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Mao D, Li S, Xu Y, Chen H, Liu P, Hu W. Factors influencing efficacy and relapse of adrenocorticotropic hormone in infantile epileptic spasms syndrome. Epilepsy Behav 2024; 161:110055. [PMID: 39312843 DOI: 10.1016/j.yebeh.2024.110055] [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: 06/25/2024] [Revised: 08/22/2024] [Accepted: 09/14/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Infantile epileptic spasms syndrome (IESS) is a severe epileptic condition characterized by persistent uncontrolled seizures, with some children experiencing recurrent seizures despite multiple pharmacological therapies. The prognostic risk factorsassociated with IESS remain unclear. This study aimed to evaluate the factors influencing the efficacy and relapse of adrenocorticotropic hormone (ACTH) treatment for IESS in infants, as well as to assess the correlation between the Burden of Amplitudes and Epileptiform Discharges (BASED) score and clinical outcomes. METHODS A retrospective analysis was conducted on a cohort of 88 pediatric patients diagnosed with IESS who received ACTH therapy at our hospital from February 2016 to August 2023. Patients were categorized into response (n = 47) and non-response (n = 41) groups based on their treatment response at day 28. Responders were further classified into relapse and non-relapse groups. A modified Poisson regression model and receiver operating characteristic (ROC) curves were employed to evaluate the positive predictive values. RESULTS In this study, a total of 47 patients (53.4 %) responded to ACTH treatment. Patients in the response group demonstrated significantly greater reductions in BASED scores by day 14 of ACTH treatment, yielding an area under the curve (AUC) of 0.859 (95 % CI: 0.782-0.937, P<0.05), with a sensitivity of 68.1 % and a specificity of 95.1 %. The optimal cut-off point was established at ≥ 2, corresponding to a Youden index of 0.632. Notably, patientswho were on anti-seizure medications (ASMs) before ACTH treatment and those with developmental delay prior to the onset of spasms exhibited lower short-term response rates (P<0.05), although these factors did not demonstrate predictive value. Among the responders, 20 cases (42.6 %) experienced a relapse, with only those patients showing specific abnormalities on cranial magnetic resonance imaging (MRI) exhibiting a statistically higher proportion of relapse. CONCLUSION Patients receiving ASMs before ACTH treatment and those with developmental delays prior to the onset of spasms may have a less favorable therapeutic response. A reduction in BASED scores of 2 or greater by day 14 of ACTH treatment may signify a potentially positive treatment response. Additionally, patients with IESS who present with specific abnormalities on cranial MRI may have an increased likelihood of relapse following ACTH treatment.
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Affiliation(s)
- Dandan Mao
- Pediatric Neurology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Sixiu Li
- Pediatric Neurology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Yang Xu
- Pediatric Neurology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Hui Chen
- Pediatric Neurology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Ping Liu
- Pediatric Neurology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China
| | - Wenguang Hu
- Pediatric Neurology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China.
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Sasaki M, Okanishi T, Matsuoka T, Yoshimura A, Maruyama S, Shiohama T, Hoshino H, Mori T, Majima H, Matsumoto H, Kobayashi S, Chiyonobu T, Matsushige T, Nakamura K, Kubota K, Tanaka R, Fujita T, Enoki H, Suzuki Y, Nakamura S, Fujimoto A, Maegaki Y. Infantile Epileptic Spasms Syndrome Complicated by Leigh Syndrome and Leigh-Like Syndrome: A Retrospective, Nationwide, Multicenter Case Series. Pediatr Neurol 2024; 157:29-38. [PMID: 38848614 DOI: 10.1016/j.pediatrneurol.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Six percent of patients with Leigh syndrome (LS) present with infantile epileptic spasms syndrome (IESS). However, treatment strategies for IESS with LS remain unclear. This retrospective study aimed to evaluate the efficacy and safety of treatment strategies in patients with IESS complicated by LS and Leigh-like syndrome (LLS). METHODS We distributed questionnaires to 750 facilities in Japan, and the clinical data of 21 patients from 15 hospitals were collected. The data comprised treatment strategies, including adrenocorticotropic hormone (ACTH) therapy, ketogenic diet (KD) therapy, and antiseizure medications (ASMs); effectiveness of each treatment; and the adverse events. RESULTS The median age at LS and LLS diagnosis was 7 months (range: 0 to 50), whereas that at the onset of epileptic spasms was 7 (range: 3 to 20). LS was diagnosed in 17 patients and LLS in four patients. Seven, two, five, and seven patients received ACTH + ASMs, ACTH + KD + ASMs, KD + ASMs, and ASMs only, respectively. Four (44%) of nine patients treated with ACTH and one (14%) of seven patients treated with KD achieved electroclinical remission within one month of treatment. No patients treated with only ASMs achieved electroclinical remission. Seven patients (33%) achieved electroclinical remission by the last follow-up. Adverse events were reported in four patients treated with ACTH, none treated with KD therapy, and eight treated with ASMs. CONCLUSION ACTH therapy shows the best efficacy and rapid action in patients with IESS complicated by LS and LLS. The effectiveness of KD therapy and ASMs in this study was insufficient.
