Indication for anti-epileptic drug treatment of benign childhood epilepsy with centro-temporal spikes

Background and PurposeThis study is to assess the responsiveness of electroencephalography (EEG) abnormalities and their effects on language ability after initiating different types of antiepileptic therapy in children with newly diagnosed benign epilepsy of childhood with centrotemporal spikes (BECTS).MethodsThe records of patients newly diagnosed with BECTS (n=120; 69 males) were reviewed retrospectively. The patients were randomly treated with lamotrigine, oxcarbazepine, or topiramate monotherapy, and underwent at least two EEG and standardized language tests. Effects were compared using Pearson's chi-square tests and paired t-tests.ResultsThe recurrence rates for seizures in the lamotrigine, topiramate, and oxcarbazepine groups were 19.4%, 21.7%, and 11.4%, respectively, while complete or partial recovery (as indicated by EEG) occurred in 32%, 39%, and 16% of the patients. Patients in the lamotrigine group showed significant improvements in all parameters assessed by the Test of Language Problem Solving Abilities, except for ‘determining cause.’ Patients in the oxcarbazepine group also showed improvements, except for ‘making inferences’ (p<0.05). Most linguistic index scores were worse in the topiramate group except for Mean Length of Utterance in Words. Patients in the lamotrigine and oxcarbazepine groups showed significant improvements in the receptive language test (p<0.05). EEG improvements were not related to language ability.ConclusionsThe improvements in language and problem-solving performance in children with BECTS were greater for lamotrigine and oxcarbazepine than for topiramate. However, EEG remission did not imply that language function would be improved after the treatments.

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“…Language tests assessing important aspects of pragmatic ability were designed as reported previously. 16 …”

Section: Methodsmentioning

confidence: 99%

“… 7 8 9 10 11 12 13 In contrast, the arguments against treatment are that it may be unnecessary in most cases and potentially lead to worse outcomes than BECTS itself. 14 15 Hamada et al 16 maintained that patients with BECTS with isolated seizures at night do not require treatment.…”

Section: Introductionmentioning

confidence: 99%

Effects of Antiepileptic Drugs on Language Abilities in Benign Epilepsy of Childhood with Centrotemporal Spikes

Han

Kim

2018

J Clin Neurol

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“…The decision whether to treat children with RE or not requires a particularly careful risk-benefit analysis [2,[158][159][160][161][162][163]. Many authors suggest that drug treatment is not necessary for typical RE because of its good prognosis, and usually infrequent nocturnal seizures [114,154].…”

Section: Treatmentmentioning

confidence: 99%

“…Moreover, in 40-50% of cases, the seizures are difficult to control with drugs [148]. Besides, the treatment with AED usually does not influence the duration of active epilepsy [163].…”

Section: Treatmentmentioning

confidence: 99%

Rolandic Epilepsy: Self-Limited Epilepsy with Centrotemporal Spikes

Guliyeva¹,

Tatishvili²,

Kaiyrzhanov³

2021

Epilepsy - Update on Classification, Etiologies, Instrumental Diagnosis and Treatment

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Childhood epilepsy with centrotemporal spikes, had been previously considered as benign childhood epilepsy. According to the new classification proposed by Sheffer I. and colleagues the term “benign” has been changed to “self-limited”. Many studies reported that BECTS may cause transient or long lasting cognitive and behavioral disturbances. Rolandic epilepsy is the most frequent among the childhood focal epilepsy and may account for about 15–25% of all epileptic syndromes diagnosed between the ages of 5 to 15 years. The incidence range changes between 7.1–21 per 100000 in population younger than 15 years with male predominance. The age of onset in 90% of cases between 1 and 10 years with peak around 6–7 years. Seizures mainly occur during a night sleep, whereas the probability of awake seizures are less than 10%. The characteristic clinical features are: (1) focal motor seizure with unilateral orofacial tonic or clonic contractions; (2) speech arrest; (3) hypersalivation; (4) sensory symptoms represented by unilateral numbness or paresthesia of tongue, lips, gum and inner part of the check; (5) unilateral clonic jerk in leg and arm with postictal paresis; (6) generalized seizures. The EEG picture is distinctive in Rolandic epilepsy. The background activity is almost always preserved in awake state and during a sleep. The typical interictal EEG pattern is high voltage, diphasic spikes or sharp waves frequently with slow activity on central-midtemporal region. The centrotemporal spikes or rolandic spikes come from the lower rolandic region created a horizontal dipole with maximal electronegativity in the centrotemporal region and electropositivity in the frontal region usually seen unilateral or bilateral. In most cases children with RE have a good prognosis regarding both seizures and neurodevelopment. The remission of seizures usually occurs before the age of 18 years. The cognitive and behavior problem may happen in active period of disease which are reversable in most of patients.

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“…Moreover a small study suggests that it is effective and associated with a low incidence of neuropsychiatric events in very young children, but the body of evidence in the patient population is still limited [17]. Antiepileptic medication may be unnecessary in patients with isolated seizure during sleep, but can be necessary in patients with multiple seizures at onset; therefore, even when the epilepsy tends to follow a benign course, treatment decision requires clinical judgment and observations over time, especially with frequent seizures, seizures recurring during wakefulness or when ictal events are disruptive to the patient or family [12,28]. Our group already reported a preliminary study (first part of an open prospective analysis) on the efficacy, tolerability and safety of OXC in children with epilepsy [5].…”

Section: Introductionmentioning

confidence: 98%

Prospective study on long-term treatment with oxcarbazepine in pediatric epilepsy

et al. 2009

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Following a previous preliminary report on a group of children suffering from partial epilepsies, we present the final considerations on the same group in order to evaluate the long-term efficacy, tolerability and safety of oxcarbazepine (OXC). We enrolled 36 patients (mean age 8.5), between January 2003 and December 2004, with new diagnosis of partial epilepsy: 25 patients were affected by idiopathic partial epilepsy, eight by symptomatic epilepsy and three by cryptogenic epilepsy. Each patient was scheduled to attend the center four times after the initial examination: 3 months (T1), 12 months (T2), 24 (T3) months and 36 (T4) months after the beginning of OXC-monotherapy (T0). At the end of our study, 20 patients were seizure free (SF): nine stopped OXC because of SF for at least 2 years, 11 were still on therapy. One patient showed a reduction of seizure frequency >or=50%, three were non responders (but still on therapy), nine stopped OXC due to a non-responder condition during follow-up before T4 and one because of adverse effects. At the end of the study no EEG focal abnormalities became generalized because of treatment. Normalization of EEG was observed in ten patients. Our preliminary findings have been confirmed. OXC can be considered an effective and well tolerated first line drug for long-term monotherapy in children with epilepsy, both for idiopathic and symptomatic/cryptogenic forms.

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Indication for anti-epileptic drug treatment of benign childhood epilepsy with centro-temporal spikes

Cited by 15 publications

References 3 publications

Effects of Antiepileptic Drugs on Language Abilities in Benign Epilepsy of Childhood with Centrotemporal Spikes

Effects of Antiepileptic Drugs on Language Abilities in Benign Epilepsy of Childhood with Centrotemporal Spikes

Rolandic Epilepsy: Self-Limited Epilepsy with Centrotemporal Spikes

Prospective study on long-term treatment with oxcarbazepine in pediatric epilepsy

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