Diagnostic utility of specific abnormal EEG patterns in children for determining epilepsy phenotype and presence of structural brain abnormalities
Mohammed Ashour,
Erica Minato,
Abdulla Alawadhi,
Saoussen Berrahmoune,
Elisabeth Simard-Tremblay,
Chantal Poulin,
Kenneth A. Myers
Affiliations
Mohammed Ashour
Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada; Department of Pediatrics, University of Jeddah, Hamzah Ibn Al Qasim St, Al Sharafeyah, Jeddah, Saudi Arabia
Erica Minato
Research Institute of the McGill University Medical Centre, 5100 Blvd de Maisonneuve Montreal, Quebec H4A 3T2, Canada; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006 Australia
Abdulla Alawadhi
Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada; Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada; Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates; Dubai Health Authority, Dubai, United Arab Emirates
Saoussen Berrahmoune
Research Institute of the McGill University Medical Centre, 5100 Blvd de Maisonneuve Montreal, Quebec H4A 3T2, Canada
Elisabeth Simard-Tremblay
Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada; Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
Chantal Poulin
Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada; Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada
Kenneth A. Myers
Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada; Research Institute of the McGill University Medical Centre, 5100 Blvd de Maisonneuve Montreal, Quebec H4A 3T2, Canada; Department of Neurology & Neurosurgery, Montreal Children’s Hospital, McGill University, 1001 Décarie Blvd, Montreal, Quebec H4A 3J1, Canada; Corresponding author.
Objective: Estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EEG findings: centrotemporal spikes, photoparoxysmal response, asymmetric photic driving, and asymmetric sleep spindles, for epilepsy phenotype and presence of structural brain abnormalities. Methods: In this case-control study we reviewed children referred for EEG over a 4-year period, with at least one of centrotemporal spikes, photoparoxysmal response, asymmetric photic driving, or asymmetric sleep spindles. This cohort was analyzed in combination with a research database of pediatric patients with seizures. Results: Centrotemporal spikes had 100% sensitivity for childhood epilepsy with centrotemporal spikes or atypical childhood epilepsy with centrotemporal spikes, but lower specificity (70%) and PPV (58%). Photoparoxysmal response had high specificity (92%) and NPV (92%) for genetic generalized epilepsy. Asymmetric photic driving had low sensitivity for structural brain abnormalities (17%), with specificity 80%. In contrast, asymmetric sleep spindles had much higher sensitivity and specificity, 44% and 97%, respectively. Conclusions: Although centrotemporal spikes are classically associated with childhood epilepsy with centrotemporal spikes, these discharges are seen in other conditions. Photoparoxysmal response is highly indicative of a genetic generalized epilepsy, though may be seen in other epilepsy phenotypes. Relative attenuation of sleep spindles is a more reliable indicator of structural brain malformation than asymmetric photic driving. Significance: The quantitative diagnostic utility of EEG findings should be considered when incorporating these results into clinical decision-making.
