Overall, Benign epileptiform variants lack pathological significance, although 6-Hz spike-and-wave bursts and small sharp spikes showed a stronger association with epilepsy and may be considered variants of uncertain significance warranting clinical follow-up.
Abstract
INTRODUCTION
Benign epileptiform variants (BEV) are uncommon epileptiform-like EEG graphoelements that do not meet diagnostic criteria for epileptiform or pathological discharges. The clinical significance of some subtypes remains uncertain.
Methods
We conducted a single-centre, retrospective, observational study of 57 408 EEG recordings from 32 349 patients who were followed up for more than one year. We determined the prevalence of each BEV and compared the presence of epilepsy at baseline and at the end of follow-up.
Results
BEV were identified in 192 patients (287 EEG recordings), yielding a prevalence of 0.58% in the total cohort and 1.26% among patients with otherwise normal EEG recordings (n = 15 172). Diagnosis of epilepsy was observed in 39% of patients with BEV at baseline and 35% of patients with BEV after a mean follow-up of 7.4 years. In subtype-based analyses, the 6-Hz spike-and-wave bursts subtype was significantly associated with a higher prevalence of epilepsy at baseline (OR: 12.3; 95% CI, 1.47-103.2; P = .021), and the small sharp spikes variant was associated with a higher prevalence of focal epilepsy at the end of follow-up (OR: 3.05; 95% CI, 1.43-6.50; P = .004), as compared to other BEV. In contrast, wicket spikes were associated with a lower presence of epilepsy (OR: 0.31; 95% CI, 0.13-0.72; P = .007) than other BEV.
Conclusions
BEV are infrequent, heterogeneous EEG findings. Correct recognition, particularly of wicket spikes, may prevent overdiagnosis and unnecessary treatment. Overall, they lack pathological significance, although 6-Hz spike-and-wave bursts and small sharp spikes showed a stronger association with epilepsy and may be considered variants of uncertain significance warranting clinical follow-up.
Epilepsy affects a significant proportion of people globally, with many cases beginning in childhood. However, there is a lack of longitudinal studies exploring the long-term outcomes and characteristics of childhood-onset epilepsy into adulthood. This study aimed to analyze the trajectory of childhood-onset epilepsy to identify particular characteristics and outcomes that could help guide future management. This retrospective cohort study was conducted between June 2021 and December 2022 at adult and paediatric clinics. Participant data were obtained from medical records and corroborated through history taking during follow-up visits. A total of 100 participants diagnosed with epilepsy since childhood were included. The mean age of the cohort was 23.15 (SD = 8.80) years, with a mean age at epilepsy diagnosis of 3.97 years. Focal seizures were the most prevalent type (53%), with structural causes being the predominant aetiology of epilepsy. A total of 48% of participants were identified with intellectual disabilities, 24% with learning disabilities, and 32% with behavioural difficulties. Consequently, 45% required enrollment in special education institutions. We did not observe a statistically significant difference in seizure control over the 10-year follow-up period, and no analyzed factors were significantly associated with seizure control. Childhood-onset epilepsy is associated with substantial long-term neurodevelopmental and psychosocial consequences. Our findings highlight the need for individualized, multidisciplinary management and clear, structured transition pathways from paediatric to adult neurology services. We outline several recommendations to enhance overall management as patients transition into adulthood.
J. Tan, J. Tan, M. M. Tan et al.· Acta Epileptologica· 0 citations
SCSs are present in approximately one quarter of presurgical epilepsy patients and show moderate concordance with CS and IED localization and their distinct localization profile and frequent containment within CS zones support their value as complementary information in epilepsy care.
L. Lankhuijzen, Monique Cloherty, J. Winston et al.· Frontiers in Neurology· 0 citations
Early diagnosis, comprehensive treatment with appropriate antiepileptic drug selection based on seizure type and epilepsy etiology, and rehabilitation improve prognosis and quality of life for children with epilepsy.
L. B. Novikova, K. M. Ziultsle, A. Akopyan et al.· Epilepsy and paroxysmal cond...· 0 citations
BACKGROUND
We aimed to identify the proportion of individuals with a confirmed diagnosis of childhood absence epilepsy (CAE) or juvenile absence epilepsy (JAE) who show a negative routine EEG (rEEG), and to determine the main factors associated with this finding.
METHODS
Individuals with CAE or JAE underwent both an rEEG and a 24-h ambulatory EEG (24-h-aEEG). Participants were classified as 'rEEG positive' if generalised spike-wave discharges (GSWs) and/or typical absences (TAs) were observed, and as 'rEEG negative' if no such features were detected. 24-h-aEEG recordings served as the ground truth to confirm the diagnosis in cases with a negative rEEG.
