content:self_limited_epilepsy_with_centrotemporal_spikes_selects

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content:self_limited_epilepsy_with_centrotemporal_spikes_selects [2024/03/23 19:22] – biju.hameed@gmail.comcontent:self_limited_epilepsy_with_centrotemporal_spikes_selects [2024/03/23 19:44] (current) – [Treatment] biju.hameed@gmail.com
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   * Triphasic, high-voltage (100-microvolts to 300microvolts) sharp waves (initial low-amplitude positivity, then high amplitude negativity followed again by low amplitude positivity), with a transverse dipole (frontal positivity, temporo-parietal negativity), often followed by a high voltage slow wave.    * Triphasic, high-voltage (100-microvolts to 300microvolts) sharp waves (initial low-amplitude positivity, then high amplitude negativity followed again by low amplitude positivity), with a transverse dipole (frontal positivity, temporo-parietal negativity), often followed by a high voltage slow wave. 
   * The discharges may be isolated or occur in trains of doublets and triplets, and focal, rhythmic, slow activity is occasionally observed in the same region as the spikes.    * The discharges may be isolated or occur in trains of doublets and triplets, and focal, rhythmic, slow activity is occasionally observed in the same region as the spikes. 
-  * The discharges may be unilateral or bilateral and independent FIXME(Figure 2A)+  * The discharges may be unilateral or bilateral and independent
   * There may be discharges seen outside the centrotemporal region (midline, parietal,frontal, occipital).    * There may be discharges seen outside the centrotemporal region (midline, parietal,frontal, occipital). 
   * A marked increase in the frequency of epileptiform activity in drowsiness and sleep always occurs.   * A marked increase in the frequency of epileptiform activity in drowsiness and sleep always occurs.
-  * The EEG pattern may also change such that sharp- or spike-and-slow waves have a broader field and become bilaterally synchronous FIXME(Figure 2B). +  * The EEG pattern may also change such that sharp- or spike-and-slow waves have a broader field and become bilaterally synchronous 
   * In 10-20% of children, centrotemporal sharp- or spike-and-slow wave may be activated by sensory stimulation of the fingers or toes   * In 10-20% of children, centrotemporal sharp- or spike-and-slow wave may be activated by sensory stimulation of the fingers or toes
-  * Seizures may be accompanied by a brief decrease in amplitude of the background EEG, followed by diffuse sharp wave discharges of increasing amplitude, predominantly in one centrotemporal region41, followed by high amplitude slowing and then a return to the usual interictal EEG (Figure 2C).  +  * Seizures may be accompanied by a brief decrease in amplitude of the background EEG, followed by diffuse sharp wave discharges of increasing amplitude, predominantly in one centrotemporal region, followed by high amplitude slowing and then a return to the usual interictal EEG.  
-  * With focal to bilateral tonic-clonic seizures, ictal rhythms may become bilaterally synchronous (as opposed to generalized) sharp- or spike-and slow-wave activity 42–44+  * With focal to bilateral tonic-clonic seizures, ictal rhythms may become bilaterally synchronous (as opposed to generalized) sharp- or spike-and slow-wave activity
  
 ==== Genetics ==== ==== Genetics ====
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   * Patients with SeLECTS may show "atypical" symptoms, such as starting their seizures early (<4 years old), having side effects from AEDs, having different types of seizures, having seizures that can't be controlled or a history of status epilepticus, having seizures during the day, having atypical EEG abnormalities or peculiar EEG abnormalities activation during sleep, and having developmental delay or neurologic deficits before the seizures start.  It is important carry out cognitive and neuropsychological assessments at the time of diagnosis and during the follow-up to trace the trajectories of neuropsychological development of these patients more deeply.   * Patients with SeLECTS may show "atypical" symptoms, such as starting their seizures early (<4 years old), having side effects from AEDs, having different types of seizures, having seizures that can't be controlled or a history of status epilepticus, having seizures during the day, having atypical EEG abnormalities or peculiar EEG abnormalities activation during sleep, and having developmental delay or neurologic deficits before the seizures start.  It is important carry out cognitive and neuropsychological assessments at the time of diagnosis and during the follow-up to trace the trajectories of neuropsychological development of these patients more deeply.
  
-==== References ====+==== Treatment ====
  
-====== Editors ======+  * As the seizures associated with SeLECTS often stop around the age of puberty, it is not clear whether it is necessary to prescribe ASMs to all children who present with this condition. 
 +  * When considering the use of antiseizure medications for SeLECTS, it is important to have a thorough discussion with the individual, their family, and caregivers (if applicable). This discussion should focus on developing a personalized medication strategy based on the specific epilepsy syndrome, treatment objectives, and the preferences of the individual and their family or caregivers. 
 +  * lamotrigine and levetiracetam should be considered as first-line treatment[(:cite:978-1-4731-4513-9>National Guideline Alliance (UK). Effectiveness of antiseizure medications for self-limited epilepsy with centrotemporal spikes: Epilepsies in children, young people and adults: Evidence review Q. London: National Institute for Health and Care Excellence (NICE); 2022 Apr. (NICE Guideline, No. 217.) Available from: [[https://www.ncbi.nlm.nih.gov/books/NBK581163/]])] 
 +  * As second-line treatment, carbamazepine, oxcarbazepine and zonisamide are recommended 
 +  * school performance is a good indicator of cognition since it measures processing and retention.If any deterioration is noted, an EEG should be performed to exclude [[content:developmental_and:or_epileptic_encephalopathy_with_spike-wave_activation_in_sleep_d:ee-swas|Developmental and/or epileptic encephalopathy with spike-wave activation in sleep D/EE-SWAS]]. A neuropsychology assessment to review academic performance should also be performed.
  
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-====== Editors ====== +==== References ====
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-~~AUTHORS~~ +
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-====== Editors ====== +
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