EEG and clinical findings in pediatric epilepsy and control groups using video‐based pattern stimulation

OBJECTIVE: This study aimed to compare EEG responses and clinical findings during video-based pattern stimulation in pediatric epilepsy and control groups, and to evaluate differences according to epilepsy subgroups and seizure control status. METHODS: A total of 438 children (190 with epilepsy, 248 controls) were included. All participants underwent a 100-second video protocol consisting of 10 different patterns. Epileptiform activity during pattern stimulation and simultaneous clinical symptoms (nausea, dizziness, lightheadedness, etc.) were recorded. Responses to hyperventilation and photic stimulation were also assessed. The epilepsy group was analyzed according to seizure control (controlled/uncontrolled) and epilepsy syndromes (juvenile idiopathic generalized epilepsy, childhood absence epilepsy, self-limited epilepsy with autonomic seizures (SeLEAS), self-limited epilepsy with centrotemporal spikes (SeLECTS), and focal epilepsy). Statistical analyses were performed using chi-square tests and multivariable logistic regression. RESULTS: EEG pattern sensitivity was observed in 8.9% of the epilepsy group and 3.2% of controls (p = .012). Clinical symptoms occurred in 11.5% of epilepsy patients and 15.7% of controls (p = .265). Pattern sensitivity was significantly higher in uncontrolled epilepsy (p = .009). Subgroup analysis revealed the most prominent difference in juvenile idiopathic generalized epilepsy. In multivariable analysis, hyperventilation (p = .044) and photic response (p = .042) were identified as independent predictors of pattern sensitivity. SIGNIFICANCE: Pattern sensitivity is not exclusive to children with epilepsy and may also occur at a lower rate in healthy controls. Children with uncontrolled epilepsy and those with juvenile idiopathic generalized epilepsy (JIGE) are particularly at risk. EEG abnormalities during pattern stimulation provide a more reliable indicator than clinical symptoms. The video-based protocol used in this study increases ecological validity by mimicking real-life visual stimuli. Our findings support the need for international standardization of pattern stimulation, similar to hyperventilation and photic stimulation protocols.