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Affiliation(s)
- Michiru Sasaki
- Course of Medicine for Children with Disabilities, Faculty of Medicine and Graduate School of Medical Sciences, Tottori University, Yonago, Japan
| | - Tohru Okanishi
- Faculty of Medicine, Division of Child Neurology, Institute of Neurological Science, Tottori University, Yonago, Japan.
| | - Tsuyoshi Matsuoka
- Division of Child Neurology and Child Psychiatry, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center and Children's Medical Center, Haebaru, Japan
| | - Ayumi Yoshimura
- Department of Pediatrics, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shinsuke Maruyama
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Hoshino
- Department of Pediatrics, Toho University Medical Center Sakura Hospital, Chiba, Japan
| | - Tatsuo Mori
- Department of Pediatrics, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Hisakazu Majima
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroshi Matsumoto
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | - Satoru Kobayashi
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - Tomohiro Chiyonobu
- Department of Molecular Diagnostics and Therapeutics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Matsushige
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazuyuki Nakamura
- Department of Pediatrics, Yamagata University Hospital, Yamagata, Japan
| | - Kazuo Kubota
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Ryuta Tanaka
- Department of Pediatrics, Ibaraki Children's Hospital, Mito, Japan
| | - Takako Fujita
- Faculty of Medicine, Department of Pediatrics, Fukuoka University, Fukuoka, Japan
| | - Hideo Enoki
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Yasuhiro Suzuki
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Sadao Nakamura
- Department of Pediatrics, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshihiro Maegaki
- Faculty of Medicine, Division of Child Neurology, Institute of Neurological Science, Tottori University, Yonago, Japan
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Mytinger JR, Albert DVF, Aylward SC, Beatty CW, Bhalla S, Bhatia S, Brock GN, Ciliberto MA, Choudhari PR, Clark DJ, Cohen JM, Czech TM, Fredwall MM, Gonzalez-Giraldo E, Harini C, Hunter SE, Sandoval Karamian AG, Katyayan A, Kistler I, Kulkarni N, Liu VB, McCabe C, Murray T, Neville K, Patel SH, Pavuluri S, Phillips DJ, Samanta D, Sirsi D, Spelbrink EM, Stafstrom CE, Steenari M, Takacs DS, Terrill T, Tran L, Vidaurre J, Shrey DW. A Multicenter Training and Interrater Reliability Study of the BASED Score for Infantile Epileptic Spasms Syndrome. J Clin Neurophysiol 2024:00004691-990000000-00161. [PMID: 38995949 DOI: 10.1097/wnp.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
PURPOSE The best possible outcomes in infantile epileptic spasms syndrome require electroclinical remission; however, determining electrographic remission is not straightforward. Although the determination of hypsarrhythmia has inadequate interrater reliability (IRR), the Burden of AmplitudeS and Epileptiform Discharges (BASED) score has shown promise for the reliable interictal assessment of infantile epileptic spasms syndrome. Our aim was to develop a BASED training program and assess the IRR among learners. We hypothesized moderate or better IRR for the final BASED score and the presence or absence of epileptic encephalopathy (+/-EE). METHODS Using a web-based application, 31 learners assessed 12 unmarked EEGs (length 1-6 hours) from children with infantile epileptic spasms syndrome. RESULTS For all readers, the IRR was good for the final BASED score (intraclass correlation coefficient 0.86) and +/-EE (Marginal Multirater Kappa 0.63). For all readers, the IRR was fair to good for all individual BASED score elements. CONCLUSIONS These findings support the use of our training program to quickly learn the BASED scoring method. The BASED score may be a valuable clinical and research tool. Given that the IRR for the determination of epileptic encephalopathy is not perfect, clinical acumen remains paramount. Additional experience with the BASED scoring technique among learners and advances in collaborative EEG evaluation platforms may improve IRR.
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Affiliation(s)
- John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Dara V F Albert
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Shawn C Aylward
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Christopher W Beatty
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Sonam Bhalla
- Division of Neurology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, U.S.A
- Division of Pediatric Neurology, Children's Healthcare of Atlanta, Atlanta, Georgia, U.S.A
| | - Sonal Bhatia
- Department of Pediatrics, Division of Pediatric Neurology, Medical University of South Carolina and Shawn Jenkins Children's Hospital, Charleston, South Carolina, U.S.A
| | - Guy N Brock
- Department of Biomedical Informatics, College of Medicine
- Center for Biostatistics, Wexner Medical Center, Biostatistics Resource at NCH (BRANCH), Nationwide Children's Hospital and The Ohio State University, Columbus, OH, U.S.A
| | - Micheal A Ciliberto
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, U.S.A
| | - Purva R Choudhari
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Southwestern, Dallas, Texas, U.S.A
| | - Daniel J Clark
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Jennifer Madan Cohen
- Department of Neurology, Connecticut Children's Hospital, University of Connecticut, Hartford, Connecticut, U.S.A
| | - Theresa M Czech
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, U.S.A
| | - Megan M Fredwall
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Ernesto Gonzalez-Giraldo
- Department of Neurology, Division of Epilepsy, University of California, San Francisco, San Francisco, California, U.S.A
| | - Chellamani Harini
- Department of Neurology, Division of Epilepsy, Harvard University, Boston, Massachusetts, U.S.A
| | - Senyene E Hunter
- Department of Neurology, Division of Child Neurology, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A
| | | | - Akshat Katyayan
- Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Isaac Kistler
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Biostatistics Resource at Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Neil Kulkarni
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Virginia B Liu
- Division of Neurology, Orange California & Department of Pediatrics, Children's Hospital of Orange County, UC Irvine, Orange, California, U.S.A
