1
|
Shiraki A, Yamamoto H, Ohno A, Kumai S, Suzui R, Sawamura F, Kawaguchi M, Suzuki T, Maki Y, Ito Y, Nakata T, Kidokoro H, Numaguchi A, Natsume J. Color density spectral array findings on continuous EEG during therapeutic hypothermia in children with acute encephalopathy. Brain Dev 2024:S0387-7604(24)00112-8. [PMID: 39242349 DOI: 10.1016/j.braindev.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/01/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Quantitative EEG is frequently used to monitor children affected by acute encephalopathy (AE), with the expectation of providing comprehensive insights into continuous EEG monitoring. However, the potential of quantitative EEG for estimating outcomes in this context remains unclear. We sought reliable prognostic markers within the color density spectral array (CDSA) of the continuous EEG for AE-affected children undergoing therapeutic hypothermia (TH). METHODS This retrospective study analyzed CDSA data from eight scalp electrodes of 15 AE-affected children undergoing TH. Two CDSA features were investigated-high-frequency lines (HFLs) and periodic elevation in the low frequency band (PLFB)-along with the corresponding EEG characteristics. The inter-rater reliability for CDSA was assessed by four pediatric neurologists. Outcomes were grouped into either no/mild or severe decline in motor and cognitive functions, then compared with CDSA features. RESULTS The median EEG recording time was 114 (81-151) h per child. While at least 41 % of HFLs corresponded to typical sleep spindles, 94 % of PLFB aligned with cyclic changes in the amplitude of delta/theta waves on the raw EEG. Inter-rater reliability was higher for HFLs than for PLFB (kappa values: 0.69 vs. 0.46). HFLs were significantly more prevalent in children with no/mild decline than in children with severe decline (p = 0.017), whereas PLFB did not differ significantly (p = 0.33). CONCLUSIONS This study provides preliminary evidence that reduced HFLs on CDSA predict unfavorable outcomes in AE-affected children undergoing TH. This suggests that maintaining high-frequency waves is critical for optimal brain function.
Collapse
Affiliation(s)
- Anna Shiraki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsuko Ohno
- Department of Child Neurology, Toyota Municipal Child Development Center Nozomi Clinic, Toyota, Japan
| | - Sumire Kumai
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryosuke Suzui
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumi Sawamura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Kawaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Maki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiko Nakata
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Numaguchi
- Department of Emergency and Critical Care Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| |
Collapse
|
2
|
Lähdetie J, Muñoz-Ruiz M, Kokki H. Does the absence or presence of sleep spindles on EEG have prognostic value for cognitive outcome in children with infantile epileptic spasms syndrome? A systematic literature review. Epileptic Disord 2024; 26:60-68. [PMID: 38116687 DOI: 10.1002/epd2.20192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
Infantile Epileptic Spasms Syndrome (IESS) is an epileptic encephalopathy in childhood that affects infants under the age of two years. When spasm series occur, prognosis for cognitive outcome is poor in the majority of cases. The encephalopathy in IESS includes delayed maturation of normal sleep phenomena in the EEG, such as sleep spindles. Children with intellectual disabilities often have abnormal sleep, and children with sleep problems have difficulties learning at school. We examined whether there is evidence of prognostic value of detection of sleep spindles in the EEG of children with IESS on their future cognitive development. A systematic literature search yielded five studies touching this question. They were evaluated by two scorers independently. The lack of normal sleep patterns including lack of sleep spindles was used as a biomarker of poor cognitive outcome. Positive (PPV) and Negative (NPV) prognostic values were calculated. A summary of all five studies indicates a PPV of 82% and an NPV of 45%. Given the small amount of data, the retrospective quality of most studies, and the differences in the outcome parameters reported, it is prudent to say that currently available data do not allow us to conclude whether spindles have a specific and independent role in the cognitive prognosis of affected children. Since sleep spindles are needed for memory consolidation and demonstrate the active role of sleep for learning and memory, the hypothesis remains that their absence in the EEG may indicate an increased risk of cognitive delay, but more supporting data are needed to reach such a firm conclusion.
