Benign epilepsy with centrotemporal spikes (BECTS) is the most common childhood epilepsy syndrome, accounting for 20% of all childhood epilepsy and characterized by a transient period of seizure susceptibility of uncertain duration in school-age children. Despite extensive clinical experience with this disease, it remains a challenge to determine who will benefit from antiepileptic drug (AED) trea
tment and when it is safe to discontinue. Current clinical practice requires a trial-and-fail method for AED initiation and discontinuation with wide variability and controversy in treatment strategies across practitioners. Although non-treatment or premature taper may result in seizures and injury, chronic AED exposure is also not benign and may cause attentional deficits, aggression, hostility, nervousness, and somnolence in 30-70% of exposed children. A biomarker to isolate which children are at risk for ongoing seizures would help to avoid the unnecessary consequences of over- or under-medication during critical years of cognitive, psychosocial and behavioral maturation in this large cohort of children. In this work, we use advanced, safe, non-invasive multimodal recording techniques from quantitative neurophysiology, structural, and functional neuroimaging to develop objective measures of seizure risk and cognitive function in children with BECTS. By focusing on this unique, well-characterized, though poorly understood patient population over the course of this transient disease, we also aim to identify candidate biomarkers of seizure risk which may have a broader relevance to other epilepsy syndromes.
