EEG criteria predictive of complicated evolution in idiopathic rolandic epilepsy

Background: Although so-called "benign" epilepsy with centrotemporal spikes (BECTS) always has an excellent prognosis with regard to seizure remission , behavioral problems and cognitive dysfunctions may sometimes develop in i ts course. To search for clinical or EEG markers allowing early detection o f patients prone to such complications, the authors conducted a prospective study in a cohort of unselected patients with BECTS. Methods: In 35 childr en with BECTS, academic, familial, neurologic, neuropsychological, and wake and sleep EEG evaluations were repeated every 6 to 12 months from the begi nning of the seizure disorder up to complete recovery. Results: In 25 of 35 patients (72%), behavioral and intellectual functioning remained unimpaire d. In 10 of 35 patients (28%), educational performance and familial maladju stment occurred. These sociofamilial problems were correlated with impulsiv ity, learning difficulties, attention disorders, and minor (7/35 cases, 20% ) or serious (3/35 cases, 8%) auditory-verbal or visual-spatial deficits. W orsening phases started 2 to 36 months after onset and persisted for 9 to 3 9 months. Occurrence of atypical evolutions was significantly correlated wi th five qualitative and one quantitative interictal EEG pattern: intermitte nt slow-wave focus, multiple asynchronous spike-wave foci, long spike-wave clusters, generalized 3-c/s "absence-like" spike-wave discharges, conjuncti on of interictal paroxysms with negative or positive myoclonia, and abundan ce of interictal abnormalities during wakefulness and sleep. Clinical deter ioration was not linked with seizure characteristics or treatment. Conclusi on: Different combinations of at least three of six distinctive interictal EEG patterns and their long-lasting (greater than or equal to6-month) persi stence seem to be the hallmarks of patients with BECTS at risk for neuropsy chological impairments.