Elsevier

Epilepsy Research

Volume 70, Issue 1, July 2006, Pages 89-94
Epilepsy Research

Short communication
Cognition and behavior in children with benign epilepsy with centrotemporal spikes (BECTS)

https://doi.org/10.1016/j.eplepsyres.2006.02.005Get rights and content

Abstract

Characteristics of cognitive deficits in benign childhood epilepsy with centrotemporal spikes (BECTS) remain unclear. The authors screened 200 BECTS children presenting for a clinical trial, finding relative weaknesses in fine motor control, visual learning, and attention in the presence of overall normal intellect, with simple partial seizures associated with more difficulty. Parental concerns for psychosomatic and learning problems were noted. Monitoring select cognitive and behavioral features in BECTS appears appropriate.

Introduction

Benign childhood epilepsy with centrotemporal spikes (BECTS) is one of the most common forms of childhood epilepsies with published prevalence rates ranging from 10 to 24% (Bouma et al., 1997, Cavazzuti, 1980, Hauser, 1994, Lerman, 1992, Loiseau et al., 1991). BECTS is slightly more frequent in boys (58.2%) (Bouma et al., 1997). Seizure frequency is low, typically 2–5 total seizures, but also quite variable, ranging from a single lifetime episode to multiple seizures per day (Bouma et al., 1997). BECTS prognosis is excellent, with 98% of children outgrowing the disorder by puberty (Bouma et al., 1997).

Normal neurologic and psychological findings are usually reported, although some studies suggest a link between BECTS and visuomotor, attention, language, memory, and behavior difficulties (Croona et al., 1999, Dalessandro et al., 1990, Heijbel and Bohman, 1975, Staden et al., 1998, Weglage et al., 1997). While this raises questions about the benign nature of BECTS, small sample sizes, potential confounds of sample bias and antiepileptic drug (AED) effects make definitive conclusions premature. Understanding cognitive and behavioral co-morbidities, even in the context of a relatively benign seizure disorder, remains an important area of concern, which we have approached in a relatively large sample of children with BECTS.

Section snippets

Methods

Subjects were 200 children (115 males, 57.5%) completing brief psychometric screens prior to the treatment phase of a 49 center, double-blind, placebo-controlled study of gabapentin. Ages ranged from 4 to 13 years, with grade placement from kindergarten to seventh. Thirty-one (15.5%) children were in special education. Ten (5.0%) were taking attention deficit/hyperactivity disorder (ADHD) medication.

Inclusion criteria were: (a) diagnosis of BECTS with partial or secondarily generalized

Results

BECTS with simple partial seizures was found in 20% of the children. Twenty-one percent had complex partial seizures, and the remaining 59% had secondarily generalized tonic–clonic seizures. AED use was found in 34% of children, and percentages did not differ across seizure types (χ2 = 0.75, p = 0.69). The three seizure groups did not differ significantly in age (F = 1.56, p = 0.21), education (F = 0.82, p = 0.44), distribution of special education (χ2 = 0.20, p = 0.90), or the number of seizures in the past

Discussion

Data from this large sample of children with BECTS are consistent with previous findings of higher incidence in males and generally average intellect. At the same time, our data suggest some evidence for select cognitive and behavioral difficulties compared to normative populations. Specifically, BECTS children performed worst on a subtest reflecting verbal attention, number/letter, with the next lowest score being on a visual attention subtest, finger windows, consistent with other findings

Acknowledgements

The authors wish to thank the site primary investigators and coordinators of this multicenter trial for their assistance with data collection.

This research was sponsored by a grant from Pfizer Pharmaceuticals Inc., Global Research Division. Drs. Garofalo and Sharma were employees of this company at the time that this study was conducted. Dr. Giordani has received limited consultation fees from this company. Dr. Giordani's spouse is employed by the company, thus, the family holds stock options

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