Our Daughter Was Diagnosed With Epilepsy Two Years Ago. For The Past Several Months, Her Seizures Have Been Managed With Medication. Last Week, An EEG Revealed Abnormal Activity (categorized As Level III) With Poly Spikes. However, No Seizures Were Observed During The Test. What Does This Mean?

Posted on Thu, 16 Mar 2023

Question: Our daughter was diagnosed with epilepsy two years ago. For the past several months, her seizures have been managed with medication. Last week, an EEG revealed abnormal activity (categorized as level III) with poly spikes. However, no seizures were observed during the test. What does this mean?

Answered by Dr. Sudhir Kumar (28 minutes later)

Brief Answer:
Abnormality in EEG can persist despite being on treatment.

Detailed Answer:
Hi,
I have noted your daughter's clinical details. Based on this, she has epilepsy. Abnormality in EEG- poly spike discharges- is suggestive of epilepsy. Use of anti-epileptic drugs control the seizures, however, abnormal EEG discharges may persist. This does not mean that the medications are ineffective. The efficacy of anti-epileptic drugs is assessed on the basis of their ability to control the clinical seizures. EEG usually improves with anti-epileptic medications, however, it may not become normal.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Thnanks

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sudhir Kumar (45 minutes later)

Thank you for this information. Our daughter is 8 years old and was diagnosed with Childhood Absence Epilepsy. She also has had 4 tonic-clonic seizures, which were suggested could have been secondary generalized seizures. She takes Ethosuximide and Lamotragine to control her seizures. While it took some time to get to control, she has been seizure free for four months.

At one time, we were told she could still grow out of this. However, our hope has been diminished given the fact that she has has prior convulsive seizures and the EEG shows abnormal activity suggestive of seizures. Does the prognosis for her appear less since the EEG revealed abnormality?

Answered by Dr. Sudhir Kumar (21 hours later)

Brief Answer:
She would get better.

Detailed Answer:
Thank you for getting back with more information.

Abnormal EEG does not make the prognosis of epilepsy worse. However, children with abnormal EEG need treatment with anti-epileptic drugs for at least three seizure-free years. After that, about 60-70% of children remain seizure-free and an attempt may be made to slowly withdraw the medications.

Ethosuximide and lamotrigine are safe and effective anti-epileptic medications and they can be continued for long-term.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar