伴中央-颞区棘波的良性癫痫患儿认知功能分析

目的 探讨BECCT患儿的认知功能状况。方法 对20例BECCT患儿及20例正常儿童进行事件相关电位P3测定及神经心理测验，比较两组间各认知功能指标的差异。结果BECCT患儿较正常儿VIQ低(P＜0．05)。P3潜伏期延长(P＜0．01)。结论 BECCT患儿存在认知功能障碍，主要为大脑对外界信息的反应速度及综合能力受影响。     

儿童良性癫痫伴中央颞区棘波的研究进展

儿童良性癫痫伴中央颞区棘波(Benign childhood epilepsy with centrotemporal spikes,BECTS)是一种儿童时期发病的癫痫综合征,属于特发性局灶性癫痫,在所有儿童癫痫中约占8％～23％.其临床特征为局灶性发作,发作间期脑电图显示特征性的中央颞区棘波.目前关于儿童良性癫痫伴...     

儿童良性癫痫伴中央颞区棘波患者发作期脑电图特点分析

目的了解儿童良性癫痫伴中央颞区棘波(benign epilepsy with centrotemporal spikes in children,BECT)的发作期脑电图。方法利用5a时间收集605例BECT患者的临床和脑电图资料。结果 30例患者出现30次癫痫发作。这些患者发作期EEG被分为4种发作期图形。最多的一种类型为A型,12例出现,低电压快节律棘波,波幅逐渐增高节律逐渐变慢。B型,7例次,棘波混合尖波频率和波幅逐渐增高。C型,6例次,θ波波幅逐渐增高和频率逐渐减慢。D型,5例次,局部电活动减弱,继之为前3型。结论虽发作间期BECT脑电图相似,均呈中央颞区放电,BECT发作期图形不是唯一不变的;发作前脑电图电抑制和发作后慢波比较常见,不影响BECT的诊断;发作前图形、发作中脑电图可以相互转化,不影响BECT的诊断。     

儿童良性癫痫伴中央颞区棘波药物治疗的研究进展

儿童良性癫痫伴中央颞区棘波(Benign childhood epilepsy with centrotemporal spikes,BECT)是最常见的儿童局灶性癫痫综合征,可导致患儿神经心理功能的广泛受损.然而,BECT的治疗一直存在颇多争议,抗癫痫药物的使用时机缺乏统一结论,药物治疗的具体风险和收益尚未明了.本文...     

具有中央颞区棘波的小儿良性癫痫

小儿良性局灶性癫痫指的是临床具有局灶性发作的表现 ,发生在某一特定的年龄阶段 ,脑电图有特征性表现 ,抗癫痫药物治疗反应良好 ,预后较好的一组癫痫综合征。小儿良性局灶性癫痫的发病机制一般认为与遗传因素密切相关 ,目前已确定了几种类型癫痫基因突变的部位及突变形式。由于基因调控异常 ,使离子通道转运、神经递质或其受体功能障碍 ,导致正处于发育阶段的大脑神经元之间兴奋与抑制环路平衡紊乱 ,局部神经元的兴奋性异常增高 ,因此出现癫痫发作。小儿大脑具有较强的可塑性 ,随年龄的增长与神经介质及其受体的发育 ,大脑内部逐渐进行神经…     

儿童良性癫痫伴中央颞区棘波共患注意缺陷多动障碍的临床特征及认知损害分析

目的 探讨儿童良性癫痫伴中央颞区棘波(BECT)共患注意缺陷多动障碍(ADHD)的临床特征及认知损害情况。方法 选取2017年1月至2022年3月江苏中国人民解放军联勤保障部队第九〇四医院收治的BECT患儿98例,根据是否共患ADHD分为BECT+ADHD组和单纯BECT组(BECT组),同期健康体检患儿40例(对照组)。对比三组的临床特征、韦氏儿童智力量表(WISC-Ⅳ)、视听整合连续测试(IVA-CPT)结果。结果 98例BECT患儿中23例共患ADHD(23.47%),且以注意缺陷为主(65.22%),性别、起病年龄、病程、多种抗癫痫药物联用与共患ADHD相关。BECT+ADHD组和BECT组的事件相关电位P300潜伏期较对照组延长,P300波幅较对照组降低,WISC-Ⅳ评分和IVA-CPT均低于对照组(P<0.05)。与BECT组比较,BECT+ADHD组的P300潜伏期延长,P300波幅、WISC-Ⅳ评分和IVA-CPT均明显降低(P<0.05)。结论 BECT共患ADHD与单纯BECT比较,认知损害程度进一步加重。     

