Clinical Significance of Positive Spike Wave Discharges in the Pediatric Population: Insights Beyond Neonates
1Department of Pediatrics, Division of Neurology, BC Children's Hospital, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada.
Insights
Positive spike waves (PSW) on pediatric EEG indicate a higher likelihood of seizures, epilepsy, and developmental issues. These EEG findings are linked to brain abnormalities and poorer outcomes in children.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
- Epileptology
Background:
- Positive spike wave (PSW) discharges on electroencephalogram (EEG) are recognized in neonates, but their clinical significance in older children is less understood.
- This study investigates the clinical implications of PSW in children aged 1 month to 19 years over a 30-year period.
Purpose of the Study:
- To evaluate the clinical significance of focal positive spike waves (PSW) in pediatric patients.
- To compare outcomes between children with PSW and those with focal negative interictal epileptiform discharges.
Main Methods:
- Retrospective analysis of pediatric EEG data from 1992 to 2020.
- Comparison of clinical information between 326 children with focal PSW and 898 control patients with focal negative interictal epileptiform discharges.
Main Results:
- Positive spike waves (PSW) were identified in 0.57% of pediatric EEGs.
- PSW were associated with earlier seizure onset, increased odds of seizures, epilepsy, drug-resistant epilepsy, developmental delay, and school difficulties.
- PSW correlated with abnormal neurologic exams and structural brain abnormalities, including malformations of cortical development.
Conclusions:
- Positive spike waves on pediatric EEG are associated with underlying congenital or acquired brain abnormalities.
- The presence of PSW predicts less favorable seizure control and neurodevelopmental outcomes in children.
Introduction:
Positive spike wave (PSW) discharges on EEG are well-documented in neonates, but data regarding their significance in other populations are limited. This study aimed to assess the clinical significance of PSW in children aged 1 month to 19 years at a single tertiary care center over approximately three decades.
Methods:
Clinical information of children with focal PSW ( n = 326) was compared with control patients with focal negative interictal epileptiform discharges ( n = 898).
Results:
From 77,500 pediatric EEGs in our laboratory from 1992 to 2020, PSW were identified in 445 (0.57%) children, of which 326 met inclusion criteria. Positive spike waves were located in the following brain regions: occipital (139), central (65), frontal (63), temporal (43), parietal (9), and centro-temporal (7). Positive spike wave patients had a younger median age of seizure onset than control patients (1.1 years [0.30, 4.00] versus 4 years [1.3, 7.5], P < 0.001).Logistic regression analysis confirmed that PSW were associated with high odds of seizures [odds ratios (OR) 3.78; CI: 2.14-2.14; P < 0.005], epilepsy [OR 2.05; CI: 1.39-1.39; P < 0.005], and drug-resistant epilepsy, [OR 3.51; CI: 2.67-2.67; P < 0.005]. Furthermore, PSW correlated with a greater odd of developmental delay [OR 3.69; CI: 2.77-2.77; P < 0.005], school difficulties [OR 2.85; CI: 2.07-2.07; P < 0.005], abnormal neurologic exam [OR 2.8; CI: 2.15-2.15; P < <0.005], and structural brain abnormalities [OR 1.74; CI: 1.32-1.32; P < 0.005], such as malformation of cortical development, compared with control patients.
Conclusions:
Positive spike waves on pediatric EEG are associated with congenital or acquired brain abnormalities and less favorable seizure and neurodevelopmental outcomes.
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