The Importance of Epileptiform Activities in Breach Rhythms

Abstract

Objective: The breach rhythm is a benign activity variant that can be confused with epileptiform discharges. We aimed to investigate the relationship between breach rhythms and seizures, even though they are known as benign variants. In addition, to identify whether the seizure was related to seizures and which conditions should be considered by electroencephalographers. Methods: Electroencephalograph records recorded between October 2017 and March 2021 were re-examined. Breach rhythms were classified for localization, frequency, morphology, and presence/absence of sporadic epileptiform discharges. The placement of skull defects, etiology of skull defects, presence of encephalomalacia, symptomatic seizures, and anti-seizure medication use were documented. Statistical analysis was performed using Statistical Package for Social Sciences software version 26.0. Results: We included 71 recorded breach rhythm activities. All breach rhythms had a similar placement to skull defects. Twenty-three (32.4%) patients had an epileptiform abnormality with a breach rhythm in the same area. The presence of epileptiform abnormalities was associated with seizures more than 4.5 times [p=0.004, odds ratio (OR): 4.667]. The theta frequency was related to the presence of sporadic epileptiform activity exceeding 3.3 times (p=0.029, OR: 3.316). Conclusion: Our study showed that breach rhythms are unrelated to seizure unless sporadic epileptiform activity is present. If the breach rhythm frequency is theta, the risk of sporadic epileptiform activity is higher than the alpha or beta frequency breach rhythm. According to our study results, the breach rhythm is a benign variant, unless accompanied by sporadic epileptiform discharges.

Keywords

• benign variants
• breach effect
• breach rhythm
• epileptiform discharges
• seizure