Abstracts

Rationale: Benign childhood epilepsy with centrotemporal spikes (BECTS) is one of the most common pediatric epilepsy syndromes, accounting for 10-15% of children with epilepsy. Children can experience a varied seizure course and high incidence of neuropsychological comorbidities. Here we characterize the natural history of BECTS in a large prospective US cohort, evaluate prognostic factors of disease course, and whether clinical features and treatment are associated with neuropsychiatric outcomes. Methods: All children diagnosed with BECTS in the long term Connecticut Study of Epilepsy, a community-based prospective cohort study of children with newly diagnosed epilepsy, were included (n=61). Subjects were enrolled at diagnosis and contacted every 3 months to track disease course, medication, and neuropsychiatric status into young adulthood. Children with BECTS had a mean duration of follow-up of 15.86 +/- 3.38 years. Group comparisons between those treated and untreated were done using Mann-Whitney test and Welch’s t-test. The relationship between clinical variables and neuropsychological outcome was evaluated using a logistic regression model. Results: Average age of first and last seizure were 7.2 (range 3.1-10.6) and 10.0 years (range 4.3-22.3) (Figure 1, Table 1). Of the 61 children, 40 were treated with anticonvulsant medication (ACD). Age at first seizure did not correlate with the observed duration of disease (R2 =.00) nor the total number of seizures (R2=.03).There was no difference in mean age of first seizure (p=0.59), median early seizure frequency (p=.91), median duration of disease (time from first to last seizure) (p=.98), nor median total seizure count (p=0.11) between treated and untreated children. The median duration of ACD treatment was 3.0 years (range .7-10.8), which was significantly longer than the observed duration of disease in treated children (p=.02).After achieving 1 year seizure-free, 18/61 (29.5%) children experienced a relapse. 12 occurred in the treated group, 6 were attributed to missed or tapered ACD doses, and 7 were unexplained. In the untreated group, 1 had a clear provoking factor, and 4 were unexplained.18/61 (29.5%) reported at least one neuropsychiatric diagnosis over the duration of the follow-up period.Depression (n=12) and ADHD (n=11) were the most common diagnoses reported. Age at onset (p=0.38), observed duration of disease (p=0.25), and duration of ACD treatment (p=0.75) did not significantly predict neuropsychiatric complications. Seizure count was the strongest predictor of neuropsychiatric diagnoses (p=.004). Conclusions: This large prospective study demonstrates that age at first seizure is not an accurate prognostic marker, predicting neither number of seizures nor observed duration of disease.Nearly one-third of this cohort was diagnosed with a neuropsychiatric complication, with the major predicting factor of these diagnoses being total number of seizures. Funding: NINDS R37-NS31146, NINDS K23-NS092923