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01-04-2022 | Mood Disorders | Review

Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment

Authors: Ronald J. Swatzyna, Martijn Arns, Jay D. Tarnow, Robert P. Turner, Emma Barr, Erin K. MacInerney, Anne M. Hoffman, Nash N. Boutros

Published in: European Child & Adolescent Psychiatry | Issue 4/2022

Abstract

In the field of psychiatry diagnoses are primarily based on the report of symptoms from either the patient, parents, or both, and a psychiatrist’s observations. A psychiatric diagnosis is currently the most widely used basis for medication selection and the brain is seldom investigated directly as a source of those symptoms. This study addresses the request from the National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC) for scientific research into neurological abnormalities that can be linked to psychiatric symptoms for the purpose of predicting medication response. One such neurological abnormality that has been the focus of many studies over the last three decades is isolated epileptiform discharges (IEDs) in children and adolescents without seizures. We conducted a systematic review of the literature to determine prevalence rates of IEDs within diagnostic categories. We then compared the prevalence of IEDs in the selected literature to our IRB-approved data archive. Our study found a consistent high prevalence of IEDs specifically for ADHD (majority > 25%) and ASD (majority > 59%), and consistent low prevalence rates were found for Depression (3%). If children and adolescents have failed multiple medication attempts, and more than one-third of them have IEDs, then an EEG would be justified within the RDoC paradigm.

Insel T (2013) Director’s blog: transforming diagnosis. https://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. Accessed 3 Oct 2014

Olbrich S, Dinteren RV, Arns M (2015) Personalized medicine: review and perspectives of promising baseline EEG biomarkers in major depressive disorder and attention deficit hyperactivity disorder. Neuropsychobiology 72(3–4):229–240. https://doi.org/10.1159/000437435CrossRefPubMed

Widge AS, Bilge MT, Montana R, Chang W, Rodriguez CI, Deckersbach T, Carpenter LL, Kalin NH, Nemeroff CB (2018) Electroencephalographic biomarkers for treatment response prediction in major depressive illness: a meta-analysis. AM J Psychiatry 176(1):44–56. https://doi.org/10.1176/appi.ajp.2018.17121358CrossRefPubMedPubMedCentral

Boutros NN, Kirollos SB, Pogarell O, Gallinat J (2014) Predictive value of isolated epileptiform discharges for a favorable therapeutic response to antiepileptic drugs in nonepileptic psychiatric patients. J Clin Neurophysiol 31(1):21–30. https://doi.org/10.1097/WNP.0000000000000023CrossRefPubMed

Bridgers SL (1987) Epileptiform abnormalities discovered on electroencephalographic screening of psychiatric inpatients. Arch Neurol 44(3):312–316. https://doi.org/10.1001/archneur.1987.00520150056022CrossRefPubMed

Shelley BP, Trimble MR, Boutros NN (2008) Electroencephalographic cerebral dysrhythmic abnormalities in the trinity of nonepileptic general population, neuropsychiatric, and neurobehavioral disorders. J Neuropsychiatry Clin Neurosci 20(1):7–22. https://doi.org/10.1176/appi.neuropsych.20.1.7CrossRefPubMed

Zimmerman EM, Konopka LM (2013) Preliminary findings of single- and multifocused epileptiform discharges in nonepileptic psychiatric patients. Clin EEG Neurosci 45(4):285–292. https://doi.org/10.1177/1550059413506001CrossRefPubMed

Arns M, Gordon E, Boutros N (2015) EEG abnormalities are associated with poorer depressive symptom outcomes with escitalopram and venlafaxine-xr, but not sertraline. Clin EEG Neurosci 48(1):33–40. https://doi.org/10.1177/1550059415621435CrossRefPubMed

Van der Vinne N, Vollebregt MA, Boutros NN, Fallahpour K, van Putten MJAM, Arns M (2019) Normalization of EEG in depression after antidepressant treatment with sertraline: a preliminary report. J Affect Disord 259:67–72. https://doi.org/10.1016/j.jad.2019.08.016CrossRefPubMed

10.

Swatzyna RJ, Tarnow JD, Tannous JD, Pillai V, Schieszler C, Kozlowski GP (2014) EEG/QEEG technology identifies neurobiomarkers critical to medication selection and treatment in refractory cases. J Psychol Clin Psychiatry 1(7):00046. https://doi.org/10.15406/jpcpy.2014.01.00046CrossRef

11.

