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content:self_limited_epilepsy_with_centrotemporal_spikes_selects [2024/03/23 19:22] – biju.hameed@gmail.com | content:self_limited_epilepsy_with_centrotemporal_spikes_selects [2024/03/23 19:44] (current) – [Treatment] biju.hameed@gmail.com | ||
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* Triphasic, high-voltage (100-microvolts to 300microvolts) sharp waves (initial low-amplitude positivity, then high amplitude negativity followed again by low amplitude positivity), | * Triphasic, high-voltage (100-microvolts to 300microvolts) sharp waves (initial low-amplitude positivity, then high amplitude negativity followed again by low amplitude positivity), | ||
* The discharges may be isolated or occur in trains of doublets and triplets, and focal, rhythmic, slow activity is occasionally observed in the same region as the spikes. | * The discharges may be isolated or occur in trains of doublets and triplets, and focal, rhythmic, slow activity is occasionally observed in the same region as the spikes. | ||
- | * The discharges may be unilateral or bilateral and independent | + | * The discharges may be unilateral or bilateral and independent |
* There may be discharges seen outside the centrotemporal region (midline, parietal, | * There may be discharges seen outside the centrotemporal region (midline, parietal, | ||
* A marked increase in the frequency of epileptiform activity in drowsiness and sleep always occurs. | * A marked increase in the frequency of epileptiform activity in drowsiness and sleep always occurs. | ||
- | * The EEG pattern may also change such that sharp- or spike-and-slow waves have a broader field and become bilaterally synchronous | + | * The EEG pattern may also change such that sharp- or spike-and-slow waves have a broader field and become bilaterally synchronous |
* In 10-20% of children, centrotemporal sharp- or spike-and-slow wave may be activated by sensory stimulation of the fingers or toes | * In 10-20% of children, centrotemporal sharp- or spike-and-slow wave may be activated by sensory stimulation of the fingers or toes | ||
- | * Seizures may be accompanied by a brief decrease in amplitude of the background EEG, followed by diffuse sharp wave discharges of increasing amplitude, predominantly in one centrotemporal | + | * Seizures may be accompanied by a brief decrease in amplitude of the background EEG, followed by diffuse sharp wave discharges of increasing amplitude, predominantly in one centrotemporal |
- | * With focal to bilateral tonic-clonic seizures, ictal rhythms may become bilaterally synchronous (as opposed to generalized) sharp- or spike-and slow-wave activity | + | * With focal to bilateral tonic-clonic seizures, ictal rhythms may become bilaterally synchronous (as opposed to generalized) sharp- or spike-and slow-wave activity |
==== Genetics ==== | ==== Genetics ==== | ||
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* If a continuous spike-and-slow-wave pattern is present in sleep, the child should be evaluated for progressive language or cognitive impairment or regression. This EEG pattern should only lead to a diagnosis of D/EE-SWAS if developmental plateauing or regression is also present[(: | * If a continuous spike-and-slow-wave pattern is present in sleep, the child should be evaluated for progressive language or cognitive impairment or regression. This EEG pattern should only lead to a diagnosis of D/EE-SWAS if developmental plateauing or regression is also present[(: | ||
* Patients with SeLECTS may show " | * Patients with SeLECTS may show " | ||
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+ | ==== Treatment ==== | ||
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+ | * As the seizures associated with SeLECTS often stop around the age of puberty, it is not clear whether it is necessary to prescribe ASMs to all children who present with this condition. | ||
+ | * When considering the use of antiseizure medications for SeLECTS, it is important to have a thorough discussion with the individual, their family, and caregivers (if applicable). This discussion should focus on developing a personalized medication strategy based on the specific epilepsy syndrome, treatment objectives, and the preferences of the individual and their family or caregivers. | ||
+ | * lamotrigine and levetiracetam should be considered as first-line treatment[(: | ||
+ | * As second-line treatment, carbamazepine, | ||
+ | * school performance is a good indicator of cognition since it measures processing and retention.If any deterioration is noted, an EEG should be performed to exclude [[content: | ||
+ | |||
==== References ==== | ==== References ==== | ||