Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment

Ronald J Swatzyna*, Martijn Arns, Jay D Tarnow, Robert P Turner, Emma Barr, Erin K MacInerney, Anne M Hoffman, Nash N Boutros

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


In the field of psychiatry diagnoses are primarily based on the report of symptoms from either the patient, parents, or both, and a psychiatrist's observations. A psychiatric diagnosis is currently the most widely used basis for medication selection and the brain is seldom investigated directly as a source of those symptoms. This study addresses the request from the National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC) for scientific research into neurological abnormalities that can be linked to psychiatric symptoms for the purpose of predicting medication response. One such neurological abnormality that has been the focus of many studies over the last three decades is isolated epileptiform discharges (IEDs) in children and adolescents without seizures. We conducted a systematic review of the literature to determine prevalence rates of IEDs within diagnostic categories. We then compared the prevalence of IEDs in the selected literature to our IRB-approved data archive. Our study found a consistent high prevalence of IEDs specifically for ADHD (majority > 25%) and ASD (majority > 59%), and consistent low prevalence rates were found for Depression (3%). If children and adolescents have failed multiple medication attempts, and more than one-third of them have IEDs, then an EEG would be justified within the RDoC paradigm.

Original languageEnglish
Pages (from-to)545-552
Number of pages8
JournalEuropean Child & Adolescent Psychiatry
Issue number4
Early online date14 Jul 2020
Publication statusPublished - Apr 2022
Externally publishedYes


  • Adolescents
  • Attention deficit hyperactivity disorder
  • Autism spectrum disorder
  • Children
  • EEG
  • Isolated epileptiform discharges
  • Prevalence
  • Psychiatric symptoms
  • RdoC

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