Incidental interictal epileptiform discharges in infants with nonepileptic events
Maria A Montenegro1, Michaela Tsuha1, Shifteh Sattar1
1Department of Neurosciences, Rady Children's Hospital/University of California, San Diego, San Diego, California, USA.
Insights
Incidental interictal epileptiform discharges (IEDs) are common in infants with non-epileptic events, detected via prolonged video-electroencephalography (EEG). These findings in healthy infants require careful clinical interpretation.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Evaluating infants with non-epileptic events presents diagnostic challenges.
- Incidental interictal epileptiform discharges (IEDs) can complicate interpretation in this population.
Purpose of the Study:
- To determine the frequency and characteristics of incidental IEDs in infants with non-epileptic events.
- To provide guidance for clinicians and families regarding these findings.
Main Methods:
- Retrospective analysis of 216 infants with normal development and neurological exams presenting with non-epileptic events.
- Video-electroencephalography (video-EEG) recordings were reviewed by an experienced epileptologist.
- Family history of epilepsy was assessed up to three generations.
Main Results:
- Incidental IEDs were detected in 23.6% of infants, predominantly focal.
- Most IEDs were rare (80.4%); frequency did not correlate with family history of epilepsy.
- Longer video-EEG duration was associated with a higher detection rate of IEDs (p=0.0001).
Conclusions:
- Prolonged video-EEG recording increases incidental IED detection in infants with non-epileptic events.
- The clinical significance of these incidental IEDs is uncertain, as they occur in healthy infants.
- Findings aid in contextualizing video-EEG results for infants with non-epileptic events.
Objective:
Incidental interictal epileptiform discharges (IEDs) add an unexpected variable to the evaluation of infants with nonepileptic events. The objective of this study was to evaluate the frequency and characteristics of incidental IEDs in infants presenting with nonepileptic events diagnosed by video-electroencephalography (EEG).
Methods:
This retrospective study included infants with normal developmental milestones and neurological examination presenting with nonepileptic events. Video-EEG was evaluated by an experienced epileptologist. Family history of epilepsy was assessed up to three generations.
Results:
A total of 216 patients were included in the analysis (108 boys and 108 girls); ages ranged from 1 month to 24 months (mean = 7 months). Video-EEG duration ranged from 1 to 72 h (mean = 17 h, median = 24 h). Incidental IEDs were seen in 51 of 216 (23.6%) patients (96% were focal, 4% generalized). The frequency of incidental IED was rare in 41 of 51 (80.4%), occasional in nine of 51 (17.6%), and frequent in one of 51 (2%) patients. Brain magnetic resonance imaging was available for 42% of patients presenting with incidental IEDs, all of which was normal. Family history of epilepsy did not increase the frequency of incidental IEDs (p = .75). Longer video-EEG duration correlated with a higher frequency of epileptiform discharges (p = .0001).
Significance:
Prolonged video-EEG recording, necessary to capture nonepileptic events, has increased the detection of IEDs in infants. However, the clinical significance of incidental IEDs remains unclear. As these discharges may also be found in healthy and normal developing infants, these findings provide valuable guidance for clinicians and families in contextualizing video-EEG results.
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