title: Sleep-potentiated epileptiform activity in early thalamic injuries: Study in a large series (60 cases).
abstract: OBJECTIVE
  The study aims at a better definition of continuous spike-waves during sleep (CSWS) with an early thalamic lesion, focusing on various grades of sleep-potentiated epileptiform activity (SPEA). Their possible relationship with different clinical features was studied to try to define prognostic factors of the epileptic disorder, especially relating to behavior/cognitive outcome, in order to improve prevention and treatment strategies.
  
  
  METHODS
  Sixty patients with early thalamic injury were followed since the first registration of SPEA with serial neurological, long term EEG monitoring and neuropsychological examinations, as well as neuroimaging and a detailed clinical history. They were classified in three different groups according to the sleep spike-waves (SW) quantification: electrical status epilepticus during sleep (ESES), more than 85% of slow sleep; overactivation between 50% and 85% and simple activation between 10 and 50%). Results were then examined also with a statistical analysis.
  
  
  RESULTS
  In our series of CSWS occurring in early brain injured children with unilateral thalamic involvement there is a common neuropathologic origin but with various grades of SPEA severity. Statistical analysis showed that patients evolving toward ESES presented more commonly the involvement of the mediodorsal part of thalamus nuclei and a bilateral cortico-subcortical brain injury, epilepsy was more severe with a delayed onset; moreover, in the acute stage .ESES patients presented the worst behavior/cognitive performances. As to cognitive and behavior outcome, longer SPEA duration as well as bilateral brain injury and cognitive/behavior impairment in acute phase appear linked to a poor outcome; some particular neuropathology (ischemic stroke and haemorrhagic infarction) as well as hydrocephalus shunting are associated with behavior disorders.
  
  
  CONCLUSIONS
  Discrete features seem to support different underlying mechanisms in ESES patients in comparison with less severe SPEA; they represent negative prognostic factors. Longer SPEA duration as well as bilateral brain injury and cognitive/behavior impairment in acute phase seem predictive of a worse cognitive/behavior outcome.
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Emma
authors.initials: E
authors.lastname: Losito
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Battaglia
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Chieffo
authors.affiliation: Institute of Public Health, Catholic University, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Raponi
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Domiziana
authors.initials: D
authors.lastname: Ranalli
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Contaldo
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giansanti
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: De Clemente
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Quintiliani
authors.affiliation: Unit of Neuroradiology, Catholic University, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Antichi
authors.affiliation: Unit of Neuroradiology, Catholic University, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Verdolotti
authors.affiliation: Institute of Public Health, Catholic University, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: de Waure
authors.affiliation: Unit of Neuroradiology, Catholic University, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Tartaglione
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Mercuri
authors.affiliation: Child Neurology and Psychiatry, Catholic University, Rome, Italy. Electronic address: fguzzetta@rm.unicatt.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guzzetta
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D012890:Sleep / Q000187:drug effects / Q000502:physiology*; D013788:Thalamus / Q000187:drug effects / Q000293:injuries* / Q000503:physiopathology*
chemical_list: D000927:Anticonvulsants
keywords: CSWS; ESES; Epilepsy behavior/cognitive outcome; Thalamic lesions