Abstract
Our aim is to use neurophysiological sleep-related consolidation (SRC) phenomena to identify putative pathophysiological mechanisms in CECTS linked to diffuse neurocognitive deficits. We argue that there are numerous studies on the association between seizure aspects and neurocognitive functioning but not as many on interictal variables and neurocognitive deficits. We suggest two additional foci. First, the interictal presentation in CECTS and second, neuronal oscillations involved in SRC processes. Existing data on mechanisms through which interictal epileptiform spikes (IES) impact upon SRC indicate that they have the potential to: (a) perturb cross-regional coupling of neuronal oscillations, (b) mimic consolidation processes, (c) alter the precision of the spatiotemporal coupling of oscillations, and (d) variably impact upon SRC performance. Sleep spindles merit systematic study in CECTS in order to clarify: (a) the state of the slow oscillations (SOs) with which they coordinate, (b) the precision of slow oscillation-spindle coupling, and (c) whether their developmental trajectories differ from those of healthy children. We subsequently review studies on the associations between IES load during NREM sleep and SRC performance in childhood epilepsy. We then use sleep consolidation neurophysiological processes and their interplay with IES to help clarify the diffuse neurocognitive deficits that have been empirically documented in CECTS. We claim that studying SRC in CECTS will help to clarify pathophysiological mechanisms toward diverse neurocognitive deficits. Future developments could include close links between the fields of epilepsy and sleep, as well as new therapeutic neurostimulation targets. At the clinical level, children diagnosed with CECTS could benefit from close monitoring with respect to epilepsy, sleep and neurocognitive functions.
Highlights
Childhood Epilepsy With Centrotemporal SpikesChildhood epilepsy with centrotemporal spikes (CECTS) belongs to a common group of idiopathic focal childhood epilepsies (IFEs), often of genetic origin (Panjwani et al, 2016; Strug and Pal, 2017)
Info on IEDs: IEDs included sharp waves, spikes, spike and slow wave complexes, and polyspike- and slow wave complexes; The count was recorded as the number of IEDs per minute, calculated by dividing the total number of IEDs by the duration of sleep time over which they were counted
V and NV performance negatively correlated with IEDs rate; a longer history of epilepsy associated with greater contribution of sleep to V performance
Summary
Childhood epilepsy with centrotemporal spikes (CECTS) belongs to a common group of idiopathic focal childhood epilepsies (IFEs), often of genetic origin (Panjwani et al, 2016; Strug and Pal, 2017). It is conceptualized as an agerelated neurodevelopmental dysfunction of a self-remitting nature (Miano and Datta, 2019). CECTS was thought to be free of structural abnormalities and this is still reflected in some of the diagnostic practices (Pavlou et al, 2012). Evidence of subtle functional and structural abnormalities in CECTS has been mounting (Pardoe et al, 2013; Dryzałowski et al, 2018). The incidence of the disorder is between 10 and 20: 100,000 in children between the ages of 3 and 15 (Parakh and Katewa, 2015; Smith et al, 2016) and its prevalence is approximately 15% in children with epilepsy between 1 and 15 years of age (Parakh and Katewa, 2015)
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