Skip to main content
NCBI home page
Neurology logoLink to Neurology
. 2015 Jan 27;84(4):436. doi: 10.1212/WNL.0000000000001173

Variations in EEG discharges predict ADHD severity within individual Smith-Lemli-Opitz patients

Selim R Benbadis 1
PMCID: PMC10687620  PMID: 25628433

Editors' Note: In reference to “Variations in EEG discharges predict ADHD severity within individual Smith-Lemli-Opitz patients,” Dr. Benbadis cautions against the overinterpretation of benign EEG discharges as epileptiform. Authors Ewen et al. defend their methodology. Drs. Ziemssen and Ziemssen disagree with several terms used in “Dynamic formation of macular microcysts independent of vitreous traction changes” and question the need to include explanations of vitreoretinal forces. Authors Brandt and Lagrèze respond to both points.—Megan Alcauskas, MD, and Robert C. Griggs, MD

Schreiber et al.1 described attention-deficit/hyperactivity disorder prediction capabilities of variations in EEG discharges, yet it is unclear what constitutes an epileptiform discharge. Benign sharp transients are notoriously over-read as epileptiform2,3 so illustrations of spikes and sharp waves would have strengthened the authors' findings.

Neurology. 2015 Jan 27;84(4):436.

Author Response

Joshua B Ewen 1, John M Schreiber 2, William H Trescher 3

We appreciate Dr. Benbadis' comments about our results and respect his work stressing the need for conservative interpretation of EEGs. This point was consistently repeated to each of the 3 clinical neurophysiologist authors during our fellowship training. As the classification of EEG features is necessarily subjective, it is relevant to mention that the 3 pediatric clinical neurophysiologists involved in interpretation are fellowship-trained and board-certified in EEG. In addition, there was perfect agreement among raters in a subsample of records, as we reported.1

We can confirm that the transients in question were epileptiform in morphology and consistent throughout each record in both morphology and topography. None was consistent with a known normal variant, with the caveat of the limited predictive value of central-temporal sharp waves for epilepsy, as we covered in the Discussion.1 This consideration is, of course, not a limitation of the findings but rather speaks directly to our interpretation: these transients are not associated with epilepsy in this sample, but, nevertheless, show an association with cognitive effects.

Footnotes

Author disclosures are available upon request (journal@neurology.org).

References

  • 1.Schreiber JM, Lanham DC, Trescher WH, et al. Variations in EEG discharges predict ADHD severity within individual Smith-Lemli-Opitz patients. Neurology 2014;83:151–159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Benbadis SR. The tragedy of over-read EEGs and wrong diagnoses of epilepsy. Expert Rev Neurother 2010;10:343. [DOI] [PubMed] [Google Scholar]
  • 3.Benbadis SR. “Just like EKGs!” Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? Neurology 2013;80(suppl 1):S47–S51. [DOI] [PubMed] [Google Scholar]

Articles from Neurology are provided here courtesy of American Academy of Neurology

RESOURCES