| | - Corinne McCabe
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A
| | - Thomas Murray
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kerri Neville
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Shital H Patel
- Department of Pediatrics, Division of Pediatric Neurology, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Spriha Pavuluri
- Children's Hospital and Medical Center, Omaha, Nebraska, U.S.A
| | - Donald J Phillips
- Division of Neurology, Orange California & Department of Pediatrics, Children's Hospital of Orange County, UC Irvine, Orange, California, U.S.A
| | - Debopam Samanta
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Deepa Sirsi
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Emily M Spelbrink
- Department of Neurology, Division of Child Neurology, Stanford Children's Hospital, Stanford University, Palo Alto, California, U.S.A
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Maija Steenari
- Division of Neurology, Orange California & Department of Pediatrics, Children's Hospital of Orange County, UC Irvine, Orange, California, U.S.A
| | - Danielle S Takacs
- Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Tyler Terrill
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Linh Tran
- Comprehensive Epilepsy Program, Jane and John Justin Neuroscience Center, Cook Children's Medical Center, Fort Worth, Texas, U.S.A
| | - Jorge Vidaurre
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Daniel W Shrey
- Division of Neurology, Orange California & Department of Pediatrics, Children's Hospital of Orange County, UC Irvine, Orange, California, U.S.A
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Rajaraman RR, Smith RJ, Oana S, Daida A, Shrey DW, Nariai H, Lopour BA, Hussain SA. Computational EEG attributes predict response to therapy for epileptic spasms. Clin Neurophysiol 2024; 163:39-46. [PMID: 38703698 DOI: 10.1016/j.clinph.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/10/2024] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE We set out to evaluate whether response to treatment for epileptic spasms is associated with specific candidate computational EEG biomarkers, independent of clinical attributes. METHODS We identified 50 children with epileptic spasms, with pre- and post-treatment overnight video-EEG. After EEG samples were preprocessed in an automated fashion to remove artifacts, we calculated amplitude, power spectrum, functional connectivity, entropy, and long-range temporal correlations (LRTCs). To evaluate the extent to which each feature is independently associated with response and relapse, we conducted logistic and proportional hazards regression, respectively. RESULTS After statistical adjustment for the duration of epileptic spasms prior to treatment, we observed an association between response and stronger baseline and post-treatment LRTCs (P = 0.042 and P = 0.004, respectively), and higher post-treatment entropy (P = 0.003). On an exploratory basis, freedom from relapse was associated with stronger post-treatment LRTCs (P = 0.006) and higher post-treatment entropy (P = 0.044). CONCLUSION This study suggests that multiple EEG features-especially LRTCs and entropy-may predict response and relapse. SIGNIFICANCE This study represents a step toward a more precise approach to measure and predict response to treatment for epileptic spasms.
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Affiliation(s)
- Rajsekar R Rajaraman
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, CA, USA
| | - Rachel J Smith
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shingo Oana
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, CA, USA
| | - Atsuro Daida
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel W Shrey
- Division of Pediatric Neurology, University of California, Irvine, Irvine, CA, USA; Department of Neurology, Children's Hospital of Orange County, Orange, CA, USA
| | - Hiroki Nariai
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, CA, USA
| | - Beth A Lopour
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Shaun A Hussain
- Division of Pediatric Neurology, UCLA Mattel Children's Hospital and University of California, Los Angeles, Los Angeles, CA, USA.
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Mason JA, Juarez-Colunga E, Knupp KG. Electrographic screening for infantile epileptic spasms syndrome in a single sleep-wake cycle. Epilepsia 2024; 65:1737-1743. [PMID: 38572956 PMCID: PMC11166524 DOI: 10.1111/epi.17967] [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: 10/02/2023] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Infantile epileptic spasms syndrome (IESS) is a common and urgent diagnosis with seizure and nonseizure mimics. Evaluation with prolonged video-electroencephalography (EEG) can be time-consuming and costly. This study investigated the use of EEG review of a single sleep-wake cycle to exclude IESS. METHODS We retrospectively reviewed video-EEG studies to rule out IESS in children between the ages of 2 months and 2 years in the period from January 2019 through June 2020. EEG studies were reviewed from the start of the recording through the first sleep-wake cycle and scored as "normal," "consistent with IESS," or "abnormal but not diagnostic of IESS." Scores were compared to the clinical report created by analysis of the entire video-EEG. RESULTS Inclusion criteria were met in 238 EEG studies. The mean patient age was 7.6 months. The median duration of the full study was 908 min, compared to 107.5 min for the first sleep-wake cycle only. The median difference in recording time was 801 min, p-value < .01. Scored outcomes were similar. Sixty-eight percent of EEG studies were scored as "normal" on first sleep-wake cycle review as compared to 63% on full study review, 13% scored as "consistent with IESS" compared to 16% and 19% scored as "abnormal but not diagnostic of IESS" compared to 21%. Sensitivity and specificity of the first sleep-wake cycle review for studies "consistent with IESS" was 84% and 100%, respectively. No cases of IESS were scored as normal on first sleep-wake cycle review. SIGNIFICANCE A single sleep-wake cycle captured on EEG can triage studies when IESS is suspected. A normal first sleep-wake cycle did not miss cases of IESS and could result in reduced EEG recording time. Because most of these cases presented to an emergency department, a normal first sleep-wake cycle may help providers determine the acuity, or necessity, of further testing.
