Evie Summers
Spike bursts on a sleeping EEG can be indicative of several conditions, most notably epilepsy and its various associated syndromes. EEG, or electroencephalography, is a method of recording electrical activity in the brain and is often used to detect neurological disorders. In the context of epilepsy, spike bursts are known as spike-and-wave discharges, which are characterised by a combination of high-voltage bursts and slow waves. These discharges can occur during sleep and are indicative of epileptic activity. Certain types of epilepsy, such as Lennox-Gastaut syndrome (LGS) and Ohtahara syndrome, are commonly associated with spike-and-wave patterns during sleep. Additionally, children with developmental delays or autism may exhibit spike bursts during sleep, even in the absence of epilepsy, which could be indicative of underlying brain injuries or early strokes.
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What You'll Learn
- Spike bursts can indicate underlying brain injuries, strokes, or epilepsy
- They are more common in children with developmental delays or autism
- They can be caused by pushing teeth together or eye blinks
- They are characterised by high voltage bursts and slow waves on an EEG
- They can be treated with anti-seizure medications or, in rare cases, surgery
Spike bursts can indicate underlying brain injuries, strokes, or epilepsy
Spike bursts, or spike-and-wave discharges, are a pattern observed on an electroencephalogram (EEG) during epileptic seizures. This pattern is characterized by high-voltage bursts and slow waves mixed with multifocal spikes. While the underlying mechanisms are complex and not yet fully understood, research suggests that they involve the cerebral cortex, the thalamocortical network, and intrinsic neuronal mechanisms. This pattern is most commonly observed in absence epilepsy but is also prevalent in several other types of epilepsies, such as Lennox-Gastaut syndrome (LGS) and Ohtahara syndrome.
LGS is a form of epilepsy that can result from focal, multifocal, or diffuse brain damage. It is characterized by a combination of atonic absences, tonic seizures, cognitive deterioration, and slow spike-wave activity in the EEG. The age of onset for LGS is typically between 1 and 10 years, with symptomatic cases occurring between 2 and 6 years old.
Ohtahara syndrome (OS), also known as early infantile epileptic encephalopathy (EIEE), is the most severe and earliest-developing epileptic encephalopathy in children. OS exhibits high-voltage bursts and slow waves mixed with multifocal spikes on EEG readings. This syndrome can transition into West syndrome or LGS as the child ages.
Spike bursts can also be indicative of underlying brain injuries or strokes. Studies have shown that mild and brief elevations in intracranial pressure can trigger spreading depolarizations, which are associated with an increased occurrence of strokes. These pressure spikes result in a detrimental effect on stroke outcomes, as indicated by enlarged infarct volumes.
Furthermore, in the context of epilepsy, spike bursts can be influenced by glucose levels. In a study, mice with a genetic predisposition for absence epilepsy exhibited increased spike-and-wave activity when their blood glucose levels were lowered through insulin injections or overnight fasting. This suggests that low glucose levels could potentially trigger absence seizures in individuals with epilepsy.
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They are more common in children with developmental delays or autism
Electroencephalography (EEG) is a widely used tool to detect epileptic brain activity. It is characterized by a high temporal resolution that allows for a precise temporal examination of cortical activity. EEG studies have been used to understand neurophysiological substrates, identify distinct patient subgroups, and track novel treatment outcomes in autism spectrum disorders (ASDs). ASDs are a group of complex developmental disorders involving multiple neural system dysfunctions.
EEG abnormalities have been observed in children with ASDs, with studies reporting a U-shaped profile of electrophysiological power alterations, abnormal functional connectivity, and enhanced power in the left hemisphere of the brain. These abnormalities can be used to monitor treatment outcomes and have been shown to improve executive test performance in individuals with ASDs.
Children with developmental delays or autism may exhibit unrecognized epilepsy-like brain activity during sleep, as reported by researchers at Boston Children's Hospital. These nighttime electrical spikes, known as spike bursts, are detectable only by EEGs and can occur even in children without known epilepsy. They appear to result from early strokes or other early life injuries to the developing brain. Up to 20% of children with heightened nighttime brain electrical activity do not exhibit seizures or recognizable epilepsy.
The presence of spike bursts during sleep in children with developmental delays or autism can have significant implications for their learning and development. If left undiagnosed and untreated, these spike bursts may interfere with their cognitive and behavioral functioning, potentially leading to permanent intellectual disabilities. Therefore, early detection and treatment are crucial to mitigate the potential negative consequences on their overall development.
DEE-SWAS, or DEE with Spike Wave Activation In Sleep, is a type of epilepsy that is often diagnosed in children with developmental delays or autism. It is characterized by a failure to attain new developmental skills or a loss of previously acquired skills. The EEG readings in children with DEE-SWAS show significant activation of abnormal discharges during sleep compared to when they are awake. Treatment options for DEE-SWAS include anti-seizure medications, and in rare cases, surgery may be recommended.
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They can be caused by pushing teeth together or eye blinks
An EEG or electroencephalogram is a test that detects electrical activity in the brain using flat, metal discs (electrodes) attached to the scalp. EEGs are used to help diagnose epilepsy, sleep disorders, and other conditions.
An EEG can detect tiny electrical signals from brain cells, which are usually very difficult to detect. However, the electrodes also pick up electrical activity from other sources, such as muscle contractions on the face, eye blinks, and movements. These are called "artifacts".
