EEG criteria predictive of complicated evolution in idiopathic rolandic epilepsy.
BACKGROUND
Although so-called "benign" epilepsy with centrotemporal spikes (BECTS) always has an excellent prognosis with regard to seizure remission, behavioral problems and cognitive dysfunctions may sometimes develop in its course. To search for clinical or EEG markers allowing early detection of patients prone to such complications, the authors conducted a prospective study in a cohort of unselected patients with BECTS.


METHODS
In 35 children with BECTS, academic, familial, neurologic, neuropsychological, and wake and sleep EEG evaluations were repeated every 6 to 12 months from the beginning of the seizure disorder up to complete recovery.


RESULTS
In 25 of 35 patients (72%), behavioral and intellectual functioning remained unimpaired. In 10 of 35 patients (28%), educational performance and familial maladjustment occurred. These sociofamilial problems were correlated with impulsivity, learning difficulties, attention disorders, and minor (7/35 cases, 20%) or serious (3/35 cases, 8%) auditory-verbal or visual-spatial deficits. Worsening phases started 2 to 36 months after onset and persisted for 9 to 39 months. Occurrence of atypical evolutions was significantly correlated with five qualitative and one quantitative interictal EEG pattern: intermittent slow-wave focus, multiple asynchronous spike-wave foci, long spike-wave clusters, generalized 3-c/s "absence-like" spike-wave discharges, conjunction of interictal paroxysms with negative or positive myoclonia, and abundance of interictal abnormalities during wakefulness and sleep. Clinical deterioration was not linked with seizure characteristics or treatment.


CONCLUSIONS
Different combinations of at least three of six distinctive interictal EEG patterns and their long-lasting (> or =6-month) persistence seem to be the hallmarks of patients with BECTS at risk for neuropsychological impairments.
Massa
R
R
Unité d'Exploration Fonctionnelle des Epilepsies and INSERM U.398, Hôpitaux Universitaires de Strasbourg, France. rita-massa@lycos.com
de Saint-Martin
A
A
Carcangiu
R
R
Rudolf
G
G
Seegmuller
C
C
Kleitz
C
C
Metz-Lutz
M N
MN
Hirsch
E
E
Marescaux
C
C
D000293:Adolescent; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000503:physiopathology; D001931:Brain Mapping; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000503:physiopathology; D002675:Child, Preschool; D018450:Disease Progression; D004569:Electroencephalography; D019305:Epilepsy, Rolandic / Q000175:diagnosis* / Q000503:physiopathology; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D009483:Neuropsychological Tests; D011379:Prognosis; D012307:Risk Factors; D012931:Social Environment; D013702:Temporal Lobe / Q000503:physiopathology