Cognitive deterioration in childhood: Never forget electrical status epilepticus during slow-wave sleep.

W a child shows any signs of change in cognitive/behavioral functioning (characterized by poorer attention and memory skills, loss of personal autonomy, restlessness, etc.), in the medical work-up, we should never forget the diagnostic hypothesis of electrical status epilepticus during slow-wave sleep (ESES); an electroclinical condition characterized by an electroencephalogram (EEG) picture with diffuse paroxysmal abnormalities (spike-and-waves) lasting for at least 85% of the duration of slow sleep (nonrapid eye movement [NREM] sleep). On the clinical side, in addition to the change in cognitive/behavioral functioning, which should be examined whenever possible through a neuropsychological assessment, focal or generalized epileptic seizures with heterogeneous semeiology, and motor impairment (including, inter alia, ataxia, and dyspraxia) have been described.[1,2] While for most forms of neurocognitive deterioration in childhood (e.g., those due to neurometabolic diseases), there is currently no effective treatment; in the case of ESES, effective therapy and more or less complete recovery are possible. It is mainly for this reason that the diagnostic hypothesis of ESES should never be forgotten when a child shows neurocognitive deterioration. The classic form of ESES syndrome is rare but well-known in the context of childhood epileptology. According to the International Classification of Epilepsies, ESES has been included in epileptic encephalopathies, in which by definition the relevant EEG abnormalities disrupt the neurodevelopment of the individual, leading to an often severe cognitive deterioration.[3] It should also be emphasized that in recent years in the literature, the tendency to distinguish between the term ESES, describing only the EEG findings, and the term continuous spike and wave during slow-wave sleep, which refers to the clinical picture characterized by neurocognitive deterioration related to spike-wave discharges disrupting most of NREM sleep, has been gaining ground.[4]