伴中央颞区棘波的儿童良性癫痫典型及非典型病例探讨

目的 探讨ＢＥＣＣＴ典型与非典型特征,以提高对该病的认识。方法 分别５６例ＢＥＣＣＴ临床发作形式、ＥＥＧ表现、影像学及治疗资料。结果 ５６例中典型者２３例（４１．０７％）;不典型病例３３例（５８．９３％）,其中临床发作形式不典型１６例（２８．５７％）,ＥＥＧ不典型２５例（４４．６４％）。头ＣＴ及ＭＲＩ检查正常４６例,轻度异常１０例。卡马西平及丙戊酸对治疗典型和非典型的ＢＥＣＣＴ均有效,以卡马西平为优。结论 ＢＥＣＣＴ的诊断应建立在对发病年龄、发作时间及形式、发作间期ＥＥＧ综合分析基础上,可以有不典型的发作。曾接受ＡＥＤｓ治疗者ＥＥＧ可能不典型。     

伴中央-颞区棘波的儿童良性癫痫患儿临床下痫样放电对认知功能的影响

目的　探讨BECCT患儿临床下放电对认知功能的影响。方法　在录像脑电图监测下,对20例BECCT患儿静脉注射氯硝西泮(0.03~ 0.05 mg/kg)抑制临床下放电后,进行 ERP测定及神经心理学测验,并与用药前所测各项认知功能指标进行比较。结果　BECCT患儿临床下放电被抑制后,FSIQ升高(P <0.05),短时视觉记忆增强(P <0.01),而PIQ、VIQ及P3潜伏期用药前后均无显著性差异。结论　临床下放电可能是引起 BECCT患儿认知功能损害的重要原因之一,有效抑制临床下放电,可能会改善患者认知功能。     

儿童失神癫痫与伴中央颞区棘波的儿童良性癫痫共存现象的脑电图与临床特征分析并文献复习

伴中央颞区棘波的儿童良性癫痫(BECT)又称儿童良性Rolandic癫痫,属儿童常见的年龄依赖的自限性疾病,3～13岁起病,青春期前后恢复正常,临床表现为入睡后不久口咽喉部和半侧上肢感觉运动性癫痫发作,脑电图为Rolandic区负相或双相尖波放电.然而,儿童失神癫痫(CAE)属特发性全面性癫痫综合征,学龄期女孩多见,以...     

EEG characteristics related to educational impairments in children with benign childhood epilepsy with centrotemporal spikes

PURPOSE: Learning and behavioral difficulties often occur in benign childhood epilepsy with centrotemporal spikes (BCECTS). In recent years, several electroencephalogram (EEG) characteristics have been related to the occurrence of learning and behavioral problems. METHODS: From 28 children medical, school and psychological reports were present and children were rated according to a 4-point scale for educational and behavioral impairment (Part 1). Thirty 24-h EEG recordings were reanalyzed for spike frequency, the presence of atypical EEG criteria, and the presence of a nondipole spike. EEGs were scored during wakefulness, first hour of sleep and whole night sleep (minus the first hour of sleep) separately (Part 2). RESULTS: The presence of I: an intermittent slow-wave focus during wakefulness, II: a high number of spikes in the first hour of sleep (and during whole night sleep), and III: multiple asynchronous bilateral spike-wave foci in the first hour of sleep correlates significantly with a sum score > or = 3 which indicates a complicated course with educational or behavioral impairment. It is sufficient to analyze an EEG during wakefulness and a sleep EEG for only the first hour of sleep instead of a whole night recording to demonstrate those EEG criteria. CONCLUSIONS: On basis of our reanalysis we can possibly conclude that the aforementioned EEG characteristics correlate with educational impairments, and that analysing an EEG recording during wake and the first hour of sleep is sufficient to look adequately for those EEG criteria in children with BCECTS.     

Benign epilepsy of childhood with centrotemporal spikes and unilateral developmental opercular dysplasia

The case of a 15-year-old right-handed girl with developmental delay, mild retardation, astereognosis, and tactile discrimination impairment in the left arm, is reported. During sleep, right partial simple motor seizures with sialorrhea and saliva pooling were present, sometimes followed by secondary generalization. Absences and drop attacks were also observed. Electroencephalography revealed left centrotemporal spike waves spreading to the homologous contralateral region, generalized 3-Hz spike-and-wave complexes enhanced by hyperventilation, and generalized polyspike-and-wave discharges during drowsiness. Magnetic resonance imaging showed right perisylvian (opercular) malformation. Benign epilepsy of childhood with centrotemporal spikes (BECCTS) is a focal idiopathic epilepsy presumed to be of genetic origin. Although brain damage is not expected, structural lesions including opercular macrogyria have been reported. This coexistence has been considered mainly casual and only exceptionally causal. The Foix-Chavany-Marie syndrome or operculum syndrome is the result of bilateral opercular damage. In our child the right structural and the left functional lesions appeared mutually activated, yielding a transient opercular syndrome. The concomitance of BECCTS and developmental opercular dysplasia is suggestive of a common genetic substratum.     

