The challenges and "pitfalls" in diagnosing and managing children with "benign epileptic discharge": three cases report

Objective To report the clinical manifestations, EEG characteristics, diagnosis and treatment of 3 children with "benign epileptic discharge", and analyze the causes of misdiagnosis and treatment. Methods and Results The clinical data of 3 children with centrotemporal spikes (CTS) in EEG treated in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from December 2008 to October 2020 were retrospectively analyzed. Case 1 presented with non-epileptic seizure, which was misdiagnosed as "epilepsy" due to episodic events and CTS, and was eventually diagnosed as night fright based on clinical manifestations and EEG. Case 2 did not have clinical seizures, but was misdiagnosed as "epilepsy" due to CTS, and took antiepileptic drugs (AEDs) for several years. Although benign childhood epilepsy with central-temporal spikes (BECTS) was diagnosed in Case 3, the dosage and types of AEDs were increased even when the clinical seizures were well controlled. After diagnosis, AEDs was not performed in Case 1, AEDs were gradually stopped in Cases 2 and Case 3, and no epileptic seizure was observed. Conclusions "Benign epileptic discharge" is common in children's EEG examination. It is the key point to avoid the misdiagnosis and mismanagement to determine whether there is a causal relationship between EEG abnormalities and clinical seizures. For children with "benign epileptic discharge", the antiepileptic therapy is aimed at controlling clinical seizures rather than eliminating EEG abnormalities.