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To the Editor:
The value of the sleep EEG in language disorders is a controversial topic in pediatric epileptology. The arguments were recently fueled by the data of McVicar et al.1 and the accompanying editorial by Trevathan which criticized the utility of this test in children with autistic regression in addition to language regression.2
This interpretation of the data is already transforming clinical practice in some centers but may not be appropriate. While the McVicar study showed the yield of epileptiform abnormalities in children with isolated language regression (56%) was higher than that in those with language regression associated with autistic regression (28%), the latter finding should not be discounted. The two boys with autism subsequently had Landau-Kleffner syndrome, showing that at least 2 of 105 patients had a diagnostic sleep study with treatment implications influencing outcome; this is not dissimilar from the yield of many other diagnostic investigations.
Concerning the other 28% of children with language regression in the context of autistic regression, the significance of this finding is uncertain. It was unclear how frequently discharges occurred nor whether bilaterally synchronous activity was prevalent in sleep. The finding of epileptiform activity in children with autistic regression may be informing …
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