Electroclinical biomarkers predicting EEG normalization and polytherapy needs in self-limited epilepsy with...

Self-limited epilepsy with centrotemporal spikes (SeLECTS) is a well-known self-limited focal epilepsy in children. While centrotemporal discharges remit with age, the timing and biomarkers predicting EEG normalization and polytherapy needs are not well established.

This study aimed to identify the timing of EEG remission and electroclinical biomarkers influencing remission and polytherapy needs in SeLECTS.

We retrospectively reviewed 153 of 401 patients (<18 years) with SeLECTS whose sleep EEGs normalized (2010-2025, Chonnam National University Hospital).

The median age at sleep EEG normalization was 11.4 years (IQR, 10.1-13.2), with a median interval of 45.9 months (IQR, 27.0-66.8). Seizure-onset age correlated positively with EEG normalization age (R = 0.457) and negatively with the interval to normalization (R = -0.508; P < 0.001). EEG normalized younger in patients with unilateral (10.9 vs. 12.0 years, P = 0.002) or right-dominant discharges (11.2 vs. 13.0 years, P = 0.023). The EEG normalization interval increased with a longer gap between the first and second seizures (R = 0.279; P = 0.001). It was shorter in unilateral discharges (28.1 vs. 53.9 months; P < 0.001), and longer in the polytherapy group (57.3 vs. 43.5 months; P = 0.006). Polytherapy was more frequent in early childhood (50.5 % vs. 21.0 %; P = 0.005), and in patients with Todd's paralysis (71.4 % vs. 26.0 %; P = 0.019), daytime seizures (64.7 % vs. 23.5 %; P < 0.001), or attention deficit/hyperactivity disorder (ADHD; 66.7 % vs. 25.7 %; P = 0.015).

EEG remission is associated with seizure-onset age and dipole findings, whereas the need for polytherapy is influenced more by atypical clinical than electrical biomarkers.