Prevalence and Functional Significance of 14 and 6 Hz Positive Spikes in Self-Limited Epilepsy With Centrotemporal Spikes: A Case–Control Study

Purpose: – To investigate the prevalence and functional significance of 14 and 6 Hz positive spikes (PS) in children with Self-limited Epilepsy with Centrotemporal spikes and explore their potential correlation with clinical features and neurophysiological mechanisms. Methods: – Our study included 52 pediatric Self-limited Epilepsy with Centrotemporal spikes patients and 52 age-matched controls who underwent ≥48-hour video-EEG monitoring in the epilepsy monitoring unit at Oishei Children's Hospital from 2016 to 2024. EEGs were reviewed by blinded epileptologists to identify the presence, localization, and lateralization of 14 and 6 Hz PS. Results: – Fourteen and 6 Hz PS were detected in 80.8% (n = 42) of SeLECTs patients versus 0% of controls (P < 0.001). No significant lateralization correlation was found between PS and centrotemporal spikes (P = 0.651); only 28.6% of PS cases matched centrotemporal spikes lateralization. Conclusions: – This study demonstrates a significantly higher prevalence of 14 and 6 Hz PS in children with Self-limited Epilepsy with Centro-temporal spikes. Their high prevalence and similar age-dependent expression and sleep-related activation suggest that PS may reflect developmental immaturity in thalamocortical networks, immature corticolimbic circuits, and heightened cortical excitability. These findings challenge the traditional view of PS as benign and support their potential role in thalamocortical dysregulation in self-limited childhood epilepsies.