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Baer S, Schalk A, Miguet M, Schaefer É, El Chehadeh S, Ginglinger E, de Saint Martin A, Abi Wardé MT, Laugel V, de Feraudy Y, Gauer L, Hirsch E, Boulay C, Bansept C, Bolocan A, Kitadinis I, Gouronc A, Gérard B, Piton A, Scheidecker S. Copy Number Variation and Epilepsy: State of the Art in the Era of High-Throughput Sequencing-A Multicenter Cohort Study. Pediatr Neurol 2024; 159:16-25. [PMID: 39094250 DOI: 10.1016/j.pediatrneurol.2024.07.007] [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: 01/04/2024] [Revised: 06/12/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Genetic epilepsy diagnosis is increasing due to technological advancements. Although the use of molecular diagnosis is increasing, chromosomal microarray analysis (CMA) remains an important diagnostic tool for many patients. We aim to explore the role and indications of CMA in epilepsy, given the current genomic advances. METHODS We obtained data from 378 epileptic described patients, who underwent CMA between 2015 and 2021. Different types of syndromic or nonsyndromic epilepsy were represented. RESULTS After excluding patients who were undertreated or had missing data, we included 250 patients with treated epilepsy and relevant clinical information. These patients mostly had focal epilepsy or developmental and epileptic encephalopathy, with a median start age of 2 years. Ninety percent of the patients had intellectual disability, more than two thirds had normal head size, and 60% had an abnormal magnetic resonance imaging. We also included 10 patients with epilepsy without comorbidities. In our cohort, we identified 35 pathogenic copy number variations (CNVs) explaining epilepsy with nine recurrent CNVs enriched in patients with epilepsy, 12 CNVs related to neurodevelopmental disorder phenotype with possible epilepsy, five CNVs including a gene already known in epilepsy, and nine CNVs based on size combined with de novo occurrence. The diagnosis rate in our study reached 14% (35 of 250) with first-line CMA, as previously reported. Although targeted gene panel sequencing could potentially diagnose some of the reported epilepsy CNVs (34% [12 of 35]). CONCLUSIONS CMA remains a viable option as the first-line genetic test in cases where other genetic tests are not available and as a second-line diagnostic technique if gene panel or exome sequencing yields negative results.
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Affiliation(s)
- Sarah Baer
- Department of Neuropediatrics, ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Institute for Genetics and Molecular and Cellular Biology (IGBMC), University of Strasbourg, CNRS UMR7104, INSERM U1258, Illkirch, France.
| | - Audrey Schalk
- Laboratories of Genetic Diagnosis, Institut de Génétique Médicale d'Alsace (IGMA), Strasbourg University Hospitals Strasbourg France, Strasbourg, France
| | | | - Élise Schaefer
- Clinical Genetics Unit, Institut de Génétique Médicale d'Alsace (IGMA), Strasbourg, France
| | - Salima El Chehadeh
- Clinical Genetics Unit, Institut de Génétique Médicale d'Alsace (IGMA), Strasbourg, France
| | | | - Anne de Saint Martin
- Department of Neuropediatrics, ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marie-Thérèse Abi Wardé
- Department of Neuropediatrics, ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Vincent Laugel
- Department of Neuropediatrics, ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yvan de Feraudy
- Department of Neuropediatrics, ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lucas Gauer
- Epilepsy Unit "Francis Rohmer," ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Edouard Hirsch
- Epilepsy Unit "Francis Rohmer," ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clotilde Boulay
- Epilepsy Unit "Francis Rohmer," ERN EpiCare, French Centre de référence des Épilepsies Rares (CréER), Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Department of Pediatrics, Émile Muller Hospital, Mulhouse, France
| | - Claire Bansept
- Department of Pediatrics, Émile Muller Hospital, Mulhouse, France
| | - Anamaria Bolocan
- Department of Pediatrics, Émile Muller Hospital, Mulhouse, France
| | - Ismini Kitadinis
- Department of Pediatrics, Émile Muller Hospital, Mulhouse, France
| | - Aurélie Gouronc
- Laboratories of Genetic Diagnosis, Institut de Génétique Médicale d'Alsace (IGMA), Strasbourg University Hospitals Strasbourg France, Strasbourg, France
| | - Bénédicte Gérard
- Laboratories of Genetic Diagnosis, Institut de Génétique Médicale d'Alsace (IGMA), Strasbourg University Hospitals Strasbourg France, Strasbourg, France
| | - Amélie Piton
- Institute for Genetics and Molecular and Cellular Biology (IGBMC), University of Strasbourg, CNRS UMR7104, INSERM U1258, Illkirch, France; Laboratories of Genetic Diagnosis, Institut de Génétique Médicale d'Alsace (IGMA), Strasbourg University Hospitals Strasbourg France, Strasbourg, France
| | - Sophie Scheidecker
- Laboratories of Genetic Diagnosis, Institut de Génétique Médicale d'Alsace (IGMA), Strasbourg University Hospitals Strasbourg France, Strasbourg, France
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Kanmaz S, Yılmaz S, Olculu CB, Toprak DE, Ince T, Yılmaz Ö, Atas Y, Sen G, Şimşek E, Serin HM, Durmuşalioğlu EA, Işık E, Atik T, Aktan G, Cogulu O, Gokben S, Ozkınay F, Tekgul H. The Utility of Genetic Testing in Infantile Epileptic Spasms Syndrome: A Step-Based Approach in the Next-Generation Sequencing Era. Pediatr Neurol 2024; 157:100-107. [PMID: 38905742 DOI: 10.1016/j.pediatrneurol.2024.05.018] [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: 07/20/2023] [Revised: 04/29/2024] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND To evaluate the utility of genetic testing for etiology-specific diagnosis (ESD) in infantile epileptic spasms syndrome (IESS) with a step-based diagnostic approach in the next-generation sequencing (NGS) era. METHODS The study cohort consisted of 314 patients with IESS, followed by the Pediatric Neurology Division of Ege University Hospital between 2005 and 2021. The ESD was evaluated using a step-based approach: step I (clinical phenomenology), step II (neuroimaging), step III (metabolic screening), and step IV (genetic testing). The diagnostic utility of genetic testing was evaluated to