Diazepam Useful in ESES Treatment (I3-1.006)

OBJECTIVE: To demonstrate the efficacy of high-dose diazepam in treating electrical status epilepticus of sleep (ESES). BACKGROUND: ESES is an age related, self-limited disorder of unknown etiology characterized by neuropsychological impairment, motor delays, focal or generalized epilepsy and the EEG finding of electrical status epilepticus during slow wave sleep. Our experience with diazepam for treatment of ESES has been encouraging. DESIGN/METHODS: 41 patients with ESES were included in this retrospective chart review. Parameters noted for our study included age, gender, weight, seizure types, medications, spike localizations, spike counts (initially, then after the first and second treatments with diazepam), comorbidities, MRI findings, and clinical outcomes. RESULTS: Mean age was 8 years. 78% of patients had complex partial seizures, 44% had generalized tonic clonic seizures. Comorbidities included developmental delays, behavioral difficulties, language learning disabilities, history of prematurity, autism, mental retardation, cerebral palsy, ADHD. Most patients were on levetiracetam. Commonest MRI findings included periventricular leucomalacia, hyperintensities or loss of white matter. Slow wave sleep spikes were predominantly identified over the left hemisphere. The mean of the initial spike count was 1500, and the mean total spike reduction was 80% (p < 0.01) after both diazepam treatments. Spike counts were reduced by over 75 % in 69.57% of patient admissions. CONCLUSIONS: High-dose diazepam is generally effective in the treatment of ESES and leads to significant improvement in spike index. Further studies are needed to elicit long-term outcomes, drug interaction effects, and the potential effects of spike locations on symptomatology. Disclosure: Dr. El-Hagrassy has nothing to disclose. Dr. Gunasekara has nothing to disclose. Dr. Eksioglu has nothing to disclose.