Epilepsy Behav. 2015 Feb 9;44C:117-120. doi: 10.1016/j.yebeh.2015.01.004. [Epub ahead of print]
Benign childhood epilepsy with Centro-Temporal spikes (BCECTSs), electrical status epilepticus in sleep (ESES), and academic decline - How aggressive should we be?
Abstract
Since
many of the children with BCECTSs display electrical status epilepticus
during sleep and many present with different comorbidities, mainly ADHD
and behavioral disturbances, clinicians are often confronted with the
dilemma of how aggressive they should be with their efforts of
normalizing the EEG. We conducted a retrospective study by screening
medical records of all consecutive patients with BCECTSs, spike-wave
index (SWI) >30%, and ADHD/ADD that were evaluated in our pediatric
epilepsy
service and were followed up for at least two years. Patients with
neurocognitive deterioration detected by formal testing were excluded. A
total of 17 patients with mean age of 6.9years at BCECTS diagnosis were
identified. The patients' mean SWI was 60% and that dense electrical
activity lasted 1.5years on average (range: 1-4.5years).
Six children
were formally diagnosed with learning disabilities in addition to
ADD/ADHD. All of them were treated with an average of three
antiepileptic medications, mainly for the purpose of normalizing the
EEG, but none of them was treated with steroids or high-dose diazepam.
The mean duration of follow-up was 5.5years. A cognitive or behavioral
deterioration was not detected in any of them. Our data suggest that
when treating a child with BCECTSs, high SWI, and school difficulties,
the most critical parameter that determines the necessity of using
second-line antiepileptic agents such as steroids or high-dose diazepam
is a formal psychological evaluation that proves cognitive (I.Q.)
decline. Otherwise, these agents may be avoided.
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