epileptology
Background:
- Partial epilepsies in children present diagnostic challenges.
- Distinguishing functional partial epilepsies (FPE) from organic forms is critical for management.
- Rolandic spikes on EEG are often associated with benign epilepsy syndromes.
Purpose of the Study:
- To compare interictal EEG findings in functional and organic partial epilepsies.
- To evaluate the prognostic significance of EEG findings, particularly those resembling Rolandic spikes, in pediatric partial epilepsies.
- To stress the importance of differentiating typical benign epilepsy of children with centro-temporal EEG foci (BECCT) from FPE.
Main Methods:
- Retrospective analysis of 314 children with partial epilepsies followed for over 5 years.
- Identification and classification of 122 children with functional partial epilepsies (FPE).
- Comparison of interictal EEG findings, focusing on centro-temporal and other focal patterns, between FPE and organic epilepsies.
Main Results:
- Functional partial epilepsies (FPE) constituted 39% of the studied cohort.
- Only 45% of FPE cases met the criteria for typical benign epilepsy of children with centro-temporal EEG foci (BECCT).
- Unfavorable seizure control was more frequent in FPE with frontal or multiple EEG foci compared to centro-temporal or occipital foci.
- EEG spikes resembling Rolandic spikes were observed in over 50% of both functional and organic partial epilepsies, challenging their benign implication.
Conclusions:
- Recurrent interictal spikes, even those similar to Rolandic spikes, do not guarantee a benign seizure prognosis.
- Functional partial epilepsies (FPE) can present with diverse EEG focal patterns beyond the typical centro-temporal.
- Accurate differential diagnosis between BECCT and FPE is essential for appropriate patient management and prognostic assessment.
Abstract:
Out of the 314 children with partial epilepsies below the age of 15 who had been followed for more than 5 years, 122 children with functional partial epilepsies (FPE) were the subjects of this study. The specific modality of interictal EEG findings reminiscent of that of the Rolandic spikes (Dalla Bernardina, 1982, 1984) was compared between functional and organic partial epilepsies. The results were: 1) One hundred and twenty-two patients were found to have FPE out of a total of 314 patients (39%). 2) Fifty-five patients were diagnosed as typical benign epilepsy of children with centro-temporal EEG foci (BECCT) of the 122 functional cases (45%). The remaining 67 patients who defied the diagnostic criteria of BECCT were; 9 cases with frontal EEG focus (7%), 11 cases with central and/or midtemporal EEG foci (9%), 10 cases with occipital EEG focus (8%) and 14 cases with multiple foci (11%). 3) Unfavorable seizure control was observed in cases with frontal foci (44%) and with multiple EEG foci (64%) compared with those whose EEG focus was located in the centro-midtemporal area, (including BECCT; 98%) and in the occipital region (80%). 4) It was noteworthy that the recurrent interictal spikes similar to those of the Rolandic spikes (Dalla Bernardina) were found in more than 50% of the patients not only with functional but with organic partial epilepsies. Our results, at least at the present time, appear to indicate that the recurrent spikes never did signify the benignancy of the seizure prognosis. The importance of differential diagnosis of BECCT from FPE was specifically stressed.