Abstracts

We report on a large series ([gt]25) of pediatric patients who presented to our neurology practice with various neurologic referable complaints, excluding clinical seizure activity, who were discovered to have EEG abnormalities. Patient ages varied from 3-18years. Symptoms included headache with vertigo, vertigo, visual field alterations including Alice-in -Wonderland changes and atypical speech/language dyspraxia. Prior to presentation, there had been no history of seizure or seizure like activity noted in any of the patients by history and record review. Routine surface EEG was completed on these patients as part of the workup. Findings included focal sharp wave discharges, focal spike and wave discharges, rhythmic slowing and generalized bursts of spike and polyspike and wave discharges of the non-absence type. A significant percentage also activated with sleep. Neuroimaging was normal in all cases. Therapeutic intervention varied and included the use of antiepileptic medications. A positive response to symptoms ([gt]50% improvement in symptoms) was noted in [gt]50% of patients. Of the initial nonresponders, a second antiepileptic medication was tried. Of those who did not respond to 2 medication trials, discontinuation of medication was recommended. No significant adverse events were reported for any patients who were treated. In conclusion, EEG abnormalities can be seen in pediatric patients with atypical neurologic complaints without clinical seizures.How these electrographic abnormalities contribute to symptoms is unclear. Additionally, guidelines for medication intervention will need to be established, though further investigation will be required. Given these finding and significantly positive clinical response in this limited number of patients, EEG should be considered frequently in the diagnostic evaluation of similar pediatric patients.