Boutros NN (2014) Standard EEG: a research roadmap for neuropsychiatry. Springer, Cham

12.

Terrone G, Pauletti A, Pascente R, Vezzani A (2016) Preventing epileptogenesis: a realistic goal? Pharmacol Res 110:96–100. https://doi.org/10.1016/j.phrs.2016.05.009CrossRefPubMed

13.

Dichter MA (2009) Emerging concepts in the pathogenesis of epilepsy and epileptogenesis. Arch Neurol 66(4):443–447. https://doi.org/10.1001/archneurol.2009.10CrossRefPubMed

14.

Gregory R, Oates T, Merry R (1993) Electroencephalogram epileptiform abnormalities in candidates for aircrew training. Electroencephalogr Clin Neurophysiol 86(1):75–77. https://doi.org/10.1016/0013-4694(93)90069-8CrossRefPubMed

15.

Lee EH, Choi YS, Yoon HS, Bhan GH (2015) Clinical impact of epileptiform discharge in children with attention-deficit/hyperactivity disorder (ADHD). J Child Neurol 31(5):584–588. https://doi.org/10.1177/0883073815604223CrossRefPubMed

16.

Arns M, Gunkelman J, Breteler M, Spronk D (2008) EEG phenotypes predict treatment outcome to stimulants in children with adhd. J Integr Neurosci 7(3):421–438. https://doi.org/10.1142/s0219635208001897CrossRefPubMed

17.

Swatzyna RJ, Tarnow JD, Roark A, Mardick J (2017) The utility of EEG in attention deficit hyperactivity disorder: a replication study. Clin EEG Neurosci 48(4):243–245. https://doi.org/10.1177/1550059416640441CrossRefPubMed

18.

Millichap JG, Millichap JJ, Stack CV (2011) Utility of the electroencephalogram in attention deficit hyperactivity disorder. Clin EEG Neurosci 42(3):180–184. https://doi.org/10.1177/155005941104200307CrossRefPubMed

19.

Kanazawa O (2014) Reappraisal of abnormal EEG findings in children with adhd: on the relationship between adhd and epileptiform discharges. Epilepsy Behav 41:251–256. https://doi.org/10.1016/j.yebeh.2014.09.078CrossRefPubMed

20.

Kanemura H, Sano F, Tando T, Hosaka H, Sugita K, Aihara M (2013) EEG improvements with antiepileptic drug treatment can show a high correlation with behavioral recovery in children with ADHD. Epilepsy Behav 27(2013):443–448. https://doi.org/10.1016/j.yebeh.2013.03.014CrossRefPubMed

21.

Hughes JR, DeLeo AJ, Melyn MA (2000) The electroencephalogram in attention deficit-hyperactivity disorder: emphasis on epileptiform discharges. Epilepsy Behav 1(4):271–277. https://doi.org/10.1006/ebeh.2000.0073CrossRefPubMed

22.

Hayashi K, Makino M, Hashizume M, Nakano K, Tsuboi K (2010) Electroencephalogram abnormalities in panic disorder patients: a study of symptom characteristics and pathology. Biopsychosoc Med. https://doi.org/10.1186/1751-0759-4-9CrossRefPubMedPubMedCentral

23.

Kawasaki Y, Yokota K, Shinomiya M, Shimizu Y, Niwa S (1997) Brief report: electroencephalographic paroxysmal activities in the frontal area emerged in middle childhood and during adolescence in a followup study of autism. J Autism Dev Disord 27(5):605–620. https://doi.org/10.1023/a:1025886228387CrossRefPubMed

24.

Hughes JR, Melyn M (2005) Eeg and seizures in autistic children and adolescents: further findings with therapeutic implications. Clin EEG Neurosci 36(1):15–20. https://doi.org/10.1177/155005940503600105CrossRefPubMed

25.

Mulligan CK, Trauner DA (2013) Incidence and behavioral correlates of epileptiform abnormalities in autism spectrum disorders. J Autism Dev Disord 44(2):452–458. https://doi.org/10.1007/s10803-013-1888-6CrossRef

26.

Reinhold JA, Molloy CA, Manning-Courtney P (2005) Electroencephalogram abnormalities in children with autism spectrum disorders. J Neurosci Nurs 37(3):136–138CrossRef

27.

Hashimoto T, Sasaki M, Sugai K, Hanaoka S, Fukumizu M, Kato T (2001) Paroxysmal discharges on EEG in young autistic patients are frequent in frontal regions. J Med Invest 48(3–4):175–180PubMed

28.