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Affiliation(s)
- John A Mason
- Department of Neurology, University of new Mexico, Albuquerque, New Mexico, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelly G Knupp
- Department of Pediatrics and Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Erdemir G, Moosa AN. Electroclinical Features of Infantile Epileptic Spasms Syndrome. Ann Indian Acad Neurol 2024; 27:227-235. [PMID: 38912539 PMCID: PMC11232823 DOI: 10.4103/aian.aian_445_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/25/2024] Open
Abstract
Epileptic spasms are a unique, age-dependent manifestation of epilepsies in infancy and early childhood, commonly occurring as part of infantile epileptic spasms syndrome. Developmental stagnation and subsequent decline may occur in children with epileptic spasms, partly due to the abundant high-amplitude interictal epileptiform and slow wave abnormalities. Early recognition and treatment of epileptic spasms, along with the reversal of the electroencephalography (EEG) findings, are critical for improving outcomes. Recognizing hypsarrhythmia and its variations is key to confirming the diagnosis. The various patterns of hypsarrhythmia are not etiology specific, but could indicate the severity of the disease. Several scoring systems have been proposed to improve the inter-rater reliability of recognizing hypsarrhythmia and to assess EEG progress in response to treatment. Ictal patterns during spasms are brief and composed of slow waves, sharp transients, fast activity, and voltage attenuation, either in isolation or more commonly as a combination of these waveforms. Ictal patterns are commonly diffuse, but may be lateralized to one hemisphere in children with structural etiology. A subset of patients with epileptic spasms has a surgically remediable etiology, with readily identifiable lesions on neuroimaging in most cases. Asymmetry in epileptic spasms, concurrent focal seizures, and asymmetric interictal and ictal EEG findings may be present, but a lack of focality in electrophysiological findings is not uncommon. Intracranial EEG features of epileptic spasms have been described, but the utility of intracranial EEG monitoring in surgical candidates with overt focal epileptogenic lesions on magnetic resonance imaging is questionable, and surgery could be performed using noninvasive data.
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Affiliation(s)
- Gozde Erdemir
- Department of Neurology, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ahsan N. Moosa
- Pediatric Epilepsy Section, Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Kuchenbuch M, Lo Barco T, Chemaly N, Chiron C, Nabbout R. Fifteen years of real-world data on the use of vigabatrin in individuals with infantile epileptic spasms syndrome. Epilepsia 2024; 65:430-444. [PMID: 37872396 DOI: 10.1111/epi.17808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate our treatment algorithm for infantile epileptic spasms syndrome (IESS) used between 2000 and 2018. We initiated vigabatrin (VGB), and steroids were added if the electroclinical response (spasms and electroencephalogram [EEG]) to VGB was not obtained or incomplete. METHODS Individuals with IESS treated with VGB were recruited from our hospital clinical data warehouse based on electronic health records (EHRs) generated since 2009 and containing relevant keywords. We confirmed the diagnosis of IESS. Clinical, EEG, imaging, and biological data were extracted from the EHRs. We analyzed factors associated with short-term response, time to response, relapse, time to relapse of spasms, and the presence of spasms at last follow-up. RESULTS We collected data from 198 individuals (female: 46.5%, IESS onset: 6 [4.5-10.3] months, follow-up: 4.6 [2.5-7.6] years, median [Q1-Q3]) including 129 (65.2%) with identifiable etiology. VGB was started 17 (5-57.5) days after IESS diagnosis. A total of 113 individuals were responders (57.1% of the cohort), 64 with VGB alone and 38 with VGB further combined with steroids (56.6% and 33.6% of responders, respectively). Among responders, 33 (29%) experienced relapses of spasms, mostly those with later onset of spasms (p = .002) and those who received VGB for <24 months after spasms cessation compared to a longer duration on VGB (45% vs. 12.8%, p = .003). At follow-up, 92 individuals were seizure-free (46.5% of the whole cohort), including 26 free of therapy (13.1%). One hundred twelve individuals (56.6%) were still receiving VGB, with a duration of 3.2 (1.75-5.7) years. SIGNIFICANCE Our sequential protocol introducing VGB then adding steroids is an effective alternative to a combined VGB-steroids approach in IESS. It avoids steroid-related adverse events, as well as those from VGB-steroid combination. According to our data, a period of 7 days seems sufficient to assess VGB response and enables the addition of steroids rapidly if needed. Continuing VGB for 2 years may balance the risk of relapse and treatment-induced adverse events.
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Affiliation(s)
- Mathieu Kuchenbuch
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Service de Pédiatrie, Reference Center for Rare Epilepsies, member of ERN EpiCARE, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Tommaso Lo Barco
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Nicole Chemaly
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
| | - Catherine Chiron
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Université de Paris Cité, Paris, France
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Iype M, Anish TS, Saradakutty G, Kunju PM, Sreedharan M, Ahamed SM. Long-term survival and factors associated with mortality among children with infantile epileptic spasms syndrome - A retrospective cohort study. Seizure 2023; 112:18-25. [PMID: 37729722 DOI: 10.1016/j.seizure.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The existing literature indicates a higher risk of mortality among children with Infantile epileptic spasms syndrome (IESS). Our aim was to find the mortality pattern and factors that affect survival among children with IESS. METHODS Children with IESS who had age of onset between one month and 24 months were included. The primary outcome was survival. We used Kaplan-Meier estimates for survival analysis and Cox regression analyses to evaluate possible factors associated with mortality. RESULTS During the follow-up period (120 months), 19/160 children (11.9%) expired. Three children expired in the first week after initiation of ACTH. There were six deaths (3.8%; 31.6% of deaths), within two years. Clinical findings and laboratory investigations revealed the cause of death to be severe pneumonia in ten children. Three died of severe sepsis. Four died due to metabolic crisis and two children died due to probable Sudden unexpected death in epilepsy (SUDEP). On multivariable analysis, mortality was predicted by 'presence of seizures other than spasms' and an inborn error of metabolism (IEM) as the underlying cause. None of the children in the idiopathic group died. CONCLUSION Survival in our single center cohort with IESS was good in comparison to previous studies. Considering that pneumonia and sepsis were the most common cause of mortality that we detected, steps for prevention of sepsis might be worth considering in these children. Presence of seizures other than epileptic spasms, and an IEM should prompt the physician to let the family know that risk of mortality is high.
