Monday July 3, 2006 7:30-9:00 Hall 5B Teaching Session To treat or not to treat the EEG in paediatric epilepsy syndromes

Abstract

Abstract 1 R. Pressler ( 1 Department of Clinical Neurophysiology, National Hospital for Neurology, UK ) Treatment of interictal discharges can improve behaviour in children with epilepsy Increased behavioural problems in children with epilepsy are a consequence of various factors including underlying brain lesion, age of onset, antiepileptic drugs, psychosocial issues, seizure type and frequency, and interictal EEG abnormalities. Suppression of discharges will improve behaviour in children with nonconvulsive status epilepticus presenting as pseudo-dementia or more subtle behavioural changes, and in children with prolonged nocturnal discharges such as ESES. The effect of intermittent interictal EEG discharges on behaviour and cognition is still controversial. Whether cognitive and behavioural problems can be directly caused by discharges or are a coexisting phenomenon can be determining through improvement of cognition and behaviour, if EEG discharges are suppressed. In children with drug resistant epilepsy and learning difficulties suppression of discharges was associated with improvement in global rating of psychosocial function. In children showing interictal discharges but without epilepsy, suppression of discharges showed no definite effect. In children with well-controlled or mild epilepsy, improved behaviour was only observed in children who showed a reduction of discharges during active treatment, but not in patients without a change in discharge rate. The issue of ‘treating the EEG’ remains controversial. The question is not whether to treat the EEG, but whether seizures, so subtle as to be recognisable only by EEG and behavioural monitoring, produce disability sufficient to justify treatment.