Epileptiform Activity In Children Research Articles

Sleep patterns and epileptiform activity in children with severe cerebral palsy and Congenital Zika syndrome: insights and implications

Sleep patterns and epileptiform activity in children with severe cerebral palsy and Congenital Zika syndrome: insights and implications

Electroencephlographic predictors of epileptiphorm activity in children with lymphoid tumors under therapy

Objective. To identify electroencephalographic predictors of symptomatic seizure in children and adolescent with lymphoid tumors during chemotherapy.Material and methods. EEG results of a study in 20 children aged 7 to 15 years with lymphoid tumors during chemotherapy under the В-NHLBFM-90/95 и ALL IC-BFM 2002 program are presented. Depending on the presence of clinical manifestations, patients were divided into groups: 1st group (n = 10 without epileptiform signs), 2nd group (n = 10 with epileptiform signs).Results. In patients of group 1, who did not have clinical manifestations (seizures), the EEG recorded a signifiantly better, compared with patients of group 2, spectral dencity in band alpha rhythm and sensorimotor rhythm (p < 0.001) and signifiantly less delta activity and beta frequencies (p < 0.001). It was found that, despite the absence of epileptiform signs in the EEG, these patients had fewer EEG correlates of the ‘spike-wave’ complexes, and signifiantly less power levels of delta and beta-2 frequency bands (p < 0.001).Conclusions. The use of comparative EEG mapping made it possible to identify predictors of epileptiform activity in children and adolescents with lymphoid tumors during chemotherapy.

Association of epileptiform brain activity and specific language impairment (SLI) in preschool children

BackgroundEpileptiform activities can cause transient or permanent deficits that affect the children during development and may be accompanied by neurodevelopmental disorders like specific language impairment.ObjectivesThe objective of this study was to find if there is a possible association and the impact of epilepsy and epileptiform activity in children with specific language impairment.Patients and methodsThe study was conducted on 80 children suffering from specific language impairment and 80 age and sex match healthy control children. Computed tomography brain was performed and electroencephalography was recorded for children. Intelligence quotient level, cognitive age, social, and phoniatric assessment were done for all patients.ResultsEighty children with specific language impairment (51 males and 29 females) with a mean age of 4.11 ± 1.93. Patients with specific language impairment showed significantly higher rates of abnormal electroencephalography (P = 0.006) and epilepsy (P < 0.001) compared to the control group. Spearman correlation demonstrated a highly negative significant relationship linking the language, intelligence quotient with abnormal electroencephalography and epilepsy (r = − 0.91, P < 0.01 and r = − 0.91, P < 0.01 respectively). Also, there was a moderately inverse significant relationship linking the cognitive age, social with abnormal electroencephalography, and epilepsy (r = − 0.70, P < 0.05 and r = − 0.65, P < 0.05 respectively).ConclusionEpileptiform activities even without epilepsy in preschool children may alter normal language function. Specific language impairment was associated with lower intelligence quotient levels, social, and cognitive age.Trial registrationClinicalTrials.gov ID: NCT04141332

A knowledge-based approach for automatic quantification of epileptiform activity in children with electrical status epilepticus during sleep

Objective. Electrical status epilepticus during sleep (ESES), as electroencephalographic disturbances, is characterized by strong activation of epileptiform activity in the electroencephalogram during sleep. Quantitative descriptors of such epileptiform activity can support the diagnose and the prognosis of children with ESES. To quantify the epileptiform activity of ESES, a knowledge-based approach to mimic the clinical decision-making process is proposed. Approach. Firstly, a morphological operations-based scheme is designed to quickly locate the positive peaks/negative pits and roughly estimate the onset/offset of spike and slow-wave abnormalities. Then, to provide the accurate duration of ESES patterns, a set of rules for further adjusting these onsets/offsets are proposed by merging medical knowledge with a generalized threshold obtained from statistics. As such, the quantification is accomplished by evaluating the obtained spike and slow-wave abnormalities and their various durations. Main results. The effectiveness and feasibility of the proposed method were evaluated on a clinical dataset that collected at Children’s Hospital of Fudan University, Shanghai, China. We demonstrate that the proposed method can recognize different types of spike and slow-wave abnormalities. The sensitivity, precision, and false positive rate achieved 91.96%, 97.09%, and 1.88 min−1, respectively. The estimation error for the spike-wave index was 2.32%. Comparison results showed that our method outperforms the state-of-the-art. Significance. The quantification of spike and slow-waves provides information about ESES activity. The detection of variations types of spike and slow-waves improves the performance in the quantification of ESES. Experimental results suggest that the proposed method has great potential in automatic ESES quantification and can help improve the diagnosis and researches of epileptic encephalopathy with ESES.

Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment

In the field of psychiatry diagnoses are primarily based on the report of symptoms from either the patient, parents, or both, and a psychiatrist's observations. A psychiatric diagnosis is currently the most widely used basis for medication selection and the brain is seldom investigated directly as a source of those symptoms. This study addresses the request from the National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC) for scientific research into neurological abnormalities that can be linked to psychiatric symptoms for the purpose of predicting medication response. One such neurological abnormality that has been the focus of many studies over the last three decades is isolated epileptiform discharges (IEDs) in children and adolescents without seizures. We conducted a systematic review of the literature to determine prevalence rates of IEDs within diagnostic categories. We then compared the prevalence of IEDs in the selected literature to our IRB-approved data archive. Our study found a consistent high prevalence of IEDs specifically for ADHD (majority > 25%) and ASD (majority > 59%), and consistent low prevalence rates were found for Depression (3%). If children and adolescents have failed multiple medication attempts, and more than one-third of them have IEDs, then an EEG would be justified within the RDoC paradigm.

59. Electroencephalographic findings in children with behavioral disorders

Introduction In the latter years, an increase in the medical attention due to behavioral disorders in children has been observed, and anomalies in the electric cerebral activity of these patients has been described. Objective To describe the characteristics of the electroencephalographic activity in children with behavioral disorders. Material and methods A retrospective analysis of the EEGs was conducted, from September 2012 to March 2016, in children with behavioral disorder diagnosis. We excluded patients with attention deficit-hyperactivity disorder and/or associated neurologic disease. Results Twenty electroencephalograms were reviewed. Fifty-five percent presented abnormalities and 45% were normal. The most frequent finding was focal epileptiform abnormalities activated during sleep. The most common pattern was sharp waves (63%) and the most frequent location was the frontal lobe (55%). Conclusions The diagnosis of patients with behavioral disorders is essentially of clinic nature; nevertheless, almost half of patients may develop anomalies in brain electrical activity, mainly focal epileptiform discharges. This fact, suggests that EEG is a helpful ancillary test in the assessment of these patients. Significance The purpose of performing an EEG for the early diagnosis and treatment of focal epileptiform activity in children with behavioral disorders is discussed.

Incidence and Behavioral Correlates of Epileptiform Abnormalities in Autism Spectrum Disorders

Autism spectrum disorders (ASD) are associated with an increased incidence of epilepsy and of epileptiform discharges on electroencephalograms. It is unknown whether epileptiform discharges correlate with symptoms of ASD. We completed a retrospective chart review of 101 patients with ASD who had overnight electroencephalograms. We looked for a relationship between epileptiform abnormalities and diagnosis, history of regression, communication skills, and other features associated with ASD. There was a higher incidence of epileptiform activity in children with stereotypies and aggressive behavior. The incidence of epileptiform abnormalities was significantly lower in Asperger's compared with more severe forms of autism. Results suggest that increasing severity of autistic symptoms may be associated with higher likelihood of epileptiform abnormalities. Whether treatment alters outcome is unknown.

Subclinical epileptiform activity in children with electrical status epilepticus during sleep: Effects on cognition and behavior before and after treatment with levetiracetam

We performed a double-blind placebo-controlled crossover study of the effects of spike activity during sleep and when awake on learning, long-term memory, vigilance and behavior before and after treatment with levetiracetam in children with electrical status epilepticus during sleep.At baseline, verbal learning declined with increasing spike activity, but there were no relations between spike activity and memory, vigilance or behavior.Levetiracetam was effective in reducing sleep-related spike activity, but on a group level, this had no clear effects on behavior, vigilance or learning and memory.Our results do not allow firm conclusions whether to treat nocturnal epileptiform activity or not; larger samples and longer follow-up may be needed.

Benign rolandic epileptiform discharges are associated with mood and behavior problems

Children with benign rolandic epilepsy (BRE) experience elevated rates of cognitive, behavioral, and affective problems. Frequent epileptiform spike discharges may impair behavioral functioning. To elucidate this relationship, we evaluated associations between the EEG spike frequency index (SI) and parental ratings of psychosocial adjustment and executive functioning in school-aged children with EEGs typical of BRE. Twenty-one children (6–12years) participated. Parents completed validated questionnaires at a median of 5months (range: 1–8) after a routine outpatient EEG. The EEG SI was calculated for wakefulness and sleep. The strength of association between the SI and behavioral variables was evaluated by simple and multivariate correlation. Higher awake and sleep SIs were associated with more symptoms of depression (P<0.001), aggression and conduct problems (P<0.01). Higher sleep SI was associated with executive dysfunction and anxiety (P<0.05). Symptoms of hyperactivity and inattention had no correlation. Increased epileptiform activity in children with BRE may predict higher rates of mood and behavioral problems.