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Affiliation(s)
- Mary Iype
- Department of Pediatric Neurology, Government Medical College Trivandrum, Kerala, India.
| | | | - Geetha Saradakutty
- Department of Pediatrics, Government Medical College Konni, Kerala, India
| | - Pa Mohammed Kunju
- Department of Pediatric Neurology, Government Medical College Trivandrum, Kerala, India; KIMS HEALTH, Trivandrum, Kerala, India
| | - Mini Sreedharan
- Department of Pediatric Neurology, Government Medical College Trivandrum, Kerala, India
| | - Shahanaz M Ahamed
- Department of Pediatric Neurology, Government Medical College Trivandrum, Kerala, India
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9
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Dong Y, Jin L, Li M, Lian R, Wu G, Xu R, Zhang X, Du K, Jia T, Wang H, Zhao S. Crucial involvement of fast waves and Delta band in the brain network attributes of infantile epileptic spasms syndrome. Front Pediatr 2023; 11:1249789. [PMID: 37928352 PMCID: PMC10623136 DOI: 10.3389/fped.2023.1249789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Objective This study aims to describe the characteristics of the brain network attributes in children diagnosed with Infantile Epileptic Spasms Syndrome (IESS) and to determine the influence exerted by adrenocorticotrophic hormone (ACTH) or methylprednisolone (MP) on network attributes. Methods In this retrospective cohort study, we recruited 19 infants diagnosed with IESS and 10 healthy subjects as the control from the Pediatric Neurology Department at the Third Affiliated Hospital of Zhengzhou University between October 2019 and December 2020. The first thirty-minute processed electroencephalograms (EEGs) were clipped and filtered into EEG frequency bands (2 s each). A comparative assessment was conducted between the IESS group and the controls as well as the pre- and post-treatment in the IESS group. Mutual information values for each EEG channel were collected and compared including characteristic path length (CPL), node degree (ND), clustering coefficient (CC), and betweenness centrality (BC), based on graph theory. Results Comparing the control group, in the IESS group, there was an increase in CPL of the Delta band, and a decrease in ND and CC of the Delta band during the waking period, contrary to those during the sleeping period (P < 0.05), a decreased in CPL of the fast waves and an increase in ND and CC (P < 0.05) in the sleep-wake cycle, and a decrease in ND and CC of the Theta band in the waking phase. Post-treatment compared with the pre-treatment, during the waking ictal phase, there was a noted decrease in CPL in the Delta band and fast waves, while an increase was observed in ND and CC (P < 0.05). Conclusions The Delta band and fast waves are crucial components of the network attributes in IESS. Significance This investigation provides a precise characterization of the brain network in children afflicted with IESS, and lays the groundwork for predicting the prognosis using graph theory.
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Affiliation(s)
- Yan Dong
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience of Zhengzhou University, Zhengzhou, China
| | - Liang Jin
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Mengchun Li
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Ruofei Lian
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Gongao Wu
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Ruijuan Xu
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
- Department of Pediatrics, Zhumadian Central Hospital, Zhumadian, China
| | - Xiaoli Zhang
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Kaixian Du
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Tianming Jia
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Haiyan Wang
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Shichao Zhao
- Department of Pediatrics, The Third Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
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Sharawat IK, Ramachandran A, Elwadhi A, Tomar A, Panda PK. Nutritional vitamin B12 deficiency-associated Infantile epileptic spasms syndrome: Clinico-neurophysiological presentation, response to treatment, and neurodevelopmental outcome. Seizure 2023; 110:93-98. [PMID: 37331199 DOI: 10.1016/j.seizure.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION Nutritional vitamin B12 deficiency has been shown to cause Infantile epileptic spasms syndrome (IESS) in infants in anecdotal studies. METHODS In this retrospective cohort study, we intended to study the clinical presentation, neurophysiological, laboratory abnormalities, treatment, and neurodevelopmental outcome at 6-months in infants presenting with IESS secondary to nutritional vitamin B12 deficiency (NVBD) and to compare these variables from the rest of the infants with IESS without vitamin B12 deficiency. We included only spasm-free cases or those who showed at least a 50% reduction in spasm frequency on D7 after starting oral/parenteral vitamin B12. We used well-validated measurement tools like the Developmental Assessment Scale for Indian Infants (DASII), Child Feeding Index (CFI), Burden of amplitudes and epileptiform discharges (BASED) score, countable Hypsarrhythmia paroxysm index (cHPI), durational Hypsarrhythmia paroxysm index (dHPI), and Early childhood epilepsy severity scale (E-CHESS) score for documenting these variables. RESULTS Data from 162 infants with IESS (21 caused by NVBD) were included in our study. The NVBD group had more patients residing in the rural region, with lower socioeconomic status, vegetarian mothers and poor complementary feeding index (p<0.001 for all). The NVBD group also had less number of patients requiring antiseizure medications (ASMs) and hormonal therapy(p<0.001), remained seizure free at six months (p=0.008), lower number of clusters per day (p=0.02) and the number of spasms per clusters at presentation (p=0.03), lower BASED score (p=0.03) and cHPI, dHPI at presentation (p<0.001). All of them remained spasm-free, with normal electroencephalogram at 6-months. Development quotient at baseline, at 6-months, and improvement in development quotient between these two-time points were more in the vitamin B12 deficiency group (p<0.001). All of them had clinical features of pre-ITS (infantile tremor syndrome) or ITS and it was found to be the only independent predictor of NVBD in infants with IESS. Mothers of all these infants had low serum vitamin B12 levels (<200 pg/ml). CONCLUSIONS Nutritional vitamin B12 deficiency may cause IESS in infants. Hence, vitamin B12 deficiency needs to be ruled out in patients with IESS without any definite etiology.
