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The course of benign partial epilepsy of childhood with centrotemporal spikes: a meta-analysis
P A Bouma1, A C Bovenkerk, R G Westendorp
1Department of Neurology, Leiden University Hospital, Leiden, The Netherlands.
Insights
Benign epilepsy of childhood with centrotemporal spikes (BECT) shows a high remission rate, but factors influencing outcome are unclear due to biased studies. Early prediction of seizure outcome in BECT is uncertain.
Area of Science:
- Pediatric Neurology
- Epilepsy Syndromes
- Clinical Neurophysiology
Background:
- Benign epilepsy of childhood with centrotemporal spikes (BECT) is a common childhood epilepsy syndrome.
- Understanding BECT's clinical characteristics and prognosis is crucial for accurate diagnosis and management.
Purpose of the Study:
- To conduct a meta-analysis of BECT studies to clarify clinical features and outcomes.
- To identify factors influencing the prognosis of BECT.
- To assess the reliability of current knowledge on BECT.
Main Methods:
- Meta-analysis of 525 identified publications, refined to 13 cohorts (794 patients) based on International League Against Epilepsy (ILAE) criteria.
- Inclusion bias and multiple publication corrections were applied.
- Kurtzke survival analysis was used to assess remission rates by age.
Main Results:
- An aggregate proportional remission rate of 0.977 was observed, with no identifiable factors influencing outcome.
- Age at onset ranged from 3 months to 14 years; age at last seizure ranged from 3 to 18 years.
- Remission rates approached 0.9997 in older children, but study methodologies were highly heterogeneous.
Conclusions:
- Current knowledge on BECT is largely based on retrospective, biased cohort studies, potentially leading to an overestimation of syndrome uniformity.
- Early prediction of seizure outcome in individual BECT patients remains uncertain.
- Prospective, population-based studies are necessary to accurately define BECT's characteristics and prognosis.
Abstract:
We performed a meta-analysis of studies on benign epilepsy of childhood with centrotemporal spikes (BECT) to ascertain whether clinical characteristics and outcome can be stated unequivocally. Using the Index Medicus and Medline CD+, we identified 525 publications. After applying the criteria of the International League against Epilepsy (ILAE) for BECT, 32 publications on 2,561 patients remained. After correction for inclusion bias and multiple publications on the same patient groups, 13 cohorts, comprising a total of 794 patients, were included. The aggregate proportional remission was 0.977; hence, no factors influencing outcome could be identified. Age at onset ranged from 3 months to 14 years, age at last seizure ranged from 3 to 18 years. A Kurtzke survival analysis of proportions of children in remission by age was performed; at an older age, the proportion of patients in remission was 0.9997. Publications had highly heterogeneous methodologies and population characteristics; we conclude that current knowledge on BECT has been determined mainly by retrospective studies of biased cohorts, and that the uniformity per se of BECT as an epileptic syndrome may be, at least in part, a result of selection bias. We conclude that early prediction of seizure outcome in a new patient with BECT can not be given with certainty. Prospective, population-based studies are needed to delineate the clinical and EEG characteristics of this syndrome.