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

European Child & Adolescent Psychiatry (2020)Cite this article

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.

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Data availability

The data from our cross-sectional data review can be made upon request.

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Acknowledgements

We would like to thank Judy Crawford and Loree Munro for their editing work they did on this paper.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Affiliations

  1. Houston Neuroscience Brain Center, Houston, TX, USA

    Ronald J. Swatzyna, Emma Barr, Erin K. MacInerney & Anne M. Hoffman

  2. Clinical NeuroAnalytics, 1307 Oceanside Lane, League City, TX, 77573, USA

    Ronald J. Swatzyna

  3. Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands

    Martijn Arns

  4. Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands

    Martijn Arns

  5. The Tarnow Center for Self-Management, Houston, USA

    Jay D. Tarnow

  6. Network Neurology Health, Charleston, SC, USA

    Robert P. Turner

  7. Clinical Pediatrics and Neurology, USC School of Medicine, Columbia, SC, USA

    Robert P. Turner

  8. School of Medicine, RUSH University, Kansas City, MO, USA

    Nash N. Boutros

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  1. Ronald J. Swatzyna
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Contributions

RS, EB, MH, developed the original draft and started constructing the table. RS, EB, MA, NB, RT, and JT further developed the study with EB, MH, and EM compiling the relevant studies and completing the tables. RS, MA, NB, RT, and JT, expanded the scope of the study and developed the conclusions. RS, MA, NB, RT, JT, EB, MH, and EM as a group approved the final manuscript.

Corresponding author

Correspondence to Ronald J. Swatzyna.

Ethics declarations

Conflict of interest

MA is unpaid research director of the Brainclinics Foundation, a minority shareholder in neuroCare Group (Munich, Germany), reports options from Brain Resource (Sydney, Australia); and is a co-inventor on four patent applications (A61B5/0402; US2007/0299323, A1; WO2010/139361 A1) related to EEG, neuromodulation and psychophysiology, but does not own these nor receives any proceeds related to these patents; Research Institute Brainclinics received research funding from Brain Resource (Sydney, Australia), UrgoTech (Paris, France) and neuroCare Group (Munich, Germany), and equipment support from Brainsway, Deymed, neuroConn and Magventure. The author declares no conflicts of interest with respect to the research, authorship, and/or publication of this article. The other authors declare that they have no conflict of interest.

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The manuscript does not contain clinical studies or patient data.

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Swatzyna, R.J., Arns, M., Tarnow, J.D. et al. Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment. Eur Child Adolesc Psychiatry (2020). https://doi.org/10.1007/s00787-020-01597-2

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  • DOI: https://doi.org/10.1007/s00787-020-01597-2

Keywords

  • RdoC
  • Children
  • Adolescents
  • EEG
  • Isolated epileptiform discharges
  • Prevalence
  • Psychiatric symptoms
  • Autism spectrum disorder
  • Attention deficit hyperactivity disorder