Fluctuating concepts of childhood absence epilepsy

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Childhood absence epilepsy (CAE) appears not to be benign. Generations of pediatric neurologists have considered this form of childhood epilepsy to be less severe, since intellectual function is usually not severely affected. Over the past year, however, this common childhood epilepsy has received increasing attention, with results suggesting a more complex picture. The complicated relationship of seizures and attentional impairment in CAE is just one example of the broader behavioral, cognitive, and linguistic difficulties in children with CAE. In this issue of Neurology ®, Bai et al.1 investigate functional network activity as a surrogate for executive functions. They demonstrate interictal abnormalities in resting state blood oxygenation level–dependent (BOLD) functional connectivity (fc-MRI) datasets from children with CAE, compared to typically developing children. Strikingly, the difference is one of increased connectivity between homotopic areas of lateral prefrontal cortex. They show, with concurrent EEG-fMRI in the most rigorous manner possible, that the often frequent absence seizures themselves did not overtly influence the finding of increased connectivity. A finding of increased resting state functional connectivity is relatively rare in the rapidly expanding literature describing resting state fc-MRI in neurologic disease. Most studies across neurologic disease describe decreased functional connectivity, which is …