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Summary   Objective  Benign epilepsy with centrotemporal spikes ( BECTS ) is a common, self‐limited epilepsy syndrome affecting school‐age children. Classic interictal epileptiform discharges ( IED s) confirm diagnosis, and  BECTS  is presumed to be pharmacoresponsive. As seizure risk decreases in time with this disease, we hypothesize that the impact of  IED s and  anticonvulsive drug (ACD)  treatment on the risk of subsequent seizure will differ based on disease duration.    Methods  We calculate subsequent seizure risk following diagnosis in a large retrospective cohort of children with  BECTS  (n = 130), evaluating the impact of  IED s and  ACD  treatment in the first, second, third, and fourth years of disease. We use a Kaplan–Meier survival analysis and logistic regression models. Patients were censored if they were lost to follow‐up or if they changed group status.    Results  Two‐thirds of children had a subsequent seizure within 2 years of diagnosis. The majority of children had a subsequent seizure within 3 years despite treatment. The presence of  IED s on electroencephalography ( EEG)  did not impact subsequent seizure risk early in the disease. By the fourth year of disease, all children without  IED s remained seizure free, whereas one‐third of children with  IED s at this stage had a subsequent seizure. Conversely,  ACD  treatment corresponded with lower risk of seizure early in the disease but did not impact seizure risk in later years.    Significance  In this cohort, the majority of children with  BECTS  had a subsequent seizure despite treatment. In addition,  ACD  treatment and  IED s predicted seizure risk at specific points of disease duration. Future prospective studies are needed to validate these exploratory findings.

Timing matters: Impact of anticonvulsant drug treatment and spikes on seizure risk in benign epilepsy with centrotemporal spikes