Ictal EEG patterns in epilepsy with centro-temporal spikes

Abstract

Purpose: To describe the EEG pattern of seizures in patients with benign childhood epilepsy with centro-temporal spikes (BCECTS). Methods: The clinical and EEG data of 701 BCECTS patients with at least a 3 years follow-up were reviewed from 10 epilepsy centers. Results: Thirty-four seizures were recorded in 30 patients. Four different ictal EEG patterns (A-D) were identified. The most frequent (pattern A) was characterized by low voltage activity of fast rhythmic spikes, increasing in amplitude and decreasing in frequency, and occurred in 14 children. Pattern B (six patients) was constituted by a discharge of spikes intermixed with sharp waves increasing in frequency and amplitude. Pattern C (seven children) consisted of monomorphic theta which progressively formed a discharge increasing in amplitude and decreasing in frequency. Pattern D (5 children) was characterized by a initial focal depression of the electrical activity, followed by one of the three above described patterns. In 21 out of 28 children, the initial ictal pattern, altered from one pattern to another one. No clinical or EEG feature was predictive of a specific ictal pattern. Discussion: We failed to identify a unique ictal EEG pattern in our patients with BCECTS. The occurrence of per-ictal features, e.g., initial EEG depression or postictal slowing, is common and should not be interpreted with prejudice. Alteration of ictal EEG pattern from one to another is not in conflict with the diagnosis of BCECTS.

Ictal source imaging and electroclinical correlation in self-limited epilepsy with centrotemporal spikes

“…In addition, a study combining EEG source imaging and fMRI showed propagation of the interictal activity from the rolandic region corresponding to the hand and face area, to the operculum and insula [11] . It has been previously suggested that involvement of insula likely explains the sensations of laryngeal constriction and choking that is often reported by patients with self-limited epilepsy with centrotemporal spikes [3] .…”

“…The largest number of patients was reported by Capovilla and co-workers [3] . They retrospectively collected 30 patients with ictal recordings, and they identified four types of ictal patterns, the most common being the low-voltage fast activity.…”

Idiopathic focal epilepsies: the “lost tribe”

“…Rolandic epilepsy (RE) or benign childhood epilepsy with centro‐temporal spikes is the most common childhood focal epilepsy (Fejerman, ; Panayiotopoulos et al ., ), usually starting between 7 and 10 years. The cardinal features are focal seizures consisting of unilateral facial sensory‐motor symptoms, oropharyngo‐laryngeal symptoms, speech arrest, and hypersalivation (Capovilla et al ., ). Centro‐temporal spikes, typically activated by drowsiness and slow sleep, indicate that the epileptogenic zone in Rolandic epilepsy involves neuronal networks within the Rolandic cortex surrounding the central fissure bilaterally.…”

Rolandic Epilepsy: Self-Limited Epilepsy with Centrotemporal Spikes

“…In 1990, Gutierrez et al described an ictal event with speech arrest only characterized by a short train of ictal alpha activity, and then two multiple spikes and wave complexes originated from the left centrotemporal region followed by marked attenuation of the left hemispheric background [115]. Subclinical rhythmic discharges of spike and wave in the centrotemporal region have been documented by several authors in RE [116,117]. Saint-Martin et al in 2001 described a series of patients presenting with typical and also atypical ictal manifestations such as falls, negative myoclonus and observed that positive motor phenomenon correlated to the spike component preceding a negative motor phenomenon, correlated with the slow-wave component of the spike and wave complex [118].…”

“…Capovilla et al recorded 34 seizures in 30 patients with RE and described four electrographic seizure patterns thus emphasizing that ictal pattern for RE is not unique [116]:…”