ICNC Abstracts, ICNC 2018

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Continuous Spikes and Waves during Slow-Wave Sleep (CSWS) in Children: The Epilepsy Syndrome that Can’t Stop, Won’t Stop
Arushi Gahlot Saini, Naveen Sankhyan, Prahbhjot Malhi, Niranjan Khandelwal, Pratibha Singhi

Last modified: 2018-09-09


Purpose: To study pattern of continuous spikes-and-waves during slow-wave sleep (CSWS) epilepsy in children from a tertiary-care centre in a developing country

Methods: Retrospective and prospective study of electro-clinical, radiological characteristics, treatment and short-term prognosis of 42 children (age-group 1-14 years) with electrical-status-epilepticus covering >85% of non-REM sleep.

Results: Mean age of presentation was 6.6+2.2 years (range 3.25-11 years). The first neurological symptom was developmental delay (45.2%, n=19), seizures (45.2%, n=19), behavioural problems (7.1%, n=3) or language delay (2.4%, n=1). Predominant seizure types were focal (66.6%, n=28), generalized (64.3%, n=27) and atypical-absences (47.6%, n=20). Mean age at clinical deterioration was 5.3+2 years; mean age at detection of electrical-status was 6.4+2.2 years. Magnetic-resonance-imaging showed normal scan (26.2%, n=11); polymicrogyria/pachymicrogyria (19%, n=18), unilateral structural changes (7.2%, n=3),  old intracranial-bleed (7.1%, n=3), hypoglycaemic insult (4.8%, n=2), hypoxic-ischemic changes (4.8%, n=2), hydrocephalus (2.4%, n=1), ischemic stroke (2.4%, n=1) and miscellaneous changes (26%, n=11). Pulse-corticosteroid was administered in 83.3% (n=35) and intravenous immunoglobulin in 9.5% (n=4) patients. Mean duration of follow-up was 23.4+16.5 months (range 4-96 months). Five (11.9%) had resolution of seizures and electrical status, 3 (7.2%) had resolution of seizures and normalization of electroencephalographs, seizure persisted despite resolution of electrical-status in 6 (14.3%) while majority (n=28, 66.7%) had persistence of seizures and electrical-status-epilepticus in sleep.

Conclusions: This is the largest clinical series of CSWS from India. CSWS should be considered in children with polymorphic seizures and behavioural or cognitive deterioration. Significant proportions have residual neurological problems at short term follow-up.


Continuous Spikes and Waves during Slow-Wave Sleep; Electrical Status Epilepticus; Epilepsy; Children; Epileptic encephalopathy

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