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Many seizures clearly affect awareness, but between seizures, can transient bursts of interictal epileptiform activity have a clinically relevant effect on cognition? This question was first assessed by Schwab in 19411 who showed delayed reaction times proportionate to petit mal burst durations of only a few seconds or more. Since then, researchers have demonstrated the effect of transient cognitive impairment repeatedly with scalp EEG including focal effects of discharges within a particular hemisphere or lobe.2 More recent intracranial work has provided more functional-anatomic detail3,4 and mechanistic studies.5,6 Yet most clinicians, sensitive to the clinical context and without clear quantitative guidance, have remained hesitant to “treat the interictal EEG.”2
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
See page 382
- Received April 24, 2023.
- Accepted in final form May 31, 2023.
- © 2023 American Academy of Neurology
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