title: Benign childhood epilepsy with Centro-Temporal spikes (BCECTSs), electrical status epilepticus in sleep (ESES), and academic decline--how aggressive should we be?
abstract: Since many of the children with BCECTSs display electrical status epilepticus during sleep and many present with different comorbidities, mainly ADHD and behavioral disturbances, clinicians are often confronted with the dilemma of how aggressive they should be with their efforts of normalizing the EEG. We conducted a retrospective study by screening medical records of all consecutive patients with BCECTSs, spike-wave index (SWI) >30%, and ADHD/ADD that were evaluated in our pediatric epilepsy service and were followed up for at least two years. Patients with neurocognitive deterioration detected by formal testing were excluded. A total of 17 patients with mean age of 6.9years at BCECTS diagnosis were identified. The patients' mean SWI was 60% and that dense electrical activity lasted 1.5years on average (range: 1-4.5years). Six children were formally diagnosed with learning disabilities in addition to ADD/ADHD. All of them were treated with an average of three antiepileptic medications, mainly for the purpose of normalizing the EEG, but none of them was treated with steroids or high-dose diazepam. The mean duration of follow-up was 5.5years. A cognitive or behavioral deterioration was not detected in any of them. Our data suggest that when treating a child with BCECTSs, high SWI, and school difficulties, the most critical parameter that determines the necessity of using second-line antiepileptic agents such as steroids or high-dose diazepam is a formal psychological evaluation that proves cognitive (I.Q.) decline. Otherwise, these agents may be avoided.
authors: Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel.
authors: Shimrit
authors: S
authors: Uliel-Sibony
authors: Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel. Electronic address: urikramer100@gmail.com.
authors: Uri
authors: U
authors: Kramer
mesh_terms: D000124:Achievement; D000293:Adolescent; D000374:Aggression; D000927:Anticonvulsants / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000523:psychology; D002648:Child; D015897:Comorbidity; D004569:Electroencephalography; D019305:Epilepsy, Rolandic / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000453:epidemiology / Q000523:psychology; D008297:Male; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000209:etiology*; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants
keywords: Academic decline; BCECTS; ESES; Treatment