Subclinical epileptiform activity in children with electrical status epilepticus during sleep: Effects on cognition and behavior before and after treatment with levetiracetam

We performed a double-blind placebo-controlled crossover study of the effects of spike activity during sleep and when awake on learning, long-term memory, vigilance and behavior before and after treatment with levetiracetam in children with electrical status epilepticus during sleep.At baseline, verbal learning declined with increasing spike activity, but there were no relations between spike activity and memory, vigilance or behavior.Levetiracetam was effective in reducing sleep-related spike activity, but on a group level, this had no clear effects on behavior, vigilance or learning and memory.Our results do not allow firm conclusions whether to treat nocturnal epileptiform activity or not; larger samples and longer follow-up may be needed.

► Children with moderate amounts of ESES demonstrated impaired verbal learning. ► We did not find nocturnal spike activity to interfere with memory consolidation. ► Levetiracetam was effective in reducing sleep-related spike activity. ► Paradoxical behavioral effects of reduced spike activity may develop.