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Continuous spikes and waves during sleep (CSWS): A Descriptive Clinical-epidemiological Profile from India

Continuous spikes and waves during sleep (CSWS) also known as Electrical Status Epilepticus in Sleep (ESES) is a rare pediatric epileptic encephalopathy characterized by interictal epileptiform activity that is prominent during sleep leading to electroencephalogram (EEG) changes, pharmacoresistant seizures and cognitive regression.

OBJECTIVE : Review epidemiological, etiological, clinical, EEG and pharmacological findings in children with CSWS from North India. METHOD: The profiles of all patients diagnosed with CSWS from 2012 to 2021 were reviewed using medical records and relevant details were noted down. Descriptive statistics were used to summarize the patient characteristics. RESULTS: 24 children were found to be diagnosed with CSWS with male preponderance (M: F = 5:1) with median age of onset and presentation being 3 and 6 years respectively. Pre-existing etiology was found in 9 (37.5%) children. Behavioral issues were noted in all children commonly with hyperactivity (33%), autistic features (16%), difficulty in concentration (42%) and poor school performances (86%). All children received steroids following which significant seizure control was reported. Majority of the children (66%) required various polytherapy combinations while the rest (33%) were managed on high dose valproate monotherapy. Amongst our cohort 2 children each were found to have been progressed from Rolandic and Panayiotopoulos Epilepsy to develop CSWS while 3 children had classical regression of language milestones constituting the LKS spectrum of CSWS.

CONCLUSION : CSWS is a childhood epileptic-developmental encephalopathy that represents the most severe end of the seizure susceptibility syndrome requiring prompt diagnosis and aggressive treatment.
Keywords: CSWS Developmental epileptic encephalopathy ESES

Aakanksha Anand
ESIC Medical College & Hospital
India

Suvasini Sharma
Lady Hardinge Medical College
India

 

 


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