Children with ESES: variability in the syndrome.
OBJECTIVE
We undertook a retrospective study of children who present with significant activation of paroxysmal discharges during sleep to examine the clinical spectrum of disorders that present with such an EEG abnormality.


BACKGROUND
Electrical status epilepticus in sleep (ESES) is an electrographic pattern characterized by nearly continuous spike-wave discharges in slow wave sleep, usually with a frequency of 1.5-3 Hz and usually diffuse and bilateral in distribution. A variety of neurocognitive and behavioral problems have been associated with this EEG pattern.


METHODS
We conducted a retrospective review of 1497 EEG records of patients admitted to University of California, Los Angeles (UCLA) for overnight video-EEG monitoring during a 5 year interval. Demographic, clinical and electroencephalographic variables were evaluated.


RESULTS
EEG records for 102 patients meeting criteria were identified. Clinical information was available for 90 of those patients. Eighteen of these patients could be diagnosed with Landau-Kleffner syndrome (LKS). Key findings include: (1) neuroimaging abnormalities were uncommon in our LKS patients; (2) among children who do not fit the specific diagnostic criteria for LKS, a spike-wave index (SWI) >50% was more likely to be associated with global developmental disturbances than SWI < or =50% (p<0.05); (3) Children with generalized discharges were more likely to experience severe or global developmental disturbance than those with focal abnormalities, without reaching statistical significance (p=0.07).


CONCLUSIONS
Severity of ESES can vary over time between and within patients and clinical status does not always directly correlate with SWI. However, the prognosis of LKS is substantially better than CSWS and these two disorders could be classified in a dichotomous manner rather than be seen as two points along a continuum.
Van Hirtum-Das
Michele
M
Department of Pediatrics and Neurology, David Geffen School of Medicine at UCLA, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
Licht
Eliot A
EA
Koh
Susan
S
Wu
Joyce Y
JY
Shields
W Donald
WD
Sankar
Raman
R
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D018887:Landau-Kleffner Syndrome / Q000150:complications / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000145:classification*; D012890:Sleep / Q000502:physiology*; D013226:Status Epilepticus / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D013577:Syndrome; D016896:Treatment Outcome; D014741:Video Recording
D000927:Anticonvulsants