The Applied Study Of The Video Electroencephalography Monitoring In Benign Childhood Epilepsy With Centrotemporal Spikes

Objective:The purpose is to analyze the monitoring data of video electroencephalography(VEEG) in benign childhood epilepsy with centrotemporal spikes(BECT),and to summarize the characteristics of EEG during the onset and seizure of BECT.Combined with the clinical characteristics of BECT children,we discuss the diagnosis and classification of BECT by VEEG monitoring technology,and it can also guide the early rational use of antiepileptic drugs andindicate the value of prognosis.Methods:119 children with BECT diagnosed in the outpatient or inpatient department of Jiangxi Children’s Hospital from August 2017 to December 2018 were monitored with Nicolet EEG V32 or M40 video-EEG monitor produced by Natus Company for 3 or 12 hours,including waking period and at least one complete sleep cycle.Retrospective analysis of video-EEG data,summarize the characteristics of seizure and interseizure EEG and its clinical seizure characteristics,follow-up of the efficacy of antiepileptic drugs,clear the diagnosis of BECT,provide the basis for the classification of BECT,guide clinical rational drug use,and prompt the prognosis of BECT.Results:(1)68.91% of BECT children aged 5~10 years had onset,and the ratio of male to female is 1.70:1.81.51% of the attacks lasted less than 5 minutes,83.20% of the nighttime sleep attacks,and 58.83% of the attacks were partial secondary generalized seizure.80 cases were treated with antiepileptic drugs,45.38% were treated with single drug.9 cases had family history(7.56%),9 cases had fever convulsion(7.56%) and 9 cases had abnormal MRI(7.56%).(2)55 cases(46.22%) had bilateral discharges and 53.78%had unilateral discharges;15.12% had only sleep discharges;most of the discharges were in one phase(42.02%) and two phases(31.93%);the spike/sharp and slow wave complex frequencies were in 2~3 Hz(52.96%) and 3~4 Hz(36.97%);the spike/spike wave frequencies were in 8~10 Hz(45.38%) and 10~12 Hz(39.50%);61.34% had generalized discharges.The seizures were detected in 5 cases(4.20%).(3)Of 119 children with BECT,96(80.67%) were in typical BECT group and23(19.33%) were in variant BECT group.Bilateral discharges(69.57%) were more common in variant BECT group(X~2=6.25,p=0.01),and the onset age was younger(F=0.10,p=0.00),children less than 5 years old was more common in variant BECT(continuous correctionX~2=3.83,p=0.05).In the variant BECT group,the discharges were easily generalized(X~2=35.06,p=0.00).The highest discharge amplitude of typical BECT group was significantly lower than that of variant BECT group(Z=-5.64,p=0.00),while the spike/sharp and slow wave complex frequency of typical BECT group was more than 3 Hz(X~2=5.03,p=0.03).The variant BECT group was often treated(X~2=10,46,p=0.00).(4)The older patients with BECT were less susceptible to generalization(max X~2=3.25,p=0.00),and the shorter course of BECT patients were also less susceptible(X~2=-2.09,p=0.04).When continue 5 minutes discharge index in the first non-rapid eye movement sleep(NREM)period was more than 40%,the age of onset was younger(t=-2.56,p=0.01).The age of onset was younger when the longest discharge duration was more than 5 seconds(t=-2.37,p=0.02).The duration of the disease was longer in children with discharge maximum amplitude(>260 MV)(t=2.08,p=0.04),and the onset age was younger(t=-2.48,p=0.02).(5)The highest discharge amplitude of untreated children was lower than that of treated children(Z=-2.35,p=0.02),and the duration of untreated children was shorter(Z=-5.56,p=0.00),and the longest discharge duration was shorter(Z=-2.01,p=0.04).Generalized discharge occurred more frequently in the treatment group(X~2=8.05,p=0.01).(6)Generalization was rare in those with the lowest discharge amplitude(Z=-7.53,p=0.00),but it was easier in children with spike/sharp and slow wave complex frequency<3 Hz(X~2=4.65,p=0.03).Children with lower continue 5minutes discharge index in the first NREM period were less susceptible to generalization(X~2=-6.74,p=0.00),and those with the longest discharge duration were less susceptible to generalization(Z=-6.97,p=0.00).In the first NREM period,the highest discharge amplitude was higher in children whose continue 5 minutes discharge index in the first NREM period was more than 40%(t=5.58,p=0.00).The highest amplitude of discharges in children with spike/sharp and slow wave complex frequency(≥3 Hz)was significantly lower than that in children with<3 Hz(t=-3.92,p=0.00).The discharge phases of children with<3 Hz were less than 2(X~2=-7.01,p=0.01);the highest amplitude of discharge was relatively lower in children with discharge phases≥2(t=2.17,p=0.02);the discharge phases of children were less than 3,when discharges appeard in waking and sleeping states(continuous correction X~2=4.94,p=0.01).The maximum discharge amplitude are higher,when the maximum discharge duration was more than 5 seconds(t=5.85,p=0.00).The continue 5 minutes discharge index in the first NREM period was relatively lower(Z=-2.35,p=0.02)in unilateral discharge.(7)Bilateral discharges were more common in children with seizures after 6 months of follow-up(X~2=10.16,p=0.00).The age of onset in uncontrolled group was younger than that in controlled group(t=-2.34,p=0.02).46.15%(12/26) of children with onset age less than 6 years old had uncontrolled episodes,which was significantly higher than 20.45%(9/44) of children with onset age more than 6 years old(χ~2=5.14,p=0.02).Conclusion:(1)BECT boys are more frequent,the onset age is mostly concentrated in 5-10 years old,the onset time is short,and closely related to sleep,the onset type is mostly partial secondary to comprehensive seizures.(2)VEEG monitoring is irreplaceable in BECT diagnosis and differential diagnosis.The proportion of unilateral and bilateral discharges in Rolandic area during the interparoxysmal period is similar.15.12% only occurred in the sleep period,and the detection rate of discharge increased during the sleep period;mainly in one or two discharge phases;most of the spike/sharp and slow wave complex frequencies were 2~4 Hz;spike/sharp wave frequencies were 8~12 Hz;discharge was limited and could be generalized.(3)VEEG plays an important role in the classification of BECT.When the onset of BECT is less than 5 years old,the frequency of spike/sharp and slow wave complex is less than 3 Hz,the discharge is bilateral,there is generalization,and the maximum discharge amplitude is high,the variant probability increases obviously.(4)Children with BECT usually need treatment,when the highest discharge amplitudes are high,the courses of disease are long,the longest discharge durations are long,and the discharges are generalied.(5)The continue 5 minutes discharge index in the first NREM period is lower when unilateral discharge occurs,and when that is low,the discharge generalization is less and the maximum discharge amplitude is lower.In children with spike/sharp and slow wave complex frequency(≥3Hz),the highest discharging amplitude is low,the type of phase(≥2),and the highest discharging amplitude is low.(6)Bilateral discharges were more common in children who still had seizures half a year after treatment.The younger the age,the more difficult the seizure is to control;the seizure is more difficult to control in children with BECT whose onset age is less than 6 years old.