Changes in current-source density of interictal spikes in benign epilepsy of childhood with centrotemporal spikes following treatment with oxcarbazepine

PurposeThe aim of this study was to detect clinical variables associated with the extent of change of the irritative zone in benign epilepsy of childhood with centrotemporal spikes (BECTS) after oxcarbazepine monotherapy.MethodBECTS patients receiving oxcarbazepine monotherapy were retrospectively reviewed. Changes in current-source density (CSD) of the maximum negative points of interictal spikes prior to the start of oxcarbazepine treatment were compared with CSD following oxcarbazepine treatment for 6–12 months. CSD was measured using low-resolution brain electromagnetic tomography (LORETA). Patients were divided into two groups based on the change in CSD: increased-extent or decreased-extent. Comparisons were made between the groups based on the age of onset, seizure frequency before treatment, time interval between seizure onset and treatment start, time interval between the two EEGs, oxcarbazepine dosage at the follow-up electroencephalography, occurrence of daytime seizures, and seizure control.ResultsFourteen patients were enrolled. Seven patients were in the decreased-extent group and six in the increased-extent group; one patient was excluded because she did not demonstrate any change in CSD. We found that seizure control differed significantly between the two groups: seizures were well-controlled in six out of seven patients in the decreased-extent group (85.7%), but in only one of six patients (16.7%) in the increased-extent group (p = 0.03). The other variables did not differ between the groups.ConclusionSeizure control may be associated with the extent of changes in the neuronal irritative zones of BECTS patients. We suggest that changes of CSD extent may be used as an imaging modality to evaluate clinical improvement in BECTS patients.     

Abnormal neuroimaging in patients with benign epilepsy with centrotemporal spikes

PURPOSE: Neuroimaging procedures are usually unnecessary in benign epilepsy of childhood with centrotemporal spikes (BECTS) but are often performed before a specific diagnosis has been reached. By definition, BECTS occurs in normal children; however, recent reports have shown that it also can affect children with static brain lesions. We evaluated the prevalence of abnormal neuroimaging in BECTS and assessed whether the lesions had influenced the clinical and EEG expression of this epilepsy. RESULTS: Among 98 consecutive cases first referred between 1984 and 1999, neuroimaging had been performed in 71 (72%) [magnetic resonance imaging (MRI), 20; computed tomography (CT), 59; MRI+CT, eight]. In ten (14.8%), neuroradiologic procedures were abnormal: enlargement of lateral venticles in five cases including a shunted hydrocephalus in two (no etiology in one, neonatal intraventricular hemorrhage in one), a moderate ventricular dilation in one (neonatal distress), a slight ventricular dilation and hypersignal intensities in the white matter in one (premature birth at 27 weeks), and a moderate enlargement of the right temporal horn in one. A right hippocampal atrophy, a biopercular polymicrogyria, a cavum septum pellucidum, a small cystic lesion located in the epiphysis, and an agenesis of the corpus callosum with macrocrania also were observed once each. The outcome was benign in all, in accordance with the overall prognosis of BECTS. CONCLUSIONS: This study confirms that neuroimaging may be abnormal in patients with BECTS and shows that the presence of brain lesions has no influence on the prognosis. Conversely, BECTS can be diagnosed in patients with brain lesions with or without significant neurologic history or abnormalities.     

Benign epilepsy with centrotemporal spikes

Benign epilepsy with centrotemporal spikes (BECTS) is a common disorder in childhood. After a brief overview of BECTS, a review of the data in favor of treatment with anticonvulsant medications is followed by the data indicating that treatment is not indicated. Some children appear to have cognitive consequences from BECTS. The parents and children with BECTS require a full discussion of the pros and cons of treatment, but based on data available at this time, it is concluded that treatment is generally not indicated for most patients. Future research may lead to changes in the recommendations.     

The attention networks in benign epilepsy with centrotemporal spikes: A long-term follow-up study

PurposeTo evaluate the long-term prognosis of attention deficit in children with newly diagnosed benign childhood epilepsy with centrotemporal spikes (BECTS).MethodsAttention network test (ANT) was performed over a period of 7 years on 42 patients who were newly diagnosed with BECTS, in the Department of Neurology of Anhui Provincial Children's Hospital.ResultsIn the patients’ group, the accuracy of ANT was lower (P = 0.000), the total response time was longer (P = 0.000), and the efficiency of orienting (P = 0.000) and alerting (P = 0.041) networks was lower than that of the control group. Accuracy was positively correlated with age of onset (b = 1.184) and negatively correlated with number of seizures (b = −1.321). After 7 years, there was no significant difference in the accuracy (P = 0.385); total response time (P = 0.661); and alerting (P = 0.797), orienting (P = 0.709), and executive control (P = 0.806) network efficiencies between the patients and controls. Accuracy was positively correlated with age of onset (b = 0.8583) and negatively correlated with number of seizures (b = −1.017) and duration of antiepileptic drugs therapy (b = −3.203).ConclusionsIn our study, the newly diagnosed BECTS patients had impaired attention network, mainly in the alerting and orienting domains. Age of onset, number of seizures, and time of antiepileptic treatment may affect the attention networks. With the remission of BECTS, the attention network dysfunction was reversed.     

