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To the Editor:
Since the first descriptions of the so-called “benign” epilepsy with centrotemporal spikes (BECTS), atypical evolutions have been repeatedly recognized.1 Ong and Wyllie2 reported two new cases displaying numerous (more than 100 per day) and brief (several seconds) epileptiform episodes that consisted of arm myoclonia associated with loss of posture, or of eyelid, mouth, and arm myoclonia associated with staring.2 Concomitantly, bursts of sharp waves or spikes-and-waves (their figure 2) predominated over the central region of one hemisphere. Both patients were unsuccessfully treated with several combinations of antiepileptic drugs (AEDs) including carbamazepine, phenytoin, phenobarbital, valproic acid, and tiagabine. Such cases called into question the ictal or interictal nature of short-lasting clonic/atonic phenomena in BECTS, and the potential deleterious effect of AEDs.
A clear distinction is classically drawn between ictal discharges, accompanied by overt clinical symptoms, and interictal discharges, supposed to be asymptomatic. Nevertheless, subtle neurologic signs (focal or axial atonia, transient consciousness impairments, and unilateral or bilateral clonic jerks) may occur in strict conjunction with interictal BECTS abnormalities.1,3⇓ When negative or positive myoclonia appear in …
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