Co-existence of self-limited focal epilepsies of childhood (SelFEC) and epileptiform discharges in the context of SelFEC in children with structural focal epilepsies and in children with brain lesions

The co-occurrence of self-limited focal epilepsies of childhood (SelFEC) and epileptiform discharges in the context of SelFEC (EDSelFEC) in children with structural focal epilepsies and with brain lesions has received little attention in the literature to date, mainly in the form of case reports. The few reports on the occurrence of EDSelFEC and SelFEC in children who have undergone presurgical evaluation due to focal seizures that cannot be controlled by medication also suggests that these are relatively rare constellations. Recent publications, on the other hand, are showing that in children who have suffered pre-/perinatal complications, the incidence and prevalence of EDSelFEC and SelFEC are relatively high, especially when the white matter is damaged. The pathophysiology that leads to the generation of EDSelFEC and SelFEC, when the white matter is damaged, is not fully understood. A surprisingly high number of abnormalities is detected when magnetic resonance imaging is performed systematically on children with self-limited epilepsy with centrotemporal spikes (SelECTS). A misunderstanding of EDSelFEC and SelFEC as expressions of epileptogenic focal structural (cortical) lesions can, in individual cases, lead to a significant deterioration of epilepsy due to the administration of potentially aggravating medications, such as sodium channel blockers, and in children who have suffered pre-/perinatal complications the parents may not be informed about the relatively positive long-term prognosis of their child’s epilepsy. This article reviews recent findings on the prevalence of EDSelFEC and SelFEC in children with structural focal epilepsies and with brain lesions and their potential impact on diagnosis and treatment.