The stability of spike counts in children with interictal epileptiform activity

PURPOSE Little is known about the stability of serial measures of spike counts in children or whether spike counts are an inherently stable or unstable measure. We investigated the variation in first- and second-night spike counts in children undergoing 48-h ambulatory EEG recording. METHODS We analyzed 40 consecutive 48-h ambulatory EEGs performed at Boston Children's Hospital that manifested spikes but no seizures. Distinct spike foci in the same child were counted separately. We visually counted all spikes in the first 20min after the first sleep spindle during nighttime sleep, comparing the first and second nights. RESULTS Fifty-five unique spike foci were counted in 40 children (age range: 9 months to 19 years; median: 8.4 years). Considerable variation was seen when comparing Night 1 and Night 2 spike counts: for all foci, Night 1 mean and median spike counts were 304.5 and 126 and Night 2 counts were 309.5 and 148, respectively. For each focus, the mean change in spike frequency between Night 1 and Night 2 was 42.1% (median=28.3%, IQR 19.0-50.0%). The coefficient of variation of 0.94 suggested a large amount of variation. The percentage change weighted according to high or low spike frequency was 25.1%. CONCLUSION In 40 children with 55 unique spike foci, significant variability in spike frequency was seen between consecutive nights of sleep, suggesting significant natural variation in spike frequency. A quarter of spike foci varied by 50% or more. Spike counts separated by longer intervals may show even more dramatic natural variation.