Treatment for the Benign Childhood Epilepsy With Centrotemporal Spikes: A Monocentric Study

Abstract

Background and Purpose: To date, there is no specific treatment guideline for the benign childhood epilepsy with centrotemporal spikes (BECTS). Several countries recommend levetiracetam, carbamazepine, sodium valproate, oxcarbazepine, and lamotrigine as first-line drugs. Nevertheless, some of these drugs are associated with cognitive decline. Available studies that investigated the efficacy of levetiracetam and sodium valproate on BECTS involved small sample sizes. This study aimed to evaluate the efficacy of levetiracetam and sodium valproate on cognition, and to investigate the prognostic factors for BECTS as whole.Methods: Clinical data and treatment status of all patients with BECTS at Xiangya Hospital, Central South University followed from 2008 to 2013 were analyzed retrospectively. Since electrical status epilepticus in sleep (ESES) has been confirmed to play a role in cognitive deterioration, in order to evaluate the response to drugs and their cognitive effects, we created two groups of patients according to the levels of spike wave index (SWI): group 1; 0–50% SWI and group 2; >50% SWI at the last follow up.Results: A total of 195 cases were enrolled: 49.7% received monotherapies, 24.1% duotherapies and 27.2% polytherapies. Medications included; levetiracetam plus other drug (s) (75.9%), levetiracetam alone (32.8%), sodium valproate plus other drug (s) (31.3%), and sodium valproate alone (5.1%). After 2 years of treatment and follow up, 71% of the cases had a good seizure outcome, 15.9% had an improvement of SWI, and 91.7% had a normal DQ/IQ. Sodium valproate combined with levetiracetam, and sodium valproate alone correlated with good improvement of SWI, whereas, focal spikes were linked with poor improvement. For both groups (group 1 and group 2): monotherapy, levetiracetam alone, and a normal DQ/IQ at seizure onset correlated with good cognitive outcomes, in contrast, polytherapy, sodium valproate plus other drug (s), levetiracetam plus sodium valproate, an initial SWI of ≥85%, and multifocal spikes were linked to cognitive deterioration.Conclusions: Monotherapy, particularly levetiracetam seems to be a good first-line therapy which can help in normalizing the electroencephalograph and preventing cognitive decline. Polytherapy, mostly the administration of sodium valproate seems to relate with poor cognition, therefore, it is recommended to avoid it.

A Review of the Prevalence, Etiology, Diagnosis, and Management of Pediatric Epilepsies in India

“…In a single-center, retrospective analysis of patients diagnosed with BECTS, the frequency of absence seizures was found to be 2.1%. 34 In extreme cases of atypical BECTS, there is manifestation of ESES which is an age-related epileptic encephalopathy. 35 Carbamazepine is frequently used as a first-line agent in the treatment of RE.…”

Altered Language-Related Effective Connectivity in Patients with Benign Childhood Epilepsy with Centrotemporal Spikes

“…The onset age ranges from 3 to 13 years, with a peak at 9 to 10 years old [ 2 ]. Although clinical episodes are infrequent, approximately 90% of BECTS and ABPE (atypical benign partial epilepsy of childhood, which can be evolved by BECTS) patients have atypical electrical status epilepticus in sleep (ESES) and almost 75% show spikes in the Rolandic region [ 3 ]. With advances in neuropsychology research, the “benign” concept in BECTS has been challenged because some patients may suffer from some degree of cognitive impairment, especially language dysfunction [ 4 , 5 ].…”

Resting-State EEG Functional Connectivity in Children with Rolandic Spikes with or without Clinical Seizures

“…Moreover, rolandic spikes are often found incidentally on electroencephalography (EEG) in children without clinical seizures and may impair intellectual capacity [2]. BECTS is considered Biomedicines 2022, 10, 1553 2 of 13 benign because of the absence of neurological deficits and self-limited; however, some children can present with neuropsychological impairment as well as cognitive and academic problems [2][3][4].…”

“…It is unclear whether the EEG connectivity differs in BECTS patients with or without clinical seizures, and the treatment of BECTS patients remains controversial due to the emerging issue of cognitive involvement [ 3 ]. In our research, we use four parameters to evaluate functional connectivity at different proportional thresholds.…”