Journal
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY
Volume 84, Issue -, Pages 34-39Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.seizure.2020.11.008
Keywords
Continuous spike and waves during sleep (CSWS); Electrical status epilepticus during sleep (ESES); Self-limited focal epilepsy (SFE); EEG wakefulness; Epilepsy with centro-temporal spikes (ECTS); EEG score
Categories
Funding
- Fund iris-Recherche
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The study found that awake EEG criteria can differentiate epileptic encephalopathy with continuous spike and waves during sleep (EE-CSWS) from typical, self-limited focal epilepsy (SFE) at the time of cognitive regression. By analyzing the slowwave index, spike-wave index, spike-wave frequency, and other EEG indices, it was concluded that an EEG score of >= 3 is effective in distinguishing between the two types of epilepsy.
Purpose: To determine whether awake EEG criteria can differentiate epileptic encephalopathy with continuous spike and waves during sleep (EE-CSWS) at the time of cognitive regression from typical, self-limited focal epilepsy (SFE). Methods: This retrospective case-control study was based on the analysis of awake EEGs and included 15 patients with EE-CSWS and 15 age-matched and sex-matched patients with typical SFE. The EEGs were anonymised and scored by four independent readers. The following qualitative and quantitative EEG indices were analysed: slowwave index (SLWI), spike-wave index (SWI), spike-wave frequency (SWF), long spike-wave clusters (CLSW) and EEG score (between grades 0 and 4). Sensitivity and specificity were assessed using receiver operating characteristic (ROC) curves and their reproducibility with a kappa test. Results: Based on a highly sensitive cut-off, EE-CSWS patients were 8.4 times more likely than those with SFE to have an SLWI > 6%, 15 times more likely to have an SWI > 10 % and six times more likely to have a CLSW of >= 1 s. There was substantial agreement between readers (with kappa values of 0.64, 0.69 and 0.67). EE-CSWS patients were 13 times more likely to have an SWF of > 11 % and 149 times more likely to have an EEG score of >= 3 than typical SFE patients. Agreement about these ratings was almost perfect (kappa 0.91 and 0.86). Conclusion: An EEG score of >= 3 on a 20-min awake EEG differentiates typical SFE from EE-CSWS at the time of cognitive regression, with good reliability across readers with different levels of expertise.
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