RESULTS
Eighty-two individuals [40/82 (48.8%) females; mean age 12.5 ± 5.6 years] were included, of whom 39/82 (47.6%) were not receiving anti-seizure medications (ASMs) at the time of the EEG. Overall, 31/82 (37.8%) had a negative rEEG, including 10/39 (25.6%) in the cohort of ASM-naïve individuals. Compared with rEEG-positive participants, those in the rEEG-negative group had a later age at epilepsy onset (12.1 ± 4.5 years; p < 0.001) and were older at the time of EEG (16.5 ± 5.3 years; p < 0.0001). Older age at EEG emerged as significantly associated with a negative rEEG (OR = 1.23; 95% CI = 1.03-1.46; p = 0.019), independent of age at onset, epilepsy syndrome (CAE or JAE) and ASM exposure. Sensitivity analyses confirmed the association between older age and rEEG negativity across all cohorts: ASM-naïve individuals (OR = 1.41; 95% CI = 1.12-1.78), CAE (OR = 1.27; 95% CI = 1.02-1.58), and JAE (OR = 1.36; 95% CI 1.09-1.69) groups. Youden's exploratory analysis identified ≥ 14 years as the optimal threshold for predicting a rEEG negative.
CONCLUSION
Age significantly reduces the diagnostic yield of rEEG in CAE and JAE, regardless of ASM treatment.
F. Fortunato, A. Giugno, M. Sturniolo et al.· Annals of Clinical and Trans...· 0 citations
Overall, the presence of SCSs alone was not associated with a poor outcome, but the spatial non-concordance with the seizure-onset zone was highly predictive for poor seizure outcome.
P. Bosque-Varela, Panagiota-Eleni Tsalouchidou, Petra Levicka et al.· Epilepsia· 0 citations
OBJECTIVE
Despite representing the most common and fastest growing form of epilepsy in older adults, the clinical features of late onset epilepsy (LOE) and how it differs from early onset epilepsy (EOE) remain largely underexplored. Therefore, we evaluate the characteristics and risk factors of LOE compared to EOE.
METHODS
In this single-center, retrospective study, individuals with clinically diagnosed epilepsy presenting at the University of Virginia from July 1, 2024 to September 30, 2024 were included. A cohort of older adults was identified and divided into two groups: LOE if epilepsy onset occurred at ≥60 years and EOE if epilepsy onset was before 60 years. Univariable analysis was conducted using Pearson chi-squared, Fisher exact, or Wilcoxon rank-sum tests. Multivariable logistic regression was performed to identify risk factors associated with LOE.
RESULTS
A total of 326 individuals were included (LOE: n = 97, EOE: n = 229). Overall, 173 (53%) were women. Age at epilepsy onset was higher in LOE (LOE: 67 years [interquartile range (IQR) = 63-73], EOE: 32 years [IQR = 13-50], p < .001). LOE subjects were more likely to be employed/retired than unemployed/disabled (93% vs. 59%, p < .001), to have focal epilepsy (93% vs. 78%, p = .002), and to demonstrate cognitive impairment (32% vs. 16%, p = .001). Cognitive impairment developed after epilepsy onset in the majority of individuals in both groups (LOE: 82%, EOE: 93%). Among the 284 (87%) individuals who underwent electroencephalography, epileptiform discharges or seizures were less frequent in LOE (31% vs. 53%, p < .001). On multivariable analysis, intracranial hemorrhage (odds ratio [OR] = 2.85, 95% confidence interval [CI] = 1.00-8.24, p = .049), intracranial infarction (OR = 2.93, 95% CI = 1.30-6.70, p = .010), current alcohol use (OR = 4.70, 95% CI = 2.22-10.16, p < .001), former alcohol use (OR = 2.31, 95% CI = 1.18-4.55, p = .015), higher medical comorbidity burden measured by Charlson Comorbidity Index (OR = 1.40, 95% CI = 1.21-1.63, p < .001), and lower body mass index (OR = .95, 95% CI = .90-1.00, p = .045) were independently associated with LOE. LOE also demonstrated significantly less temporal lobe involvement (26% vs. 38%, p = .034), a lower lifetime seizure burden (>10 lifetime-seizures: 41% vs. 80%, p < .001), lower rate of drug-resistant-epilepsy (18% vs. 57%, p < .001), less prior exposure to antiseizure medications (ASMs; .65 ± .71 vs. 1.43 ± 1.92, p < .001), and less use of older generation and adjunctive ASMs compared with EOE.
SIGNIFICANCE
EOE and LOE represent distinct clinical phenotypes. LOE is associated with greater focal epilepsy, cerebrovascular disease (stroke and hemorrhage), cognitive impairment, and overall higher medical comorbidity burden. Conversely, EOE reflects an epileptogenic disorder characterized by long-standing temporal lobe involvement, drug resistance, and higher ASM exposure. Recognition of these distinctions may improve individualized diagnostic evaluation, cognitive screening, risk stratification, and therapeutic decision-making.
Syeda Amrah Hashmi, Mark Quigg, M. Abbas et al.· Epilepsia· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