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Aparna Ramachandran
- Department of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala 673009, India
| | - Aman Elwadhi
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Apurva Tomar
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
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11
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Brain Complexity Predicts Response to Adrenocorticotropic Hormone in Infantile Epileptic Spasms Syndrome: A Retrospective Study. Neurol Ther 2022; 12:129-144. [PMID: 36327095 PMCID: PMC9837343 DOI: 10.1007/s40120-022-00412-1] [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: 08/11/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Infantile epileptic spasms syndrome (IESS) is an age-specific and severe epileptic encephalopathy. Although adrenocorticotropic hormone (ACTH) is currently considered the preferred first-line treatment, it is not always effective and may cause side effects. Therefore, seeking a reliable biomarker to predict the treatment response could benefit clinicians in modifying treatment options. METHODS In this study, the complexities of electroencephalogram (EEG) recordings from 15 control subjects and 40 patients with IESS before and after ACTH therapy were retrospectively reviewed using multiscale entropy (MSE). These 40 patients were divided into responders and nonresponders according to their responses to ACTH. RESULTS The EEG complexities of the patients with IESS were significantly lower than those of the healthy controls. A favorable response to treatment showed increasing complexity in the γ band but exhibited a reduction in the β/α-frequency band, and again significantly elevated in the δ band, wherein the latter was prominent in the parieto-occipital regions in particular. Greater reduction in complexity was significantly linked with poorer prognosis in general. Occipital EEG complexities in the γ band revealed optimized performance in recognizing response to the treatment, corresponding to the area under the receiver operating characteristic curves as 0.8621, while complexities of the δ band served as a fair predictor of unfavorable outcomes globally. CONCLUSION We suggest that optimizing frequency-specific complexities over critical brain regions may be a promising strategy to facilitate predicting treatment response in IESS.
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12
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Wan L, Zhang CT, Zhu G, Chen J, Shi XY, Wang J, Zou LP, Zhang B, Shi WB, Yeh CH, Yang G. Integration of multiscale entropy and BASED scale of electroencephalography after adrenocorticotropic hormone therapy predict relapse of infantile spasms. World J Pediatr 2022; 18:761-770. [PMID: 35906344 DOI: 10.1007/s12519-022-00583-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Even though adrenocorticotropic hormone (ACTH) demonstrated powerful efficacy in the initially successful treatment of infantile spasms (IS), nearly half of patients have experienced a relapse. We sought to investigate whether features of electroencephalogram (EEG) predict relapse in those IS patients without structural brain abnormalities. METHODS We retrospectively reviewed data from children with IS who achieved initial response after ACTH treatment, along with EEG recorded within the last two days of treatment. The recurrence of epileptic spasms following treatment was tracked for 12 months. Subjects were categorized as either non-relapse or relapse groups. General clinical and EEG recordings were collected, burden of amplitudes and epileptiform discharges (BASED) score and multiscale entropy (MSE) were carefully explored for cross-group comparisons. RESULTS Forty-one patients were enrolled in the study, of which 26 (63.4%) experienced a relapse. The BASED score was significantly higher in the relapse group. MSE in the non-relapse group was significantly lower than the relapse group in the γ band but higher in the lower frequency range (δ, θ, α). Sensitivity and specificity were 85.71% and 92.31%, respectively, when combining MSE in the δ/γ frequency of the occipital region, plus BASED score were used to distinguish relapse from non-relapse groups. CONCLUSIONS BASED score and MSE of EEG after ACTH treatment could be used to predict relapse for IS patients without brain structural abnormalities. Patients with BASED score ≥ 3, MSE increased in higher frequency, and decreased in lower frequency had a high risk of relapse.
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Affiliation(s)
- Lin Wan
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China
| | - Chu-Ting Zhang
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China
| | - Gang Zhu
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China
| | - Jian Chen
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiu-Yu Shi
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jing Wang
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Li-Ping Zou
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China.,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese People's Liberation Army, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wen-Bin Shi
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China
| | - Chien-Hung Yeh
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China.
| | - Guang Yang
- Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China. .,Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China. .,Medical School of Chinese People's Liberation Army, Beijing, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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13
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Fan Y, Chen D, Wang H, Pan Y, Peng X, Liu X, Liu Y. Automatic BASED scoring on scalp EEG in children with infantile spasms using convolutional neural network. Front Mol Biosci 2022; 9:931688. [PMID: 36032671 PMCID: PMC9399419 DOI: 10.3389/fmolb.2022.931688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, the Burden of Amplitudes and Epileptiform Discharges (BASED) score has been used as a reliable, accurate, and feasible electroencephalogram (EEG) grading scale for infantile spasms. However, manual EEG annotation is, in general, very time-consuming, and BASED scoring is no exception. Convolutional neural networks (CNNs) have proven their great potential in many EEG classification problems. However, very few research studies have focused on the use of CNNs for BASED scoring, a challenging but vital task in the diagnosis and treatment of infantile spasms. This study proposes an automatic BASED scoring framework using EEG and a deep CNN. The feasibility of using CNN for automatic BASED scoring was investigated in 36 patients with infantile spasms by annotating their long-term EEG data with four levels of the BASED score (scores 5, 4, 3, and ≤2). In the validation set, the accuracy was 96.9% by applying a multi-layer CNN to classify the EEG data as a 4-label problem. The extensive experiments have demonstrated that our proposed approach offers high accuracy and, hence, is an important step toward an automatic BASED scoring algorithm. To the best of our knowledge, this is the first attempt to use a CNN to construct a BASED-based scoring model.
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Affiliation(s)
- Yuying Fan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Duo Chen
- School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Yunhui Liu, ; Duo Chen,
| | - Hua Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yijie Pan
- Department of Computer Science and Technology, School of Information Science and Technology, Tsinghua University, Beijing, China
- Ningbo Institute of Information Technology Application, CAS, Ningbo, China
| | - Xueping Peng
- Australian AI Institute, FEIT, University of Technology Sydney, Sydney, NSW, Australia
| | - Xueyan Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yunhui Liu, ; Duo Chen,
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14
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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.
