CarolCamfield, IWK Health Centre Halifax Nova Scotia Canadacamfield@is.dal.ca
Peter Camfield and Jurriaan Peters
Submitted April 26, 2002
We thank Verrotti et al for their comments. BECT is indeed a
complicated disorder and the diagnosis is not straightforward in many
cases. We only included children with typical findings to avoid the
ambiguities mentioned by Verrotti. We apologize that the short text
permitted for a “Brief Communication” did not allow us to emphasize this
properly. Therefore, our findings apply to children with typical BECT and
should be applied cautiously to a wider spectrum of patients –
nonetheless, children with typical BECT certainly outnumber those with
major atypical features. So our conclusions can be applied to most
children with BECT.
We are aware that it is possible to measure a transient cognitive
deficit at the time of interictal EEG spike discharge in BECT. We are not
aware of any study that has demonstrated in BECT that treatment with AEDs
improves cognitive function. A randomized trial with cognitive ability as
an outcome measure is needed before treatment recommendations can be based
on this indication. After all, AEDs may have cognitive side effects that
last all day and are not restricted to the tiny fraction of the day
occupied by spike discharge in typical BECT.
We don’t doubt the heterogeneity of BECT. The point of our paper is
that in typical cases, AED treatment is OFTEN not necessary. Treatment
decisions can be individualized.
We thank Verrotti et al for their comments. BECT is indeed a complicated disorder and the diagnosis is not straightforward in many cases. We only included children with typical findings to avoid the ambiguities mentioned by Verrotti. We apologize that the short text permitted for a “Brief Communication” did not allow us to emphasize this properly. Therefore, our findings apply to children with typical BECT and should be applied cautiously to a wider spectrum of patients – nonetheless, children with typical BECT certainly outnumber those with major atypical features. So our conclusions can be applied to most children with BECT.
We are aware that it is possible to measure a transient cognitive deficit at the time of interictal EEG spike discharge in BECT. We are not aware of any study that has demonstrated in BECT that treatment with AEDs improves cognitive function. A randomized trial with cognitive ability as an outcome measure is needed before treatment recommendations can be based on this indication. After all, AEDs may have cognitive side effects that last all day and are not restricted to the tiny fraction of the day occupied by spike discharge in typical BECT.
We don’t doubt the heterogeneity of BECT. The point of our paper is that in typical cases, AED treatment is OFTEN not necessary. Treatment decisions can be individualized.