The topographic relation between focal spikes and neuropsychological deficits in children with benign partial epilepsy (BPE) was investigated using magnetoencephalography (MEG), electroencephalography (EEG) and MRI in a study of 27 children at University Children’s Hospital, Tuebingen, Germany, and University of Trento, Italy. Location of spikes was determined by dipole source estimation. Of 20 children with sufficient MEG data, 13 showed focal spikes in the perisylvian region, and 7 in the occipital region. Five had bilateral or multiple foci. Left perisylvian spikes correlated with significantly lower language test scores (p=0.01), and occipital spikes with lower scores in simultaneous information processing (p=0.01), especially in visual transformation tasks. Focal interictal spikes may interfere with complex cognitive functions. [1]

COMMENT. Children with BPE frequently have neuropsychological deficits, and the term “benign” is not always appropriate [2]. A previous report by these authors [3] refers to the association of oromotor dyspraxia in a child with benign childhood epilepsy with centrotemporal spikes (BECTS). A fluctuant course of partial seizures involving the face and right arm correlated with the intensity of EEG paroxysms located in the lower rolandic fissure. No structural lesion was detected on MRI (Ped Neur Briefs Nov 1989). A family of 9 children in three generations affected by autosomal dominant BECTS and associated with oral and speech dyspraxia and cognitive impairment is reported from Melbourne, Australia (Ped Neur Briefs Nov 1995) [4]. Partial seizures may be repetitive and frequent, more than 100 times daily, as in 2 children with BECTS who showed cognitive decline that improved after seizures resolved (Ped Neur Briefs April 2000; 14:28) [5]. In one patient the role of antiepileptic medication in the cognitive decline was suspect. A decision to treat BECTS despite invariable spontaneous remission is controversial.