The Epileptiform Significance of Intermittent Rhythmic Delta Activity in Childhood

Riviello, James J.; Foley, Catherine M.

doi:10.1177/088307389200700204

Cited by 30 publications

(24 citation statements)

References 14 publications

(2 reference statements)

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“…Epileptiform activity, either focal or generalized, was also detected in 11 cases. 19 Hence, it cannot be assumed from their findings that frontal intermittent rhythmic delta activity is epileptiform in nature. The frontal intermittent rhythmic delta activity discharge occurred independently from the epileptiform discharges in 7 of these 11 cases.…”

Section: Discussionmentioning

confidence: 95%

Clinical Correlates of Frontal Intermittent Rhythmic Delta Activity in Children

et al. 2003

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Frontal intermittent rhythmic delta activity is an electrographic pattern of unclear origin. Previously thought to correlate with deep midline and infratentorial pathology, rather, it appears to be associated with encephalopathy states in adults. The significance of frontal intermittent rhythmic delta activity in children has not been studied. We analyzed the electrographic characteristics and clinical associations of pediatric frontal intermittent rhythmic delta activity. This pattern was rarely detected, occurring in 20 of 1500 electroencephalographic (EEG) studies. Patients' ages ranged between 1.5 and 17 years. Most patients were awake and showed no signs of acute encephalopathy when frontal intermittent rhythmic delta activity occurred. Half of the children were cognitively impaired, and half had a history of epilepsy. Epileptiform activity was present in 55% of the EEG recordings. However, frontal intermittent rhythmic delta activity was part of the epileptiform discharge in only a minority of cases. The duration of frontal intermittent rhythmic delta activity bursts was longer in the mentally retarded group. Most patients did not have structural brain pathology. None had deep midline or infratentorial lesions. In conclusion, frontal intermittent rhythmic delta activity is rare in children, is not associated with acute encephalopathy or with deep midline or infratentorial lesions, and tends to occur during wakefulness. The electrographic characteristics of frontal intermittent rhythmic delta activity appear to differ between cognitively normal and mentally retarded children. ( J Child Neurol 2003;18:525—529).

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Section: Discussionmentioning

confidence: 95%

Clinical Correlates of Frontal Intermittent Rhythmic Delta Activity in Children

et al. 2003

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“…(2006) reported posterior bilateral delta activity in 32% of CAE subjects of which in 40% there was a notched appearance. In a series of 54 children with OIRDA in the EEG, epilepsy was diagnosed in 81%, of which 83% had generalized epilepsy, although syndromic classification was not provided (Riviello & Foley, 1992). OIRDA is not specific to CAE.…”

Section: Interictal Eeg In Childhood Absence Epilepsy (Cae)mentioning

confidence: 99%

The electroencephalogram of idiopathic generalized epilepsy

2011

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SUMMARYIdiopathic generalized epilepsy (IGE) is classified into several subsyndromes based on clinical and electroencephalography (EEG) features. The EEG signature of IGE is bisynchronous, symmetric, and generalized spikewave complex; although focal, irregular, and so called ''fragments'' of discharges are not uncommon. Other characteristic EEG features include polyspikes, polyspike-wave discharges, occipital intermittent rhythmic delta activity, and photoparoxysmal response. Both human and animal data suggest involvement of the thalamus and the cortex in the generation of spike-wave discharges in IGE. Circadian variations of generalized epileptiform discharges are well described, and these can be useful in diagnostic confirmation. Those discharges tend to occur more often after awakening and during cyclic alternating pattern phase-A of nonrapid eye movement sleep. Activation procedures such as hyperventilation, intermittent photic stimulation, eye closure, and fixation-off are useful techniques to increase the yield of both interictal and ictal EEG abnormalities. Although not in routine use, specific triggers such as pattern stimulation and cognitive tasks may also be of value in eliciting rare reflex seizure-related EEG abnormalities. Variations of EEG abnormalities are evident between different electroclinical syndromes. EEG is also affected by certain external as well as internal factors, which should be borne in mind when interpreting EEG studies in IGE.

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“…This patient's seizures were included because of the stereotypy of the spells and their remarkable similarity to those of the other patients in this cohort. In addition, it is well known that intermittent rhythmic delta activity (IRDA) is frequently observed in generalized epilepsy (8).…”

Section: Seizure Characteristicsmentioning

confidence: 99%

Tonic–Absence Seizures: An Underrecognized Seizure Type

Shih

Hirsch

2003

Epilepsia

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Summary: Purpose:The individual electroclinical patternstonic seizures with generalized paroxysmal fast activity (GPFA, activity >13 Hz), and absence seizures with generalized slow spike-and-wave activity (GSS&W, <3 Hz)-have been extensively described in the literature. However, only passing reference was made to the pattern of GPFA followed by GSS&W. In addition, these descriptions were formulated in the pre-EMU (Epilepsy Monitoring Unit) era, without benefit of video/clinical correlation. We now characterize this underrecognized seizure type.Methods: We retrospectively reviewed the data from eight patients with seizures that demonstrated this stereotyped EEG and clinical pattern.Results: We identified eight patients (six female patients; age 6-29 years; age at seizure onset, neonate to 10 years) who were evaluated at the Columbia University Epilepsy Monitoring Units between 1993 and 2002. All eight had an International League Against Epilepsy (ILAE) diagnosis of symptomatic generalized epilepsy, with six of eight manifesting multiple seizure types, six of eight with mild static encephalopathy, and two with normal cognition. A total of 29 seizures of this pattern was recorded; 26 of 29 seizures demonstrated GPFA (frequency between 14 and 30 Hz, lasting 2-8 s) followed by GSS&W (frequency range between 1 and 2 Hz, lasting 3-50 s). The predominant clinical correlate was bilateral tonic activity followed by a period of inattentiveness. In general, these seizures were differentiated from the patient's typical tonic seizures by this protracted period of impaired attentiveness.Conclusions: We describe a heretofore underrecognized and poorly characterized seizure type in patients with symptomatic generalized epilepsy, which we have termed tonic-absence seizures. Clinically and electrographically, this consists of a tonic seizure with GPFA followed by an absence seizure with GSS&W. Key Words: Tonic seizures-Absence seizuresVideo-EEG monitoring-Generalized epilepsy-Slow spikeand-wave-Tonic-absence.Generalized paroxysmal fast activity (GPFA, >13 Hz) and its clinical manifestations (typically a brief tonic seizure) have been extensively described in the literature (1-3). Considerable literature also focused on the electroencephalographic and clinical features of generalized slow spike-and-wave (GSS&W, <3 Hz) complexes (atypical absence seizures) (4-6). A distinct electroclinical pattern of GPFA immediately followed by GSS&W, however, has not been well described. Only passing references to this phenomenon have been made (2,7), and these observations were made in the pre-video-EEG monitoring era.We selected patients who were monitored by continuous video-EEG and who demonstrated the EEG and clinical pattern of GPFA with tonic posturing immediately preceded or followed by GSS&W with a clinical absence seizure. We then reviewed the video-EEG and clinical characteristics of this patient population. METHODSEleven patients had EEG recordings that demonstrated at least one example of a sustained period of GPFA that was either pre...

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The Epileptiform Significance of Intermittent Rhythmic Delta Activity in Childhood

Cited by 30 publications

References 14 publications

Clinical Correlates of Frontal Intermittent Rhythmic Delta Activity in Children

Clinical Correlates of Frontal Intermittent Rhythmic Delta Activity in Children

The electroencephalogram of idiopathic generalized epilepsy

Tonic–Absence Seizures: An Underrecognized Seizure Type

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