Cognition and behavior in children with benign epilepsy with centrotemporal spikes (BECTS)

doi:10.1016/j.eplepsyres.2006.02.005

Epilepsy Research

Volume 70, Issue 1, July 2006, Pages 89-94

https://doi.org/10.1016/j.eplepsyres.2006.02.005 Get rights and content

Abstract

Characteristics of cognitive deficits in benign childhood epilepsy with centrotemporal spikes (BECTS) remain unclear. The authors screened 200 BECTS children presenting for a clinical trial, finding relative weaknesses in fine motor control, visual learning, and attention in the presence of overall normal intellect, with simple partial seizures associated with more difficulty. Parental concerns for psychosomatic and learning problems were noted. Monitoring select cognitive and behavioral features in BECTS appears appropriate.

Introduction

Benign childhood epilepsy with centrotemporal spikes (BECTS) is one of the most common forms of childhood epilepsies with published prevalence rates ranging from 10 to 24% (Bouma et al., 1997, Cavazzuti, 1980, Hauser, 1994, Lerman, 1992, Loiseau et al., 1991). BECTS is slightly more frequent in boys (58.2%) (Bouma et al., 1997). Seizure frequency is low, typically 2–5 total seizures, but also quite variable, ranging from a single lifetime episode to multiple seizures per day (Bouma et al., 1997). BECTS prognosis is excellent, with 98% of children outgrowing the disorder by puberty (Bouma et al., 1997).

Normal neurologic and psychological findings are usually reported, although some studies suggest a link between BECTS and visuomotor, attention, language, memory, and behavior difficulties (Croona et al., 1999, Dalessandro et al., 1990, Heijbel and Bohman, 1975, Staden et al., 1998, Weglage et al., 1997). While this raises questions about the benign nature of BECTS, small sample sizes, potential confounds of sample bias and antiepileptic drug (AED) effects make definitive conclusions premature. Understanding cognitive and behavioral co-morbidities, even in the context of a relatively benign seizure disorder, remains an important area of concern, which we have approached in a relatively large sample of children with BECTS.

Section snippets

Methods

Subjects were 200 children (115 males, 57.5%) completing brief psychometric screens prior to the treatment phase of a 49 center, double-blind, placebo-controlled study of gabapentin. Ages ranged from 4 to 13 years, with grade placement from kindergarten to seventh. Thirty-one (15.5%) children were in special education. Ten (5.0%) were taking attention deficit/hyperactivity disorder (ADHD) medication.

Inclusion criteria were: (a) diagnosis of BECTS with partial or secondarily generalized

Results

BECTS with simple partial seizures was found in 20% of the children. Twenty-one percent had complex partial seizures, and the remaining 59% had secondarily generalized tonic–clonic seizures. AED use was found in 34% of children, and percentages did not differ across seizure types (χ² = 0.75, p = 0.69). The three seizure groups did not differ significantly in age (F = 1.56, p = 0.21), education (F = 0.82, p = 0.44), distribution of special education (χ² = 0.20, p = 0.90), or the number of seizures in the past

Discussion

Data from this large sample of children with BECTS are consistent with previous findings of higher incidence in males and generally average intellect. At the same time, our data suggest some evidence for select cognitive and behavioral difficulties compared to normative populations. Specifically, BECTS children performed worst on a subtest reflecting verbal attention, number/letter, with the next lowest score being on a visual attention subtest, finger windows, consistent with other findings

Acknowledgements

The authors wish to thank the site primary investigators and coordinators of this multicenter trial for their assistance with data collection.

This research was sponsored by a grant from Pfizer Pharmaceuticals Inc., Global Research Division. Drs. Garofalo and Sharma were employees of this company at the time that this study was conducted. Dr. Giordani has received limited consultation fees from this company. Dr. Giordani's spouse is employed by the company, thus, the family holds stock options

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The course of benign partial epilepsy of childhood with centrotemporal spikes: a meta-analysis
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Intellectual and cognitive disturbances in epileptic patients

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The influence of EEG-detected nocturnal centrotemporal discharges on the expression of core symptoms of ADHD in children with benign childhood epilepsy with centrotemporal spikes (BCECTS): A prospective study in a tertiary referral center
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Benign childhood epilepsy with centrotemporal spikes (BCECTS) is the most frequent benign focal epilepsy in childhood. Although it is described as a benign epilepsy syndrome, many studies have revealed that a significant number of patients have some degree of neuropsychological impairment.
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Citation Excerpt :
Initially, BECTS was considered as a benign epilepsy with no comorbidity associated with it. However, the “benign” nature of BECTS has been recently called into question because of cognitive and behavioral impairments, for example speech and sound disorders, language disabilities, and memory deficit, which are frequently observed in children with BECTS [2–5]. The most important behavioral impairment is an attentional problem that could seriously impact the learning process and the living condition of patients, even when the seizures have remitted [6].
Benign epilepsy affecting children with normal mental development often occurs at a particular age, responds well to medication, and could be resolved completely by puberty. Although several studies have shown neuropsychological disabilities of children with benign epilepsy with centrotemporal spikes (BECTS), there is no clear evidence about the impairment of attentional systems and the comorbidity of attentional problems. Our research was based on the attention network model and assessed the characteristics of three anatomically defined subnetworks (alerting, orienting, and executive control) of 90 children with BECTS and 90 healthy children. All the subjects enrolled in the study participated in the attention network test (ANT) with assessment of both the reaction time (RT) and accuracy of the test. The results indicated that the performance of healthy controls was significantly better in orienting of attentional system (P < 0.001) and the accuracy of attention network test (P < 0.001), compared with that of children affected by BECTS. The grand mean effect (higher score worse) was significantly higher (P < 0.001) in the patient group than that in the control group. The multiple linear regression analysis revealed a positive correlation between the age of onset and the accuracy of attention network test results, and a negative correlation between the age of onset and the results of grand mean effect. A negative correlation was observed between spike index (SI) of the non-REM sleep stage and the accuracy of attention network test results. We found no relationship between the grand mean effect and clinical factors such as gender, duration of clinical course, duration of seizures, total number of seizures, severity of seizures (seizure frequency), hemispheric lateralization of electroencephalograph (EEG), and the awake SI. Furthermore, no relationship was observed between the clinical factors and the accuracy of the test results. The findings showed that BECTS is associated with impaired attentional networks, and impairments are greater at younger ages of onset.

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Short communicationCognition and behavior in children with benign epilepsy with centrotemporal spikes (BECTS)

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

J. Am. Acad. Child Adolescent Psychiatry

The course of benign partial epilepsy of childhood with centrotemporal spikes: a meta-analysis

Neurology

Epidemiology of different types of epilepsy in school age children of Modena, Italy 1

Epilepsia

Neuropsychological findings in children with benign childhood epilepsy with centrotemporal spikes

Dev. Med. Child Neurol.

Neuropsychological features of benign partial epilepsy in children

Ital. J. Neurol. Sci.

Intellectual and cognitive disturbances in epileptic patients

Short communication
Cognition and behavior in children with benign epilepsy with centrotemporal spikes (BECTS)