Continuous spikes and waves during sleep (CSWS): A Patient Guide

Continuous spikes and waves during sleep (CSWS)—now increasingly referred by the medical community as D/EE-SWAS—is a rare and complex epilepsy syndrome that primarily affects children. Unlike most forms of epilepsy that are defined by visible seizures, this condition is heavily defined by what happens in the brain while a child is asleep. During Non-Rapid Eye Movement (NREM) sleep, the brain becomes crowded with intense electrical activity, often called “spikes and waves” or epileptiform discharges. While the child appears to be resting, researchers hypothesize that this “electrical noise” disrupts the brain’s nighttime processing, interfering with the critical maintenance needed for learning, memory, and development ^[1][2].

The most significant and often distressing hallmark of this syndrome is regression, or the loss of previously mastered skills. You may notice your child struggling to find words, becoming more clumsy, or having new behavioral challenges that seem out of character. Researchers believe this may happen because the constant electrical activity during sleep interferes with proposed mechanisms like synaptic homeostasis—processes the brain uses to “save” the day’s lessons and clear space for new information ^[3]. While some children with this condition do have visible seizures, others may only show these developmental changes, making the condition a challenge to identify without specialized sleep-based testing ^[4][5].

This condition is considered age-dependent, meaning it typically emerges in mid-childhood and the intense brain activity often “burns out” or resolves naturally by the time the child reaches their teenage years ^[6]. However, because the brain is so active and “noisy” during a critical window of development, the goal of medical care is to protect cognition. Doctors work to clear the electrical activity to minimize the time the brain is under stress, using a combination of medications, specialized sleep EEGs, and repeated developmental testing to track progress ^[1][7].

Navigating a diagnosis of CSWS can feel like entering a world of confusing acronyms and intense monitoring.

What to do next:
If you suspect regression, contact your pediatric neurologist to discuss whether a sleep EEG is appropriate. Remember that this guide cannot diagnose your child or prescribe treatment.

Understanding that the primary goal is protecting your child’s ability to learn and grow provides a clear North Star for treatment. By focusing on treating the “electrical noise” and providing the right developmental supports, the medical team aims to give your child the best possible environment for their brain to heal and continue its journey toward a “new baseline” of growth ^[8][9].