Collapse
Affiliation(s)
- Jaana Lähdetie
- Department of Child Neurology, University of Turku and University Central Hospital of Turku, Turku, Finland
| | - Miguel Muñoz-Ruiz
- Department of Clinical Neurophysiology, Central Finland Welfare District, Nova Hospital, Jyväskylä, Finland
| | - Hannu Kokki
- Department of Anesthesiology, University of Eastern Finland and University Central Hospital of Kuopio, Kuopio, Finland
| |
Collapse
|
3
|
SARİGECİLİ E, MAKHAROBLİDZE K, KÖMÜR M, OKUYAZ C. The evaluation of the neurocognitive development of the symptomatic West Syndrome patients. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: Our study was aimed to determine both demographic and clinical data of patients with symptomatic West Syndrome (WS) and to monitor their neurocognitive development with Bayley Scales of Infant and Toddler Development Screening Test, third edition (Bayley-III) test.
Materials and Methods: Fourteen symptomatic WS patients were included in our study. Clinical and demographic data, electroencephalogram (EEG) findings, treatment response, Bayley III developmental test results were recorded before starting the treatment (T0) and in the 12th months of the treatment (T1 and T12).
Results: Patients had a significant increase in Bayley-III test scores in all areas at the end of one year (p <0.05). As the patients' EEGs improved, a statistically significant increase was observed in Bayley-III test scores in all areas (p <0.05). However, when the correlation between seizure control and the Bayley-III test scores were evaluated, there was an improvement only in the language area (p< 0,05); but there was no statistically significant difference in other brain areas (p> 0.05).
Conclusion: It has been shown that the neurocognitive level gradually improves even in symptomatic type WS with effective treatment during the follow-up of the disease or with the improvement of the EEG findings and seizure control.
Collapse
Affiliation(s)
- Esra SARİGECİLİ
- Republic of Türkiye Ministry of Health University Adana City Training and Research Hospital, Pediatric Neurology
| | | | - Mustafa KÖMÜR
- Mersin University, Faculty of Medicine, Department of Pediatric Neurology
| | - Cengiz OKUYAZ
- Mersin University, Faculty of Medicine, Department of Pediatric Neurology
| |
Collapse
|
4
|
Jethwa S, Pressler RM, Kaya D, Datta AN. Sleep architecture in neonatal and infantile onset epilepsies in the first six months of life: A scoping review. Eur J Paediatr Neurol 2022; 41:99-108. [PMID: 36410286 DOI: 10.1016/j.ejpn.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/26/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
AIM Epilepsy occurs in approximately 80 per 100,000 infants in the first year of life, ranging in severity from self-limited and likely to spontaneously resolve, to severe developmental and epileptic encephalopathies. Sleep plays a key role in early brain development and the reciprocal relationship between sleep and seizures is not yet fully understood, particularly in young children. We conducted a Scoping Review to synthesise current knowledge of sleep architecture in neonates and infants with epilepsy. METHOD Peer-reviewed publications from 2005 to 2022 describing sleep architecture in infants up to six months of age with unprovoked seizures were included. The analysis set was derived from EMBASE, Web of Science and PubMED using key terms "sleep, epilepsy and infant" and related descriptors. Inclusion criteria were prospectively described in a Scoping Review protocol. Sleep architecture was assessed as macro- and micro-structural elements. RESULTS 21 publications were included in the qualitative analysis. In self-limited familial and genetic epilepsy, sleep macrostructure was generally preserved. In DEEs and in epileptic encephalopathies of genetic or structural aetiology, sleep architecture was significantly disrupted. INTERPRETATION Early identification of infants with epilepsy is important to ensure early and effective treatment. In the DEE spectrum, sleep architecture is significantly impacted, and abnormal sleep architecture may be associated with compromised developmental outcome. Further research is needed to identify the sequence of events in abnormal brain development, epilepsy and sleep disruption and potentially help to predict the course of epilepsy towards a self-limited epilepsy versus a DEE.