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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
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15
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Liu X, Chen J, Wan L, Li Z, Liang Y, Yan H, Zhu G, Zhang B, Yang G. Interrater and Intrarater Agreement of Epileptic Encephalopathy Among Electroencephalographers for Children with Infantile Spasms Using the Burden of Amplitudes and Epileptiform Discharges (BASED) EEG Grading Scale: Study Design and Statistical Considerations. Neurol Ther 2022; 11:1427-1437. [PMID: 35809161 PMCID: PMC9338191 DOI: 10.1007/s40120-022-00382-4] [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: 05/10/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Infantile spasms are a serious epilepsy syndrome with a poor prognosis. Electroencephalography (EEG) has been a key component in the prognosis and treatment of infantile spasms. This multi-center study protocol is developed to investigate interrater and intrarater agreement of an electroencephalographic grading scale—the Burden of Amplitudes and Epileptiform Discharges (BASED) score among electroencephalographers. Methods Thirty children, aged 0–2 years, with infantile spasms who were hospitalized in the Chinese PLA General Hospital will be recruited into this study by stratified sampling. Seven electroencephalographers from different Class A tertiary hospitals will select a 5-min epoch with the most severe epileptiform discharge, score the EEG reports, and provide the basis for the scoring. The 420 (30 × 7 × 2) scoring results provided by electroencephalographers in two rounds can be analyzed statistically using weighted kappa (weighted \documentclass[12pt]{minimal}
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\begin{document}$$\kappa$$\end{document}κ) statistic, and intraclass correlation coefficient (ICC) to calculate the interrater and intrarater agreement. Discussion We will recruit more electroencephalographers than were included in previous studies to assess the interrater and intrarater agreement in the selection of 5-min EEG epochs, the BASED scores, and the basis for scoring. If the BASED score has an adequate interrater and intrarater agreement, the score will have more significance for guiding the clinical management and for predicting the prognosis of patients with infantile spasms. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00382-4.
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Affiliation(s)
- Xinting Liu
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Jian Chen
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Lin Wan
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Zhichao Li
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Yan Liang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Huimin Yan
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China
| | - Guangyu Zhu
- Department of Computer Science and Statistics, University of Rhode Island, Kingston, RI, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Guang Yang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China.
- Senior Department of Pediatrics, Seventh Medical Center, PLA General Hospital, Beijing, 100000, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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16
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Assessing Risk for Relapse among Children with Infantile Spasms Using the Based Score after ACTH Treatment: A Retrospective Study. Neurol Ther 2022; 11:835-849. [PMID: 35428921 PMCID: PMC9095777 DOI: 10.1007/s40120-022-00347-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/23/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Even though adrenocorticotropic hormone (ACTH) demonstrated powerful efficacy in the initially successful treatment of infantile spasms (IS), nearly one-half of patients whose spasms were once suppressed experienced relapse. There is currently no validated method for the prediction of the risk of relapse. The Burden of Amplitudes and Epileptiform Discharges (BASED) score is an electroencephalogram (EEG) grading scale for children with infantile spasms. We sought to determine whether an association exists between the BASED score after ACTH treatment and relapse after initial response with ACTH. Methods Children with IS who achieved initial response after ACTH treatment were selected as the study subjects. Those who experienced relapse within 12 months after ACTH treatment were categorized as the relapse group, and those who did not were categorized as the non-relapse group. Their general clinical data and EEG data (using BASED scoring) after ACTH treatment were collected, and compared between groups. Cox proportional hazards models were fit to determine factors associated with relapse. Results A total of 64 children with IS were enrolled in the study, of which 37 (57.8%) experienced a relapse, and the median duration after ACTH treatment was 3 (1.5, 6) months. The BASED score was significantly higher in the relapse group than in the non-relapse group. Cox modeling demonstrated that BASED score was independently associated with relapse. The patients with a score greater than or equal to 3 showed a high rate (89.3%) of relapse. The relapse group had stronger, more stable EEG functional networks than the non-relapse group, and there were obvious correlations between BASED score and functional connectivity. Conclusion This study suggests the BASED score after ACTH treatment has potential value as a predictor for relapse after initial response. Children with IS who have a BASED score greater than or equal to 3 after the initial response of ACTH carry a high risk of relapse within 1 year. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00347-7.