Eye blinks are a key component of a normal awake EEG and are characterized by a sharp deflection that is usually strongest at the front of the brain. They are seen as a large frontal positive deflection due to Bell's Phenomenon. However, eye blinks can be mistaken for frontal spike and waves, or anterior predominant generalized spike and waves, which are associated with epileptic seizures.
Pushing teeth together or clenching the jaw can also cause spikes in EEG readings. This is because the electrodes pick up on the electrical activity of the muscles used to move the jaw, which can appear as spikes on the EEG. This is more likely to occur on newer, high-end EEG models.
In the case of the person whose daughter had a sleep-deprived EEG, the constant XL spikes occurring every 30 to 60 seconds could be normal. While spikes can indicate epileptic seizures, they can also be caused by other factors, such as eye blinks, teeth clenching, or other movements. It is important to consult with a doctor to interpret the results of an EEG accurately.
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They are characterised by high voltage bursts and slow waves on an EEG
Spike bursts on a sleeping EEG can indicate several conditions, including epilepsy and brain injuries. The specific pattern of high-voltage bursts and slow waves is characteristic of certain types of epilepsy and can help in diagnosis and treatment planning.
EEG (electroencephalogram) is a test that detects electrical activity in the brain. It is often used to diagnose and monitor seizures and epilepsy, as well as other brain disorders. During an EEG, electrodes are placed on the scalp to record the brain's electrical signals, which are then analysed by a neurologist or epileptologist.
In the context of epilepsy, spike bursts on a sleeping EEG refer to a pattern called spike-and-wave. This pattern is characterised by high-voltage bursts (spikes) followed by slower waves. The spike-and-wave pattern is typically observed during epileptic seizures, particularly in absence epilepsy, also known as 'petit mal' epilepsy. It can also be seen in other types of epilepsy, such as Lennox-Gastaut syndrome (LGS) and Ohtahara syndrome.
The presence of spike-and-wave patterns during sleep is indicative of specific types of epilepsy. For example, continuous spikes and waves during sleep (CSWS) is a rare form of epilepsy that affects children between the ages of two and seven. CSWS is characterised by seizures, neurocognitive regression, and an EEG pattern called electrical status epilepticus during sleep (ESES). ESES is characterised by near-continuous slow spikes and waves during non-rapid eye movement (non-REM) sleep. Another type of epilepsy with spike-wave activation during sleep is DEE-SWAS (developmental and epileptic encephalopathy with spike-wave activation in sleep), which is associated with seizures and a slow cognitive decline.
While spike bursts during sleep can be indicative of epilepsy, it is important to note that not all spikes are epileptiform in nature. Certain programmes used in EEG analysis may mark non-epileptiform spikes as "XL spikes", which can be misleading. Eye blinks, muscle movements, and normal sleep variants can also create spikes on an EEG. Therefore, it is crucial for trained neurologists or epileptologists to interpret the EEG results and distinguish between epileptiform and non-epileptiform spikes.
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They can be treated with anti-seizure medications or, in rare cases, surgery
Spike bursts on a sleeping EEG can be a sign of epilepsy. This is known as DEE-SWAS (Developmental/Epileptic Encephalopathy with Electro-Spike Wave Activation in Sleep), previously known as CSWS, ESES, or epilepsy with continuous spike-wave during slow-wave sleep. This is a rare form of epilepsy, affecting only 0.5% of children with epilepsy. It is characterised by a loss of skills or failure to attain new skills, and an EEG showing significant activation of abnormal discharge during sleep.
DEE-SWAS is often treated with anti-seizure medications, such as steroids or high-dose diazepam at night. Other medications used include valproate, ethosuximide, levetiracetam, sulthiame, and lamotrigine. In some cases, a combination of antiepileptic drugs is used. More than one anti-seizure medicine may be needed for treatment, and it is important to note that some medications may worsen this epilepsy syndrome, including carbamazepine (Tegretol) or oxcarbazepine (Trileptal).
In rare instances, surgery may be recommended for patients with DEE-SWAS. This is typically considered for selected patients with Continuous Spikes and Waves during Sleep (CSWS), an epileptic encephalopathy where epileptic processes are thought to contribute to the disturbance in cerebral function.
It is important to diagnose and treat DEE-SWAS quickly, as the quicker the syndrome is treated, the better the outcome. While cognitive and behavioural functioning may improve, children who have this epilepsy syndrome for many months or years can be left with permanent intellectual disabilities. The near-continuous pattern of seizure discharges in sleep seen on EEG typically improves in adolescence, but some people will continue to have EEG abnormalities into adulthood.
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Frequently asked questions
Spike bursts on a sleeping EEG can indicate underlying brain injuries in children, such as early strokes or other early-life injuries to the developing brain. These spikes may interfere with learning and development, and can be a sign of unrecognized epilepsy-like brain activity.
Typical absence seizures are characterized by generalized spike-and-wave patterns on an EEG with a discharge of 2.5 Hz or greater. They are marked by an acute onset and termination and increased synchronization of discharges in the thalamocortical circuitry. Atypical absence seizures, on the other hand, are more common in children with severe epilepsy who suffer from multiple types of seizures. The spike-and-wave pattern in this type is more irregular and slower.
CSWS stands for Continuous Spike-and-Wave during Slow-wave sleep, a rare form of age-related epilepsy that affects children between the ages of three and seven. It is characterized by continuous spike-and-wave discharges during slow sleep, seizures, and neurocognitive regression.