Collapse
Affiliation(s)
- Sangeeta Jethwa
- Paediatric Neurology and Developmental Medicine, University Children's Hospital, UKBB, Basel, Switzerland.
| | - Ronit M Pressler
- Clinical Neuroscience, UCL; GOS Institute of Child Health and Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Didem Kaya
- Acibadem University School of Medicine, İstanbul, Turkey
| | - Alexandre N Datta
- Paediatric Neurology and Developmental Medicine, University Children's Hospital, UKBB, Basel, Switzerland
| |
Collapse
|
5
|
Romero Milà B, Remakanthakurup Sindhu K, Mytinger JR, Shrey DW, Lopour BA. EEG biomarkers for the diagnosis and treatment of infantile spasms. Front Neurol 2022; 13:960454. [PMID: 35968272 PMCID: PMC9366674 DOI: 10.3389/fneur.2022.960454] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Early diagnosis and treatment are critical for young children with infantile spasms (IS), as this maximizes the possibility of the best possible child-specific outcome. However, there are major barriers to achieving this, including high rates of misdiagnosis or failure to recognize the seizures, medication failure, and relapse. There are currently no validated tools to aid clinicians in assessing objective diagnostic criteria, predicting or measuring medication response, or predicting the likelihood of relapse. However, the pivotal role of EEG in the clinical management of IS has prompted many recent studies of potential EEG biomarkers of the disease. These include both visual EEG biomarkers based on human visual interpretation of the EEG and computational EEG biomarkers in which computers calculate quantitative features of the EEG. Here, we review the literature on both types of biomarkers, organized based on the application (diagnosis, treatment response, prediction, etc.). Visual biomarkers include the assessment of hypsarrhythmia, epileptiform discharges, fast oscillations, and the Burden of AmplitudeS and Epileptiform Discharges (BASED) score. Computational markers include EEG amplitude and power spectrum, entropy, functional connectivity, high frequency oscillations (HFOs), long-range temporal correlations, and phase-amplitude coupling. We also introduce each of the computational measures and provide representative examples. Finally, we highlight remaining gaps in the literature, describe practical guidelines for future biomarker discovery and validation studies, and discuss remaining roadblocks to clinical implementation, with the goal of facilitating future work in this critical area.
Collapse
Affiliation(s)
- Blanca Romero Milà
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
- Department of Electronics and Biomedical Engineering, Universitat de Barcelona, Barcelona, Spain
| | | | - John R. Mytinger
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Daniel W. Shrey
- Division of Neurology, Children's Hospital Orange County, Orange, CA, United States
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States
| | - Beth A. Lopour
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Beth A. Lopour
| |
Collapse
|
6
|
Dong Y, Xu R, Zhang Y, Shi Y, Du K, Jia T, Wang J, Wang F. Different Frequency Bands in Various Regions of the Brain Play Different Roles in the Onset and Wake-Sleep Stages of Infantile Spasms. Front Pediatr 2022; 10:878099. [PMID: 35633963 PMCID: PMC9135356 DOI: 10.3389/fped.2022.878099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study aimed to identify the signatures of brain networks using electroencephalogram (EEG) in patients with infantile spasms (IS). METHODS Scalp EEGs of subjects with IS were prospectively collected in the first year of life (n = 8; age range 4-8 months; 3 males, 5 females). Ten minutes of ictal and interictal EEGs were clipped and filtered into different EEG frequency bands. The values of each pair of EEG channels were directly compared between ictal with interictal onsets and the sleep-wake phase to calculate IS brain network attributes: characteristic path length (CPL), node degree (ND), clustering coefficient (CC), and betweenness centrality (BC). RESULTS CPL, ND, and CC of the fast waves decreased while BC increased. CPL and BC of the slow waves decreased, while ND and CC increased during the IS ictal onset (P < 0.05). CPL of the alpha decreased, and BC increased during the waking time (P < 0.05). CONCLUSION The transmission capability of the fast waves, the local connectivity, and the defense capability of the slow waves during the IS ictal onset were enhanced. The alpha band played the most important role in both the global and local networks during the waking time. These may represent the brain network signatures of IS.
Collapse
Affiliation(s)
- Yan Dong
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Ruijuan Xu
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Yaodong Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Henan Neurodevelopment Engineering Research Center for Children, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yali Shi
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Kaixian Du
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Tianming Jia
- Henan Provincial Key Laboratory of Child Brain Injury, Department of Pediatrics, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Jun Wang
- Department of Children's Rehabilitation, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Fang Wang
- Department of Medical Record Management, Third Associated Hospital of Zheng Zhou University, Zhengzhou, China
| |
Collapse
|