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Baumer FM, Mytinger JR, Neville K, Briscoe Abath C, Gutierrez CA, Numis AL, Harini C, He Z, Hussain SA, Berg AT, Chu CJ, Gaillard WD, Loddenkemper T, Pasupuleti A, Samanata D, Singh RK, Singhal NS, Wusthoff CJ, Wirrell EC, Yozawitz E, Knupp KG, Shellhaas RA, Grinspan ZM. Inequities in therapy for infantile spasms: a call to action. Ann Neurol 2022; 92:32-44. [PMID: 35388521 DOI: 10.1002/ana.26363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether selection of treatment for children with infantile spasms (IS) varies by race/ethnicity. METHODS The prospective US National Infantile Spasms Consortium database includes children with IS treated from 2012-2018. We examined the relationship between race/ethnicity and receipt of standard IS therapy (prednisolone, adrenocorticotropic hormone, vigabatrin), adjusting for demographic and clinical variables using logistic regression. Our primary outcome was treatment course, which considered therapy prescribed for the first and, when needed, the second IS treatment together. RESULTS Of 555 children, 324 (58%) were Non-Hispanic white, 55 (10%) Non-Hispanic Black, 24 (4%) Non-Hispanic Asian, 80 (14%) Hispanic, and 72 (13%) Other/Unknown. Most (398, 72%) received a standard treatment course. Insurance type, geographic location, history of prematurity, prior seizures, developmental delay or regression, abnormal head circumference, hypsarrhythmia, and IS etiologies were associated with standard therapy. In adjusted models, Non-Hispanic Black children had lower odds of receiving a standard treatment course compared with Non-Hispanic white children (OR 0.42, 95% CI 0.20-0.89, p = 0.02). Adjusted models also showed that children with public (vs. private) insurance had lower odds of receiving standard therapy for treatment 1 (OR 0.42, CI 0.21-0.84, p = 0.01). INTERPRETATION Non-Hispanic Black children were more often treated with non-standard IS therapies than Non-Hispanic white children. Likewise, children with public (vs. private) insurance were less likely to receive standard therapies. Investigating drivers of inequities, and understanding the impact of racism on treatment decisions, are critical next steps to improve care for patients with IS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Kerri Neville
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan (Michigan Medicine), Ann Arbor, MI
| | - Christina Briscoe Abath
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Camilo A Gutierrez
- Department of Neurology, University of Maryland Medical Center, Baltimore, MD
| | - Adam L Numis
- Department of Neurology, Division of Epilepsy, University of California San Francisco, San Francisco, CA
| | - Chellamani Harini
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Zihuai He
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Shaun A Hussain
- Department of Pediatrics, Division of Pediatric Neurology, University of California, Los Angeles, CA
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Catherine J Chu
- Department of Neurology, Divisions of Child Neurology and Neurophysiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Tobias Loddenkemper
- Department of Child Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Debopam Samanata
- Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, AR
| | - Rani K Singh
- Department of Pediatrics, Atrium Health-Levine Children's, Charlotte, NC
| | - Nilika S Singhal
- Department of Neurology, Division of Epilepsy, University of California San Francisco, San Francisco, CA
| | - Courtney J Wusthoff
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Elaine C Wirrell
- Department of Neurology, Divisions of Epilepsy and Child and Adolescent Neurology, Mayo Clinic, Rochester, MN
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, NY
| | - Kelly G Knupp
- Department of Pediatrics, New York-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY
| | - Renée A Shellhaas
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan (Michigan Medicine), Ann Arbor, MI
| | - Zachary M Grinspan
- Department of Pediatrics and Neurology, University of Colorado, Aurora, CO.,Department of Healthcare Policy & Research, New York-Presbyterian Komansky Children's Hospital, Weill Cornell Medicine, New York, NY
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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.
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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
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19
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Wang W, Li H, Yan J, Zhang H, Li X, Zheng S, Wang J, Xing Y, Cheng L, Li D, Lai H, Qu J, Loh HH, Fang F, Yang X. Automatic detection of interictal ripples on scalp EEG to evaluate the effect and prognosis of ACTH therapy in patients with infantile spasms. Epilepsia 2021; 62:2240-2251. [PMID: 34309835 DOI: 10.1111/epi.17018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to explore the feasibility of using scalp-recorded high-frequency oscillations (HFOs) to evaluate the efficacy and prognosis of adrenocorticotropic hormone (ACTH) treatment in patients with infantile spasms. METHODS Thirty-nine children with infantile spasms were enrolled and divided into seizure-free and non-seizure-free groups after ACTH treatment. Patients who were seizure-free were further divided into relapse and non-relapse subgroups based on the observations made during a 6-month follow-up period. Scalp ripples were detected and compared during the interictal periods before and after 2 weeks of treatment. RESULTS After ACTH treatment, the number and channels of ripples were significantly lower, whereas the percentage decrease in the number, spectral power, and channels of ripples was significantly higher in the seizure-free group than in the non-seizure-free group. In addition, the relapse subgroup showed higher number and spectral power and wider distribution of ripples than did the non-relapse subgroup. Changes in HFOs in terms of number, spectral power, and channel of ripples were closely related to the severity of epilepsy and can indicate disease susceptibility. SIGNIFICANCE Scalp HFOs can be used as an effective biomarker to monitor the effect and evaluate the prognosis of ACTH therapy in patients with infantile spasms.
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Affiliation(s)
- Wei Wang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Hua Li
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiaqing Yan
- College of Electrical and Control Engineering, North China University of Technology, Beijing, China
| | - Herui Zhang
- Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xiaonan Li
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Su Zheng
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiaoyang Wang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Yue Xing
- Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Lipeng Cheng
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Donghong Li
- The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huanling Lai
- Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Junda Qu
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Horace H Loh
- Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Fang Fang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Yang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
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20
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Mytinger JR. Definitions and Diagnostic Criteria for Infantile Spasms and West Syndrome - Historical Perspectives and Practical Considerations. Semin Pediatr Neurol 2021; 38:100893. [PMID: 34183140 DOI: 10.1016/j.spen.2021.100893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
The term infantile spasms has been used inconsistently within the medical literature for decades. We are also without formal consensus on the diagnostic criteria for West syndrome. Author-specific definitions for these terms will determine the populations studied within research studies and thus impact the relevance of the data acquired. In addition, how one defines these terms may have serious consequences for children presenting with infantile spasms such as the inappropriate withholding of standard therapy in those who fail to meet criteria for West syndrome. The overreliance on the term hypsarhythmia is particularly problematic given that many children presenting with infantile spasms will not have this classic pattern and because the determination of hypsarhythmia has poor inter-rater reliability. Herein I review historical perspectives, relying heavily on published monographs and consensus statements, and promote practical definitions and diagnostic criteria for infantile spasms and West syndrome. In an effort to encourage best clinical practice and research methodology, I include guidance for the diagnosis of infantile spasms (a seizure type) and West syndrome (an epilepsy syndrome).
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Affiliation(s)
- John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, and The Ohio State University, Columbus, OH.
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