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Pediatric Occipital Spikes at a Single Center Over 26 Years and the Significance of Tangential Dipole
Anita N Datta1,2, Laura Wallbank2, Johann Micallef1
1Division of Neurology, Department of Pediatrics, 37210BC Children's Hospital, Faculty of Medicine, University of British Columbia Vancouver, British Columbia, Canada.
Insights
Occipital epileptiform discharges in children can predict self-limited occipital epilepsy. Abnormal eye movements and specific discharge patterns are key indicators for prognosis in pediatric epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neurophysiology
Background:
- Pediatric occipital epileptiform discharges manifest in diverse clinical scenarios, encompassing both self-limited and treatment-resistant epilepsies.
- Understanding predictors for these discharges is crucial for accurate diagnosis and management of pediatric epilepsy.
Purpose of the Study:
- To identify electro-clinical predictors that can forecast the prognosis of children experiencing occipital epileptiform discharges.
- To differentiate between self-limited occipital (SLO) epilepsy and other forms based on specific EEG and clinical features.
Main Methods:
- Analyzed electro-clinical data from 205 pediatric patients with occipital epileptiform discharges.
- Classified patients into distinct seizure groups: SLO, non-SLO, genetic-generalized, febrile, and no-seizure.
- Compared electro-clinical characteristics between the SLO and non-SLO groups to identify predictive markers.
Main Results:
- Occipital epileptiform discharges with frontal/central positivity were more prevalent in the SLO group (36.8%) compared to the non-SLO group (19.4%).
- The presence of occipital epileptiform discharges with tangential dipoles, coupled with abnormal ictal eye movements, significantly predicted SLO epilepsy (P < .048 and P < .037, respectively).
Conclusions:
- Occipital epileptiform discharges with tangential dipoles, identified through visual analysis, are predictive of self-limited occipital epilepsy in children.
- Abnormal ictal eye movements, when present with specific discharge patterns, serve as a valuable clinical predictor for SLO epilepsy.
Background:
Pediatric occipital epileptiform discharges occur in various clinical settings, including self-limited and treatment-resistant epilepsies. The study objective is to determine electro-clinical predictors for prognosis in children with occipital epileptiform discharges.
Methods:
205 patients with occipital epileptiform discharges were classified into seizure groups: self-limited occipital (SLO) (n = 57), including Panayiotopoulos and Gastaut syndrome; non-self-limited occipital (non-SLO) (n = 98), including various seizure etiologies; genetic-generalized (n = 18); febrile (n = 5); and no-seizure (n = 27) groups. Electro-clinical features of the SLO and non-SLO were compared, as this is of most clinical relevance.
Results:
The median age of seizure onset was 3 years (range: 0-19). Occipital epileptiform discharges with frontal/central positivity were present in both groups, but more common in the SLO than non-SLO groups; 21/57 (36.8%) and 19/98 (19.4%), respectively (P < .022). However, when occipital epileptiform discharges with tangential dipoles (P < .048) were accompanied by abnormal ictal eye movements (P < .037), they were predictive of SLO epilepsy.
Conclusions:
In our cohort, occipital epileptiform discharges with tangential dipole detected by visual analysis and abnormal ictal eye movements were predictive of SLO epilepsy.
