Brain excitability in children with benign focal epilepsies

Benign Focal Epilepsy of Childhood (BFEC) is the most common type of partial motor epilepsy in the school aged child. BFEC is diagnosed based on clinical features and characteristic abnormalities on their Electroencephalogram (EEG). The frequency of seizures in BFEC is quite low and long term prognosis is generally good. Most children may not require anti-epileptic drugs (AEDs) to treat seizures. However the course may be complicated by language and cognitive impairment, by frequent or severe seizures, Todd's paresis and even status epilepticus. Inspite of being one of the most frequent epilepsies, the underlying brain abnormalities remain poorly understood. Transcranial magnetic stimulation (TMS) evaluates brain excitability in a safe, non-invasive manner. TMS may help predict the clinical severity, requirement and response to AEDs, and identify those likely to have language and cognitive impairment. BFEC is postulated to be a genetic epilepsy with possible multifactorial influence. Identical epileptiform features on EEG may be found in siblings and first degree relatives of affected children. It is not clear why some children in the family have seizures and others do not - study of brain excitability may help answer these questions. Epileptiform abnormalities similar to that in BFEC are also sometimes noted incidentally in EEGs of normal children. In this project we plan to use TMS to study children with BFEC, their unaffected siblings and parents using TMS and EEG. Abnormalities in brain excitability will be correlated with clinical features (including frequency and severity of seizures), requirement and response to AEDs, and abnormality in neurological development. This may allow us to use TMS to prognosticate whether asymptomatic children will develop seizures, which children will require treatment, which AEDs to use, and those likely to need monitoring of brain function (e.g. language).