Vol.:(0123456789) 1 3 European Child & Adolescent Psychiatry https://doi.org/10.1007/s00787-020-01597-2 REVIEW Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment Ronald J. Swatzyna 1,2  · Martijn Arns 3,4  · Jay D. Tarnow 5  · Robert P. Turner 6,7  · Emma Barr 1  · Erin K. MacInerney 1  · Anne M. Hofman 1  · Nash N. Boutros 8 Received: 12 February 2020 / Accepted: 1 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract In the feld 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 scientifc research into neurological abnor- malities 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 specifcally 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 justifed within the RDoC paradigm. Keywords RdoC · Children · Adolescents · EEG · Isolated epileptiform discharges · Prevalence · Psychiatric symptoms · Autism spectrum disorder · Attention defcit hyperactivity disorder Introduction The feld of psychiatry typically bases a diagnosis primar- ily on the patient’s and parent’s report of symptoms and the psychiatrist’s observations. A psychiatric diagnosis is cur- rently the most widely used basis for medication selection. Oftentimes when clinical beneft is lacking, patients have their dosage increased and if this does not work, another medication is tried until one shows more promise. This trial- and-error approach thereby results in multiple medication attempts until fnding an adequate match. In this traditional model of psychiatric practice, the brain is seldom investi- gated directly as a source of the symptoms. The goal of this paper is to show that evaluating the brain and linking psy- chiatric symptom presentation with neurobiological abnor- malities could result in more accurate medication selection. In 2012 the National Institute of Mental Health (NIMH) established the Research Domain Criteria Project (RDoC), proposing biological, genetic, and imaging research to identify biomarkers and neurological abnormalities that * Ronald J. Swatzyna drron@eeganalysis.net 1 Houston Neuroscience Brain Center, Houston, TX, USA 2 Clinical NeuroAnalytics, 1307 Oceanside Lane, League City, TX 77573, USA 3 Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands 4 Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands 5 The Tarnow Center for Self-Management, Houston, USA 6 Network Neurology Health, Charleston, SC, USA 7 Clinical Pediatrics and Neurology, USC School of Medicine, Columbia, SC, USA 8 School of Medicine, RUSH University, Kansas City, MO, USA