Abstract
Objectives: To evaluate the spatial distribution of the epileptiform activity in electrical status epilepticus in sleep (ESES) and to correlate data from electroencephalograms (EEGs) with clinical and neuroimaging variables.
 Methods: From 2008 to 2015, 162 reports (1.01%) out of 16,000 EEGs, from 23 patients, showed ESES. We selected one representative EEG per patient. Clinical data was collected retrospectively. Neuroimaging examinations were reviewed. The EEGs were classified as generalized ESES (ESESg) and focal ESES (ESESf) according to the distribution of epileptiform discharges.
 Results: From the 23 patients, 5 were classified as ESESg and 18 as ESESf. In ESESf, there was a prevalence of focal epileptic discharges in the centrotemporal regions. Abnormal neuroimaging occurred in 100% of the patients with ESESg and in 38.9% of the patients with ESESf (p=0.037). Other clinical data did not show significant differences between the groups. All patients with ESESg had structural etiology, while only 39% of patients with ESESf had structural etiology and the remaining 61% potentially genetic epilepsies of the rolandic spectrum.
 Conclusion: ESESg occurred predominantly in patients with structural lesions, while most patients with ESESf had normal neuroimaging scans and electrical dysfunction mainly in the rolandic region.
 Significance: ESESg seems to occur mostly in structural epilepsies. Distinctly, ESESf occurs in epileptic syndromes within the functional spectrum of rolandic epilepsy.
Highlights
Since 1971, when Patry, Lyagoubi, and Tassinari first described six children with almost continuous epileptiform discharges during sleep, this electroencephalographic pattern has gained the interest of those studying childhood epilepsy [1]
To evaluate the spatial distribution of the epileptiform activity in electrical status epilepticus in sleep (ESES) and to correlate data from electroencephalograms (EEGs) with clinical and neuroimaging variables
The ESES may occur in several conditions: structural epilepsies related to different etiologies, Landau-Kleffner syndrome, opercular syndrome caused by polymicrogyria, atypical evolution of benign childhood epilepsies, and continuous spike and wave during slow sleep (CSWS) [3]
Summary
Since 1971, when Patry, Lyagoubi, and Tassinari first described six children with almost continuous epileptiform discharges during sleep, this electroencephalographic pattern has gained the interest of those studying childhood epilepsy [1]. The nomenclature is not uniform in the literature, but, in the present study, we use the term electrical status epilepticus in sleep (ESES) to describe this type of abnormality in the electroencephalogram (EEG) [2, 3]. The ESES is usually described as a generalized [1, 2] or secondary bilateral synchronized pattern [3, 5] and little is reported about eventual focal characteristics of the continuous discharges in sleep [6, 7]. The presence of structural brain abnormalities may be found in up to 70% of ESES patients [9, 10]
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