Benign Epiletiform Discharge of Childhood

Definition

Regional or multiregional sharp waves are normally followed by a negative slow wave with lower
amplitude than the negative peak of the sharp wave and occasionally show a bipolar distribution (
Luders et al 1987, Noachtar and Wyllie 1997). These sharp waves often are multiregional and are easy to
recognize by their typical morphology.if they occur in the centrotemporal region, they are alson called
rolandic spikes. They typically increase during sleep and tend to appear in series. This pattern is
frequently seen in children between ages of 5 and 15 years who suffer from benign focal epilepsy of
childhood (Luders et al 1987). The discharge, as well as the epilepsy, almost invariably diasappear after
puberty. Nevertheless, these discharges are alson encountered in approximately 1 to 2 % of healthly
children ( Eeg-Olofsson et al 1971). Probably only approximately 8% of children who show such sharp
waves in an EEG record ever have an epileptic seizure (Luders et al 1987).

Interpretation

This pattern is relatively specific for the clinical syndrome of benign focal epilepsy of childhood.

Spike and Wave Complexes

Definition

Spike-and wave complexes are spikes and waves that occur repetitively (in series) and do not fulfill the
criteria for more specific epileptiform patterns such as slow spike-and-wave complexes or 3 Hz spike
and wave complexes (see later). Note that isolated sharp waves are classified as sharp waves or spikes
and not as spike-and-wave complexes, even if a negative slow wave follow the epileptiform discharge.
Bursts of spike-and-wave complexes of longer duration frequently are symptomatic (Browne et al 1974).
The transition between interictal and ictal discharge is frequently continuous, depending primarily on
the durationof the discharge.

Interpretation

This pattern is considered relatively spedific of its clear relationship with epilepsy (Gibbs et al 1935).
During sleep, generalized spike-and-wave complexes are frequently activated and tend to appear in
shorter,irregular groups. POlyspikes may also triggered by sleep.One must differentiate 6Hz spike-and-
wave complexes (fig.34) (also called phantom or miniature spike-and-wave complexes) from this
pattern; 6Hz phantom spike-and-wave complexes occur in healthy adolescents and adullts, and they
have little value in the diagnosis of epilepsy (Klass and Westmoreland 1985). One must distinguish
between 6Hz phantom spike-and-wave complexes with miniature spikes (spikes of very low amplitude)
(see fig.34) and spike-and wave complexes with a repetition rate of approximately 6Hz and high
amplitude spikes, which must be considered definitely abnormal (see fig 33a and b). caution is also
recommended when interpreting high voltage rhythmical slow waves elicited by hyperventilation,
particularly when interspersed sharp transients are noticed. This pattern can stimulate pathological
spike-and-wave complexes (fig.35).

Degree of EEG Abnormality

This pattern is always classified as abnormal III because