Chez MG, Chang M, Krasne V, Coughlan C, Kominsky M, Schwartz A (2006) Frequency of epileptiform EEG abnormalities in a sequential screening of autistic patients with no known clinical epilepsy from 1996 to 2005. Epilepsy Behav 8(1):267–271. https://doi.org/10.1016/j.yebeh.2005.11.001CrossRefPubMed

29.

Swatzyna RJ, Tarnow JD, Turner RP, Roark AJ, Macinerney EK, Kozlowski GP (2017) Integration of EEG into psychiatric practice: a step toward precision medicine in autism spectrum disorder. J Clin Neurophysiol 34(3):230–235. https://doi.org/10.1097/wnp.0000000000000365CrossRefPubMed

30.

Inui K, Motomura E, Okushima R, Kaige H, Inoue K, Nomura J (1998) Electroencephalographic findings in patients with DSM-IV mood disorder, schizophrenia, and other psychotic disorders. Biol Psychiatry 43(1):69–75. https://doi.org/10.1016/S0006-3223(97)00224-2CrossRefPubMed

31.

Parmeggiani A, Barcia G, Posar A, Raimondi E, Santucci M, Scaduto MC (2010) Epilepsy and EEG paroxysmal abnormalities in autism spectrum disorders. Brain Dev 32(9):783–789. https://doi.org/10.1016/j.braindev.2010.07.003CrossRefPubMed

32.

Yasuhara A (2010) Correlation between EEG abnormalities and symptoms of autism spectrum disorder (asd). Brain Dev 32(10):791–798. https://doi.org/10.1016/j.braindev.2010.08.010CrossRefPubMed

33.

Tjepkema-Cloostermans MC, de Carvalho RCV, van Putten MJAM (2018) Deep learning for detection of focal epileptiform discharges from scalp EEG recordings. Clin Neurophysiol 129(10):2191–2196. https://doi.org/10.1016/j.clinph.2018.06.024CrossRefPubMed

34.

Grossi E, Buscema M, Della Torre F, Swatzyna RJ (2019) The “MS-ROM/IFAST” model, a novel analysis technique, distinguishes asd subjects from children affected with other neuropsychiaric disorders with high degree of accuracy. Clin EEG and Neurosci 50(5):319–331. https://doi.org/10.1177/1550059419861007CrossRef

35.

Swatzyna RJ, Tarnow JD, Proler ML, Roark AJ, MacInerney EK, Kozlowski GP (2017) Retrospective analysis of nonepileptic patients with isolated epileptiform discharges treated with anticonvulsants. Clin EEG Neurosci 48(5):322–326. https://doi.org/10.1177/1550059417695896CrossRefPubMed

36.

Kotchoubey B, Strehl U, Uhlmann C, Holzapfel S, König M, Fröscher W, Birbaumer N (2001) Modification of slow cortical potentials in patients with refractory epilepsy: a controlled outcome study. Epilepsia 42(3):406–416. https://doi.org/10.1046/j.1528-1157.2001.22200.xCrossRefPubMed

37.

Sterman MB, Egner T (2006) Foundation and practice of neurofeedback for the treatment of epilepsy. Appl Psychophysiol Biofeedback 31(1):21–35. https://doi.org/10.1007/s10484-006-9002-xCrossRefPubMed

38.

Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA (2009) Meta-analysis of EEG biofeedback in treating epilepsy. Clin EEG Neurosci 40(3):173–179. https://doi.org/10.1177/155005940904000310CrossRefPubMed

39.

Zaimoğlu S, Türkdoğan D, Mazlum B, Bekiroğlu N, Tetik-Kabil A, Eyilikeder S (2015) When is eeg indicated in attention-deficit/hyperactivity disorder? J Child Neurol 30:1785–1793CrossRef

Title: Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment
Authors: Ronald J. Swatzyna
Martijn Arns
Jay D. Tarnow
Robert P. Turner
Emma Barr
Erin K. MacInerney
Anne M. Hoffman
Nash N. Boutros
Publication date: 01-04-2022
Publisher: Springer Berlin Heidelberg
Keywords: Mood Disorders
Autism Spectrum Disorder
Affective Disorder
Electroencephalography
Published in: European Child & Adolescent Psychiatry / Issue 4/2022
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-020-01597-2

2024 ASCO Annual Meeting

Springer Medicine

Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

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