Correlation between scalp high-frequency oscillations and prognosis in patients with benign epilepsy of childhood with centrotemporal spikes

Aims

The study aimed to explore whether high-frequency oscillations (HFOs) can predict seizure risk and atypical manifestations of benign epilepsy of childhood with centrotemporal spikes (BECTS).

Methods

We recruited 60 patients and divided them into three groups: (1) seizure-free BECTS, (2) active typical BECTS, and (3) active atypical forms of BECTS. Electroencephalogram was used to record the number, location, average amplitude, and duration of spikes, and spike ripples were analyzed using time-frequency technology. Multivariable logistic regression analysis was used to investigate independent predictive factors for prognosis.

Results

The number of sleep spike ripples, rather than spikes, was an independent risk factor for the active period of the disease (odds ratio [OR] = 4.714, p = 0.003) and atypical forms of BECTS (OR = 1.455, p = 0.049); the optimal thresholds for the spike ripple rate were >0 (area under the curve [AUC] = 0.885, sensitivity = 96.15%, specificity = 73.33%) and >0.6/min (AUC = 0.936, sensitivity = 84.21%, specificity = 96.15%), respectively. Furthermore, in typical BECTS, the spike ripple rate showed significant negative correlations with time since the last seizure (ρ = −0.409, p = 0.009) and age (ρ = −0.379, p = 0.016), while the spike rate did not.

Conclusion

Spike ripple was a marker for distinguishing typical and atypical forms of BECTS and reflected the risk of seizure recurrence better than the spike alone. The present findings might assist clinicians in BECTS treatment.     

Deficit of endogenous spatial orienting of attention in children with benign epilepsy with centrotemporal spikes (BECTS)

Attention difficulties have been reported in children with benign epilepsy with centrotemporal spikes (BECTS) but have not yet been fully specified. The aim of this study was to evaluate the functions of exogenous and endogenous spatial orienting of attention and alerting in these children. Two versions of the spatial cueing paradigm and an alerting task, including trials with and without warning signal, were performed by 25 children with BECTS aged 6–12 years and 25 controls matched for age, gender and IQ. In these three tasks, patients were slower and made more omissions than controls. The alert effect amplitude was comparable in both groups at the longer SOAs (450 ms and 800 ms) while, at the shortest SOA (100 ms), it was greater in controls than in the BECTS group. In the first version of the spatial cueing task (peripheral cues and no probability information), the validity effect amplitude, measured by longer response times (RTs) in invalid trials compared to valid trials, was comparable in both groups. In the second version (central cues and a 75% probability that the target would appear at the cued location), the validity effect was larger in the BECTS group compared to controls because of a higher cost of invalid trials compared to neutral trials. These results suggest the existence of impairments in the endogenous orienting of attention in children with BECTS, in particular an attention disengagement deficit, while exogenous orienting of attention appears to be preserved.     

Paradoxic reaction to lamotrigine in a child with benign focal epilepsy of childhood with centrotemporal spikes

A girl aged 5 years developed nocturnal seizures (mouth twitching, salivation, anarthria, with right arm jerking and occasional secondary generalisation), with frequent focal sharp waves over the left centrotemporal region in her EEG, suggesting benign childhood epilepsy with centrotemporal spikes (BECTS). Seizures became diurnal and frequent, not modified by carbamazepine (CBZ) or valproate (VPA) but responding to VPA and lamotrigine (LTG) with recommended dosage schedules for this combination. Her school performance then deteriorated insidiously, with poor memory and concentration, clumsiness, stuttering, and emotional lability. After 4 months, new episodes, < or =10 per day, occurred. These lasted a few seconds; she stared into space, her jaw dropped, her head dropped to the right, and her eyelids flickered. She usually maintained awareness. Attacks were often provoked by blowing or sneezing. Ictal EEG showed anterior-predominant 3/s sharp-slow wave complexes lasting < or =8 s, with bilateral rolandic discharges interictally. Withdrawal of LTG resulted in rapid improvement in cognitive function and gradual remission of the new attacks. CONCLUSIONS: This appears to be a paradoxic reaction to LTG in the setting of BECTS.