Childhood Absence Epilepsy Associated With Concomitant Centrotemporal Spikes

Objectives
The coexistence of generalized epileptiform discharges of 3Hz spike-and-wave complexes, which are the
hallmark of childhood absence epilepsy (CAE), and centrotemporal spikes, which are characteristic of benign
epilepsy with centrotemporal spikes (BECTs) in the same or subsequent EEGs appears to be very rare. Only a
few published reports have shown a possible concomitance of CAE and BECTs electrographic changes. The
study aimed to analyze electrographic and clinical features of patients with CAE who had concomitant or
subsequent EEG features of BECTs.
Method
During a five-year analysis period (2014-2018), 277 children with BECTs and 93 children with CAE were
diagnosed and treated at the pediatric neurology unit of Sultan Qaboos University Hospital (SQUH) in
Muscat, Oman. Nine patients were identified to have overlapping EEG findings of both epileptic syndromes.
We then analyzed the nine children's clinical features, outcomes, and EEG findings in detail.
Results
The clinical onset of all our patients aged 5-14 years (six boys, three girls) was characterized by the absence
of seizures, either typical (seven children) or atypical (two children). Six out of nine patients presented with
concomitant electrographic features of both syndromes, whereas three patients experienced the EEG pattern
of two syndromes at different times. All nine children were treated with valproate as the first-line
medication, with reasonable seizure control. However, three patients required a second add-on medication.
Despite good seizure control, six of our patients had poor school performance and five children had
comorbid conditions such as ADHD and learning disability.
Conclusion
The coexistence of CAE and BECTS is described in the literature albeit rare. This overlap is mostly in
electrographic features with or without the clinical features seen in both syndromes.