Attention-deficit hyperactivity disorder and nocturnal epileptiform activity in children with epilepsy admitted to a national epilepsy center

The aim of this study was to determine if there exists a relationship between attention-deficit hyperactivity disorder (ADHD) and the quantity of focal nocturnal epileptiform activity on the EEG (FNEA) measured as the percentage of epileptiform activity during non-REM sleep (spike index). This was accomplished with a prospective study of children aged 6–14years consecutively admitted to our center. Of 362 patients, 44 (12.2%) had previously been diagnosed with ADHD. Twenty-four-hour ambulatory EEG recording and assessment of ADHD according to DSM-IV were performed in 46 children suspected of having ADHD. ADHD was diagnosed in 30. We could not find any correlation between the spike index in 8 children with FNEA and the severity of their ADHD symptoms. This study is underpowered and should be considered a pilot study. There is a need for further investigation of a possible causal effect of FNEA on ADHD symptoms in larger cohorts of patients with FNEA.

Effects of dexmedetomidine sedation on the EEG in children

To examine the effects of dexmedetomidine sedation on EEG background and epileptiform activity in children, comparing it to natural sleep. To provide quantitative and qualitative descriptions of the effect of dexmedetomidine sedation on the EEG of children. Children with intractable epilepsy admitted for surgery undergo 5 days of continuous EEG monitoring as well as nuclear medicine imaging studies with dexmedetomidine for sedation. Continuous EEG monitoring of each child during both natural sleep and dexmedetomidine-induced sedation provides a unique opportunity to evaluate the effects of dexmedetomidine on the EEG of children. Sixteen children undergoing dexmedetomidine sedation for nuclear medicine studies and simultaneous continuous EEG monitoring were studied. EEG segments during sedation were compared to samples of naturally occurring stage II sleep from the same child. Standard visual EEG analysis, quantification of delta, theta, alpha, beta, and total RMS power, number and location of spike foci, and frequency of spike activity were compared. The EEG during dexmedetomidine sedation resembled stage II sleep. During sedation, statistically significant increases in power of 16% for theta (P = 0.01), 21% for alpha (P = 0.03), and 40% for beta (P < 0.01) were observed, but not for delta (P = 0.63) or total EEG power (P = 0.61). Spike frequency increased by 47% during sedation but no new spike foci or seizures were observed. Dexmedetomidine sedation elicited an EEG pattern similar to that of Stage II sleep with modest increases in theta, alpha, and beta activity. Dexmedetomidine does not hinder interpretation of the EEG, suggesting that it may be a uniquely useful agent for EEG sedation in children.

The Relationship Between Heart Rate Variability and Epileptiform Activity Among Children—A Controlled Study

Autonomic symptoms frequently occur during epileptic seizures. Attention has been mainly devoted to cardiovascular changes. We studied the relationship between heart rate variability (HRV) and epileptiform activity in children with epilepsy.Simultaneous electroencephalograms and electrocardiograms were recorded in 36 children diagnosed with epilepsy and in 36 children with unrelated conditions who served as a comparison group. Heart rate variability was evaluated by time-domain analysis, before, after, and during an epileptiform event, a benign abnormal event and baseline activity.An age-related change in the HRV associated with an epileptiform event was noted in the study group but not in the comparison group. No other significant differences in HRV were noted between the two groups or between true and benign abnormal events.Age seems to be a significant covariate in the analysis of HRV in children with epilepsy. Epileptiform activity is not associated with a significant change in HRV in children.

Magnetoencephalographic pattern of epileptiform activity in children with early-onset autism spectrum disorders

ObjectiveTo provide further data around magnetoencephalographic (MEG) findings in early-onset autism spectrum disorders (ASD). MethodsThirty-six children (mean age 7 years) diagnosed of PDD (DSM-IV, ICD-10) were studied. There were 22 children with autistic disorder, 9 with Asperger’s syndrome, and 5 with pervasive developmental disorder not otherwise specified (PDD-NOS). According to the Childhood Autism Rating Scale (CARS), the autistic disorder was mild to moderate in 11, and severe in 11. Neuroimaging studies using three-dimensional MRI as well as simultaneous MEG–EEG and fusion techniques through magnetic source imaging (MSI) were performed, with the aid of anesthesia in non-cooperative patients. ResultsMost patients had no EEG abnormalities. All ASD children showed common specific abnormalities in the shape of low amplitude monophasic and biphasic spikes (isolated or short bursts) as well as acute waves, predominantly distributed in the perisylvian areas. In Asperger’s syndrome, epileptiform spikes were mostly found in the right hemisphere. No lateralized epileptiform activity was observed in non-Asperger’s autistic patients. ConclusionsMEG epileptiform activity is frequently documented in children with early-onset ASD. SignificanceSubclinical epileptiform activity is present especially in the perisylvian regions for many patients with ASD.

