The effect of early therapy on school achievement in children with Self-limited Epilepsy with Centrotemporal Spikes

Purpose This study aimed to evaluate academic performance in children diagnosed with Self-limited Epilepsy with Centrotemporal Spikes (SeLECTS). Additionally, it sought to analyze the impact of early antiseizure medicine (ASM) therapy initiation on both academic outcomes and seizure control in pediatric SeLECTS patients. Patients and Methods: This retrospective study examined 107 children with SeLECTS admitted to the Epilepsy Center of Jinan Children's Hospital from May 2019 to July 2022. Inclusion criteria required children to be over 8 years old at final follow-up and have undergone medication for a minimum of two years. The spike wave index (SWI) was calculated by summing spikes during 5 minutes of drowsiness and Non-REM stage 2 sleep, with analysis conducted in two groups: ≥ 50% and < 50%. EEG improvement, based on SWI% resolution, was categorized as good response (≥ 50% decrease in SWI) or poor response (< 50% decrease in SWI), determined through two-year sequential follow-up EEG recordings compared to baseline. School achievement was evaluated using standardized Primary and Secondary School Achievement Tests in China. Results All cases had more than 2 years of follow-up, and 94 children (87.9%) were seizure-free. All children completed the Primary and Secondary School Achievement Tests, with 64 (59.8%) children displaying high achievement (score ≥ 70) and 43 (40.2%) children displaying low achievement (score < 70) on the most recent test. The factors significantly associated (p < 0.05) with scores were the number of ASMs and seizure numbers before treatment. Children who experienced more seizures before treatment (≥ 5) and had lower SWI reduction (≤ 50%) demonstrated poorer seizure outcomes. Older onset age correlated with a good response in SWI reduction (> 50%). In multivariate logistic regression analysis, only seizure numbers before treatment were significantly associated with school achievement. Conclusions This study emphasizes the significance of initiating ASM therapy early in children diagnosed with SeLECTS. The results underscore the necessity for a tailored treatment approach, considering both clinical manifestations and electroencephalogram (EEG) characteristics to enhance outcomes for pediatric patients with SeLECTS.