Researchers at Pontificia Universidade Catolica, Campinas, Brazil studied the relationship between educational problems and clinical/EEG aspects of benign childhood epilepsy with centrotemporal spikes (BECTS) in 38 children, ages 8 to 11 years (average age 9.29 +/- 1.27). Educational problems assessed by the School Performance Test, Parent and Teacher Questionnaires on learning difficulties, and the WISC-III test were observed in 7 (18.4%) children with BECTS. In this subgroup of educationally handicapped children, relative alpha amplitudes at the central and parietal electrodes were lower as compared with the BECT subgroup with normal educational performance and a control group matched for age and gender. Alterations in background brain electrical activity appeared to be related to a tendency toward educational disorders in children with BECTS. Quantitative EEG is a possible means of assessment of cognitive deficits in children with BECTS. [1]

COMMENT. Deonna T, Roulet E and associates, of Lausanne, Switzerland, in one of the earlier prospective neuropsychological and EEG studies of 22 children with BECTS (19) and occipital spikes (3), found 21 had average IQ, 8 had school difficulties, 4 delayed language development, and 8 had transient impairments in verbal, visuospatial, or memory function. Cognitive deficits improved or normalized on follow-up, with concomitant EEG improvement or normalizaton. Transient cognitive difficulties in some children with BECTS were directly related to the paroxysmal EEG activity [2]. Wolff M et al [3], in a combined MEG/EEG study of children with benign partial epilepsy, reported a correlation between location of focal interictal spikes and selective cognitive deficits. Massa R et al [4] found that EEG interictal patterns and their persistence were the hallmarks of neuropsychological impairments in 10 of 35 patients (28%) with BECTS followed from onset to complete recovery. While these studies focused on the correlation between epileptiform discharges and cognitive impairments in children with BECTS, the current study from Brazil notes a relation between alterations in amplitude of background EEG activity and educational problems.

Ictal EEG and BECTS. Tedrus et al, the Brazil research team, also report details of an ictal EEG during oropharyngeal seizures in an 8-year-old boy with BECTS [5]. Seizure onset during sleep correlated with an increase in centrotemporal spikes followed by slow waves in the right hemisphere. A brief decrease in amplitude of background activity preceded rhythmic, diffuse sharp waves in the right centrotemporal region. Finally, high potential spikes reappeared in the central and temporal regions of the right hemisphere with normalization of background activity. The EEG changes occurred concurrently with clonic lip movements, pouting, and throat noises.