Epileptiform activity in children with developmental dysphasia: quantification of discharges in overnight sleep video-EEG

We present results of analysis of overnight sleep video-EEG in 8 patients with developmental dysphasia and rolandic discharges. We evaluated the incidence of epileptiform discharges (expressed as paroxysmal activity density) at one or more electrodes in different sleep stages in three different periods of the night (after falling asleep, around midnight and before awakening). The difference of paroxysmal activity density was never higher than 21%, indicating that quantifying the discharges in the whole night recording is not necessary. We also showed that two independent foci may differ in the frequency of discharges. We propose a scheme for evaluation of EEG reflecting both frequency and distribution of discharges.

Effects of ketogenic diet on epileptiform activity in children with therapy resistant epilepsy

The purpose was to quantify changes of epileptiform activity during ketogenic diet (KD) treatment in children with therapy resistant epilepsy, and evaluate how these changes are related to activity stage and to clinical effects on seizure frequency, seizure severity, attentional behaviour, quality of life (QOL), and beta-hydroxybutyrate (betaOHb). Eighteen children were investigated with 24h ambulatory EEG monitoring 1 week prior to KD initiation and, after 3 months of KD treatment. Epileptiform activity was evaluated by automated spike detection. This data was compared with data presented in a previous study published in Epilepsia 2006, on sleep structure and different activity stages, clinical data on seizure frequency, seizure severity, QOL and attentional behaviour on the same children [Hallbook, T., Lundgren, J., Rosén, I., 2007. Ketogenic diet improves sleep quality in children with therapy resistant epilepsy. Epilepsia 48, 59-65]. After 3 months of KD treatment the number of interictal epileptiform discharges (IEDs) was significantly reduced (p<0.001). When considering the four activity stages separately, the reduction was significant during non-rapid eye movement sleep stage 2, slow wave sleep (SWS) and rapid eye movement (REM) sleep (p=0.001, 0.001, 0.002), and not significantly so during awake (p=0.07). Beta-hydroxybutyrate was significantly increased (p<0.001). There was a significant correlation between the reduction in IEDs and clinical seizures (Spearman r=0.6, p=0.005) and between improvement in attentional behaviour and the increase in betaOHb (Spearman r=0.5, p=0.03). There was no significant correlation between changes in attentional behaviour and IEDs or clinical seizures. This study shows that KD reduces the number of IEDs, especially during sleep. It shows a correlation between reduction in epileptiform activity and clinical seizures. There were no correlations between reduction in epileptiform activity and clinical seizures and improvement in QOL or attention. The increase in betaOHb correlated with improvement in attention.

Prevalence of epileptiform activity in healthy children during sleep

Background The term epileptiform discharge typically refers to interictal paroxysmal activity that occurs more commonly during sleep. This type of paroxysmal activity does not include the electroencephalographic (EEG) activity observed during a seizure. The prevalence of epileptiform activity in the general pediatric population is unknown. Methods Polysomnographic (PSG) studies were conducted in otherwise healthy children recruited from the general population and with no previous history of seizures or any other medical conditions. All sleep studies included an eight-lead EEG montage. Spike and sharp waves, either alone or accompanied by slow waves, occurring singly or in bursts lasting <5 s were considered as representing epileptiform activity. Results Nine hundred seventy children underwent overnight PSG. In 14 children, evidence of epileptiform activity, in the absence of any additional abnormality in the PSG, occurred. Thus, the prevalence of epileptiform activity was 1.45%. Epileptiform patterns found were either spike or spike and wave and were more prominent during non-rapid eye movement (NREM) sleep, with 11 patients presenting spike and spike and wave patterns in the centro-temporal regions. Four of the six children who underwent neurocognitive tests exhibited abnormal findings in areas of behavior, attention, hyperactivity, and learning. Conclusion Epileptiform activity in otherwise healthy children from the community is relatively frequent and, if confirmed by prospective studies, could be associated with suboptimal cognitive and behavioral functions. Increased awareness by sleep professionals and use of PSG montage that includes temporal leads and >2 standard EEG leads should facilitate the detection of epileptiform activity in children.

