CSWS (Continuous spike and wave during slow wave sleep)

Background

• 1% of all epilepsy in childhood
• Clinical onset usually 4-5 years old.
• Usually- but not always- due to structural brain damage.
• Landau Kleffner Syndrome (Acquired Epileptic Aphasia (AEA)) is a subtype of CSWS, with progressively loss of receptive and expressive language ability.

Clinics

• Deterioration in development
• Different types of seizures can be seen (sometimes after typical Rolandic epilepsy).
• Dyspraxia
• Speach disturbances (in fluency, understanding): When this symptom is prominent, LKS diagnosis is more likely.
• Behavioural problems and memory disturances: When this symptom is prominent, CSWS syndrome (or nocturnal frontal lobe epilepsy, NFLS) is more likely.

EEG

• Main feature is ESES (Electrical Status Epilepticus of Sleep) : synchronic discharges during NON REM sleep
• Discharges are seen in 70-80% of the time during NON REM sleep

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ESES (Electrical Status Epilepticus of Sleep) in a 5.5-year-old girl with CSWS (double banana)

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Author: Bas Jongbloed, MD, neurology resident, ETZ Tilburg, The Netherlands