Clinical correlations of midline spikes in children

Here we describe the clinical characteristics of children with isolated midline spikes, comparing patients with and without epilepsy, and examining the evolution of midline spikes on repeat EEGs. EEGs and clinical information of 69 patients with isolated midline spikes identified from our EEG database were reviewed. Forty-three patients had a history of seizures. Most patients had complex partial seizures, and had an approximately five times higher chance of having new discharges at other sites on repeat EEGs than the nonepilepsy group (odds ratio = 4.95). Most children without epilepsy had developmental delay, attention deficit hyperactivity disorder, and pervasive developmental disorder. Their repeat EEGs showed disappearance or persistence of the midline discharges, with a two times higher probability of normal repeat EEG (58%) than the epilepsy group (24%) (odds ratio = 2.40). Isolated midline spikes may represent focal epileptiform activity, but are also found in normal children and in children with developmental and behavioral problems.