Attentional ability in children with epilepsy.

Attention problems are frequently seen in children with epilepsy. This review gives an overview of the most used constructs of attention and analyzes the available evidence for attention deficits in children with epilepsy, the effects of epilepsy variables on attention, and the possible pathophysiological mechanisms involved. Children with benign childhood epilepsy with centrotemporal spikes (BCECTS) have sustained attention difficulties. Right (R)-sided interictal epileptiform activity in these children interferes with R hemisphere function including sustained attention. Children with BCECTS also show selective and divided attention deficits if they have epileptiform discharges during sleep. Children with complex partial seizures (CPSs) have sustained attention deficits but no difficulties in selective or divided attention. Cognitive difficulties in children with epilepsy arise more frequently the earlier the onset of the epilepsy, and this could influence attentional ability development. Antiepileptic drug treatment is unlikely to impair attention, but phenobarbital has behavioral side effects similar to those in attention deficit-hyperactivity disorder. Concerning pathophysiology, evidence indicates that interictal epileptiform activity in children with BCECTS impairs sustained attention and that ongoing epileptiform discharges during sleep may impair attention. Further systematic studies of different aspects of attention in children with epilepsy are needed. Attention in children with drug-resistant epilepsy has not been addressed, and prospective studies before and after epilepsy surgery could be a useful model to study the influence of seizures on attentional ability.

Polysomnography in the Spectrum of Acquired Epileptiform Aphasia

ABSTRACT.Full night polysomnography (PSG) is proving to be useful in evaluating children with language and developmental disorders. PSG evaluation sometimes demonstrates epileptiform activity in children with loss of language who have had no seizures. PSG is also helpful in diagnosing syndromes within the autistic spectrum, a step critical to early intervention and specific treatment.

Do antiepileptic drugs differ in suppressing interictal epileptiform activity in children?

Antiepileptic drugs may suppress interictal epileptiform activity in addition to suppressing seizures, although the comparative rates of suppression of interictal epileptiform activity for phenobarbital (PHB), carbamazepine (CBZ), and valproate (VPA) in children are unknown. Electroencephalogram (EEG) pairs were identified in which the first tracing illustrated interictal epileptiform activity before antiepileptic drug treatment; the rate of clearance of such activity in the subsequent tracing was assessed according to the drug introduced. EEG pairs (n = 213) were identified for CBZ, PHB, and VPA. Overall suppression rates of epileptiform activity in the second EEG were 12/55 (22%) for PHB, 27/81 (33%) for CBZ, and 35/77 (46%) for VPA ( P = 0.005 for VPA vs PHB). When suppression rates were assessed comparing sleep-state pairs, suppression rates were 24/80 (30%) for PHB, 51/129 (40%) for CBZ, and 60/120 (50%) for VPA ( P = 0.005 for PHB vs VPA). A subanalysis for focal discharges yielded suppression rates of 10/43 (23%) for PHB, 19/60 (32%) for CBZ, and 8/19 (42%) for VPA; for generalized discharges, 2/12 (17%) for PHB, 8/21 (38%) for CBZ, and 27/58 (47%) for VPA. VPA, and to a lesser extent CBZ, appeared superior to PHB in suppressing interictal epileptiform activity, including both focal and generalized epileptiform activity.

Functional neuroimaging of autistic disorders.

Functional neuroimaging methods hold promise for elucidating the neurobiology of autistic disorders, yet they present difficult practical and scientific challenges when applied to these complex and heterogeneous syndromes. Single-state studies of brain metabolism and blood flow thus far have failed to yield consistent findings, but suggest considerable variability in regional patterns of cerebral synaptic activity. Patients with idiopathic autism are less likely to show abnormalities than are patients with comorbid illness or epilepsy. Activation studies have begun to suggest alterations in brain organization for language and cognition. Neurotransmitter studies using positron emission tomography (PET) suggest abnormalities of serotonergic and dopaminergic function. Studies using magnetic resonance spectroscopy (MRS) have begun to document metabolic deficits in the frontal cortex and cerebellum. A single study using magnetoencephalography suggests a high incidence of epileptiform activity in children with autistic regression. Research needs include well-controlled developmental studies, particularly of young subjects and relatively homogeneous subgroups, which balance scientific rigor with ethical constraints. Investigations of the serotonergic and dopaminergic systems, limbic-based memory and emotional systems, and the role of epileptiform activity in autism represent priorities for future research.