EEG and clinical features of childhood absence predict clinical outcomes.

Commentary Childhood absence epilepsy (CAE) is a common pediatric epilepsy syndrome, accounting for approximately 10 to 17 percent of childhood epilepsy (1, 2). The EEG pattern in CAE is an approximate 3-Hz bilateral synchronous, symmetric spike and slow wave, with seizures often activated by hyperventila-tion (HV). Treatment of CAE is not optimal, with many children having incomplete seizure control (3, 4). A recent multicenter, double-blind, randomized clinical trial aimed to compare the effectiveness of commonly used antiepileptic drugs (AEDs) (ethosuximide, valproate, and lamotrigine) among 446 children with newly diagnosed CAE (3, 4). Valproate and etho-suximide were found to be more effective than lamotrigine, and ethosuximide was better tolerated. These subjects had pretreatment EEG obtained as part of recruitment criteria. EEG is typically used to diagnose CAE. In addition to seizures, children with CAE are at risk for deficits in attention (3, 4). Better understanding of CAE EEG characteristics and its utility in diagnosis will help direct clinical care. Determining if there is a relationship between EEG findings and clinical outcome, including response to treatment and neuropsychologic parameters , may help identify those potentially at greater risk for adverse outcomes. Dlugos and colleagues performed an analysis of pretreat-ment EEG features among children with newly diagnosed CAE enrolled in the previously reported multicenter, double-blind, randomized, clinical trial. Associations between neuropsycho-logic function as well as treatment outcome were determined. Subjects aged between 2.5 and 13 years with the clinical diagnosis of CAE were enrolled. Entry criteria included an EEG revealing 2.7-to 5-Hz generalized spike wave (GSW) with a normal background and at least one GSW burst lasting ≥3 seconds. Subjects had a 1-hour baseline video-EEG as well as a battery of neuropsychologic tests. The specific neuropsy-chologic tests included the Conners Continuous Performance Test to assess attention and the Wisconsin Card Sorting Test for executive function. Video-EEG recordings were standardized with a predetermined protocol. The protocol included a 5-minute waking baseline period, first HV trial of 3 to 4 minutes, photic stimulation at 2 to 20 Hz, second HV trial if no electroclinical seizures were detected during first HV trial, and additional wakefulness for 1 hour total. Standard EEG recording allowed OBJECTIVE: In children with newly diagnosed childhood absence epilepsy (CAE), determine pretreatment EEG features and their associations with baseline neuropsychological function and short-term treatment outcome. METHODS: In a multicenter, randomized clinical trial, patients with CAE underwent a pretreatment, 1-hour video-EEG and neuropsy-chological testing …