Abstract
Introduction: Continuous spikes and waves during slow sleep (CSWS), are characterized by marked activation of epileptic activity on electroencephalographic (EEG) recording during slow sleep. Their topographic distribution is not homogeneous, and this could be not random. The aim of our study is to describe topographic aspects of CSWS and look for correlation with patients age.
Patients and methods: We conducted a descriptive retrospective study in the neurophysiological department of the neurological service of Fan national university hospital in Dakar (Senegal), over a 2 years period. We studied topographical aspects of EEG anomalies of children whose recordings presented CSWS, then looked for correlation between the predominant diffusion region of these and the age of patients.
Results: The CSWS were found on 1.02% of the global sample EEG and 2.60% of the children EEG. The sex-ratio was 1.42. The age varied from 3 to 14 years at the time of the first recording with a mean age of 6.65 +/- 2.63 years. The predominant age group was 3 to 8 years (81%). The main indications were generalized tonico-clonic seizures, focal seizures and benign epilepsy with centro-temporal spikes. CSWS were predominant on the left hemisphere on awake as well as sleep EEG. During waking state, the basal activity was normal on 96.97% of the recordings, anomalies were found on 96.97%, and the major diffusion location were the peri-sylvian regions. Sleep architecture was altered for 63.49% of patients. Topographically, CSWS diffused predominantly in the temporal, central and frontal regions. Children with anterior predominant diffusion of CSWS were older than those with posterior predominant diffusion and the difference was statistically significant (p = 0,031).
Conclusion: CSWS topographic distribution is variable and likely age-related. Given that brain areas have functionnal specificities, this could orient neuropsychological tests in cognitive deficits.
Keywords: Fann; Continuous; Spikes; Waves; Sleep; Topographic; Age
Abbreviations: CSWS: Continuous Spikes and Waves During Slow Sleep; EEG: Electroencephalographic, Electroencephalogram; Or: Odds Ratio; CI: Confidence Interval
Introduction
Continuous spikes and waves during slow sleep (CSWS), are characterized by marked activation of epileptic activity on electroencephalographic (EEG) recording during slow sleep [1], acom panied by the occurrence of or increase of pre-existing spikes and waves, these becoming bilateral and continuous/subcontinuous [2]. The anomalies can occur during awakness, realizing isolated spikes and waves or bursts of spikes and waves [1-3]. They can be due to epileptic encephalopathy [4,5], but sometimes to some focal epilepsies, wether structural or not [6,7]. Thus, the syndrom (epileptic encephalopathy with CSWS) must be differentiated from the EEG pattern that can be seen in different clinical contexts [8]. Many aspects have been described regarding this EEG pattern. Indeed, considering topographic feature, many studies reported a non-homogeneous topographic distribution of the anomalies on EEG, with an either anterior or posterior predominant diffusion [9- 14]. This distribution is not random.
The aim of our study is to describe topographic aspects of EEG of patients presenting CSWS on their EEG recordings and to look for correlation between the topographic distribution and the age of patients.
Patients and Methods
We conducted a descriptive and retrospective study in the neurological department of the Fann national university hospital in Dakar, from June 1st, 2017 to May 31th 2019. The study population was all patients admitted at the neurophysiological department to undergo an EEG recording. We reviewed the recordings of all the children (age from 3 to 16 years) during this period. We included in the study, all EEG on which CSWS were identified, based on quantitative criteria consistent with spikes and waves index showing occupation by the anomalies of at least 50% of the period. We collected the personal data of patients, the EEG indications, the data related to EEG recording during waking state when it was done (basal activity aspects, other anomalies), then sleep EEG recording (sleep architecture aspects, other anomalies). Regarding anomalies, we precised their type, the spikes and waves index during sleep, their topographic characteristics (major diffusion : anterior if the predominant topography was fronto-central, fronto-temporal, centro-temporal or fronto-centro-temporal; posterior if the predominant topography was temporal posterior, pariéto-temporal, temporo-occipital or temporo-pariéto-occipital). Then we looked for correlation between the location of predominant diffusion and the age of the patients, using chi2 test. Data were analyzed with Microsoft Excel and described anonymously with respect for confidentiality for all patients.
Results
Epidemiological aspects
Six thousand sixty-eight patients have had an EEG recording between June 1st 2017 and May 31th 2019, of whom 2424 were 3 to 16 years old. During this period, 97 EEG showed CSWS, corresponding to 63 patients of whom 18 benefited from control EEG. The CSWS were found on 1.02% of the global sample and 2.60% of the children EEG. They were 37 (58,73%) male and 26 females (41,27%), with a sex-ratio of 1.42. The patients’ age at the time of the first recording varied from 3 to 14 years (Table 1), with a mean age of 6.65 +/- 2.63 years and a median of 6 years. On the whole sample including the 18 control EEG, the mean age was 7,39 +/- 1.41 years. The predominant age group was 3 to 8 years (81% of the total group) with a peak frequency at >4 to 6 years (34.92%) (Table 1).
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