Clinical and electroencephalogram characteristics and treatment outcomes in children with benign epilepsy and centrotemporal spikes

INTRODUCTION

Epilepsy is a syndrome characterized by transient, rigid, paroxysmal, and repetitive central nervous system dysfunction, generally caused by excessive neuron synchronization in the brain and self-limited abnormal discharge caused by various etiological factors. As a common disease among children, the incidence rate of epilepsy has shown an increasing trend in recent years. Benign epilepsy in children with centrotemporal spike waves is an age-dependent epileptic syndrome, which generally peaks between 6–8 years old, with normal mental and motor development[1,2]. At present, the primary goal of antiepileptic treatments is to completely control epileptic seizures, while simultaneously considering prevention, control, and improvement of cognitive and behavioral dysfunction is of great significance for improving the patients’ intellectual development and quality of life. Electroencephalogram (EEG) is an important external validator of normal brain structure and function and useful to detect some brain alterations. Cognitive function, an important aspect of brain function, is also based on brain morphology and/or function. Studies have shown that abnormal EEG can predict an accelerated decline in cognitive function[3,4]. In this study, the clinical and EEG characteristics of children with benign epilepsy and centrotemporal spikes were analyzed, and the children’s treatment and outcomes also discussed.

MATERIALS AND METHODS

RESULTS

DISCUSSION

Epilepsy is a brain disease mainly characterized by transient central nervous system dysfunction caused by abnormal neuron discharge. Repeated epileptic seizures are often accompanied by a variety of neurobiological, cognitive, psychological, and social dysfunctions. Benign epilepsy with spinous waves in the central temporal region is the most common partial epilepsy in childhood, with an onset age between 3-13 years and accounting for 15%-24% of all kinds of epilepsy in children[5]. Several studies have shown that children with epilepsy and centrotemporal spikes have various degrees of cognitive and behavioral damage[6,7], while other reports have found that the cognitive impairment in these children is not caused by seizures but related to frequent clinical discharge. Neuropsychological and sociological problems exist in half of these children after adulthood[8,9]. Although the primary goal of antiepileptic treatment is to completely control epileptic seizures, prevention, control, and improvement of cognitive and behavioral dysfunction must be simultaneously considered. Therefore, clinicians must achieve a balance between controlling the epileptic seizures as much as possible and preserving cognitive and behavioral functions[10]. Long-term outbreaks of spike-and-slow wave rhythm and bilateral asynchronous spike-and-slow wave distribution cause more severe cognitive impairment than single spike waves[11]. EEG monitoring, a common modern auxiliary examination method for the clinical diagnosis of mild cognitive impairment diseases, induces no physical trauma and has confirmed value in the diagnosis of brain diseases. However, comprehensive analyses, as well as other experimental and auxiliary examinations, need to be conducted based on specific symptoms and signs; therefore, it is of great clinical significance to explore chemical markers of brain damage[12]. EEG represents the waveforms formed by the brain spontaneous potential; these waveforms can be divided into α, β, γ, θ, and δ waves according to their frequencies, with different waveforms being shown at different ages, in various consciousness states, and at various brain function levels[13,14]. Some studies have shown that abnormal EEGs can predict an accelerated decline in cognitive function. In children with epilepsy, EEGs accompanied by spinous waves in the central temporal region during the attack stage are often characterized by tonic-clonic seizures, where the initial fast wave activity of low amplitude in the central or middle temporal region on one side gradually increases in amplitude and decreases in frequency, gradually evolving into the alternating appearance of spinous and slow waves, which can be generalized to the ipsilateral hemisphere or even spread to the contralateral one[15]. At present, EEGs are considered to be highly related to epilepsy with spinous waves in the central temporal region. And compared with those of healthy peers, an increase in extremely high-amplitude spinous and slow waves in the high Rolandic region can be observed in the awake period, along with a widespread rhythmic outbreak of 2-3 Hz high-amplitude spinous and slow waves in the awake period. However, the discharge is significantly increased in the sleep period, and the spinous and slow wave discharge index is > 50% during the non-rapid-eye-movement sleep period[16]. In epilepsy accompanied by centrotemporal spikes, the presence of a status epilepticus EEG during sleep is known to cause nerve damage and cognitive changes; the higher the abnormal discharge index in the EEG, the more severe the cognitive damage in children. Therefore, we should actively diagnose, treat, and observe the therapeutic effects in children with epilepsy accompanied by centrotemporal spikes[17,18]. In this study, correlation analysis revealed that the discharge index was negatively correlated with fine motor performance and the language development quotient. Logistic regression analysis showed that an early age of onset (< 5 years old) and seizure frequency were influencing factors for the unresponsive treatment of benign epilepsy with centrotemporal spikes in children, indicating that monitoring the EEG discharge index could be used to preliminarily determine the children’s fine motor skills and language development quotient. During treatment, great attention should be given to children with early-onset and frequent seizures in whom clinical treatment has a poor effect. Frequent attacks can lead to delayed reaction time or even reaction loss in children, suggesting that abnormal discharges may be accompanied by transient cognitive function changes under clinical conditions, which reminds us that seizure control should not be the target of clinical treatment but the inhibition of clinical discharge and subsequent improvement in patients’ cognitive function[19,20]. An early age of onset is an important factor leading to poor treatment effect in children with benign epilepsy and centrotemporal spikes. Given the lack of clear clinical data on the specific scope of early-onset benign epilepsy with centrotemporal spikes, an early age at onset can be used as a relevant factor to predict treatment prognosis in these children. In this study, early age of onset was < 5 years old.

The analysis of the results of this study showed that the two antiepileptic drugs levetiracetam and lamotrigine could effectively control epileptic seizures and inhibit epileptic discharge, thus improving children’s cognitive function. However, this study has various limitations. Due to the limited number of enrolled children, there may be some deviation and error in the evaluation of discharge index, which may lead to a lack of generalizability. Therefore, further research expanding the sample size and extending follow-up time is needed.

CONCLUSION

In summary, the EGG of children with benign epilepsy and centrotemporal spikes has characteristic changes, and therapeutic effects are affected by the age and attack frequency at the time of onset.

ARTICLE HIGHLIGHTS

Data sharing statement

No additional data are available.