compare the early-NGS period (2005 to 2013, n = 183) and the NGS era (2014 to 2021, n = 131). RESULTS An ESD was established in 221 of 314 (70.4%) infants with IESS: structural, 40.8%; genetic, 17.2%; metabolic, 8.3%; immune-infectious, 4.1%. The diagnostic yield of genetic testing increased from 8.9% to 41.7% in the cohort during the four follow-up periods. The rate of unknown etiology decreased from 34.9% to 22.1% during the follow-up periods. The genetic ESD was established as 27.4% with genetic testing in the NGS era. The genetic testing in the NGS era increased dramatically in subgroups with unknown and structural etiologies. The diagnostic yields of the epilepsy panels increased from 7.6% to 19.2%. However, the diagnostic yield of whole exome sequencing remained at similar levels during the early-NGS period at 54.5% and in the NGS era at 59%. CONCLUSIONS The more genetic ESD (27.4%) was defined for IESS in the NGS era with the implication of precision therapy (37.7%).
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Affiliation(s)
- Seda Kanmaz
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Sanem Yılmaz
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye.
| | - Cemile Büşra Olculu
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Dilara Ece Toprak
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Tuğçe Ince
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Özlem Yılmaz
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Yavuz Atas
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Gursel Sen
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Erdem Şimşek
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Hepsen Mine Serin
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Enise Avcı Durmuşalioğlu
- Division of Pediatric Genetics, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Esra Işık
- Division of Pediatric Genetics, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Tahir Atik
- Division of Pediatric Genetics, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Gul Aktan
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Ozgur Cogulu
- Division of Pediatric Genetics, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Sarenur Gokben
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Ferda Ozkınay
- Division of Pediatric Genetics, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
| | - Hasan Tekgul
- Division of Child Neurology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkiye
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Zhou Z, Jiao X, Gong P, Niu Y, Xu Z, Zhang G, Zhang Y, Qin J, Yang Z. Clinical features and underlying etiology of children with Lennox-Gastaut syndrome. J Neurol 2024; 271:5392-5401. [PMID: 39008035 DOI: 10.1007/s00415-024-12465-3] [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: 04/11/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Lennox-Gastaut Syndrome (LGS) is characterized by the presence of multiple seizure types and encompasses a heterogenous group of etiologies. The aim of our study was to evaluate the etiological profile of LGS and investigate seizure outcomes based on different clinical variables. METHODS The clinical features, neuroimaging findings, genetic testing and other testing results of LGS patients were systematically reviewed. The identifiable etiology was categorized as either acquired or nonacquired. Univariate and multivariate regression analyses were performed to explore the association between clinical variables and seizure outcome at the last follow-up. RESULTS We enrolled 156 patients diagnosed with LGS, of whom 66% were male. The mean age of patients was 34.2 months and the median follow-up duration was 29.5 months (interquartile range = 14-56.25 months). The initial seizure type was epileptic spasm in 61 patients, among which 33 of them met the criteria for infantile epileptic spasm syndrome. All patients underwent neuroimaging test, with 25% falling into the acquired structural category. Etiology could be identified in 84 individuals, including pathogenetic variants found in 34 out of 117 patients with nonacquired etiology. CHD2 mutations were most frequently observed among these pathogenetic variants. At the last follow-up, favorable outcomes were observed in 27 patients. The identification of etiology emerged as a significant determinant influencing LGS outcome; specifically, patients with unknown etiology had a higher likelihood of experiencing favorable outcomes compared to those with known cause (p = 0.041). Early onset age and longer epilepsy duration significantly increased the odds of an unfavorable outcome (p = 0.006 and 0.024). SIGNIFICANCE We present novel data on the clinical and etiological spectrum of LGS, with determined etiology observed in over half of the patients. Epileptic spasms were found to be more prevalent than tonic seizures as seizure onset types in LGS. The presence of a known etiology, earlier age at onset, and longer duration of epilepsy were associated with a poorer long-term epileptological outcome.
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Affiliation(s)
- Zongpu Zhou
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
- Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Xianru Jiao
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
- Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Pan Gong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yue Niu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
- Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Zhao Xu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
- Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Genfu Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
- Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
- Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China.
- Epilepsy Center, Peking University People's Hospital, Beijing, China.
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Cheng M, Bai L, Yang Y, Liu W, Niu X, Chen Y, Tan Q, Yang X, Wu Q, Zhao HQ, Zhang Y. Novel copy number variations and phenotypes of infantile epileptic spasms syndrome. Clin Genet 2024; 106:161-179. [PMID: 38544467 DOI: 10.1111/cge.14520] [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: 12/17/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 07/02/2024]
Abstract
We summarize the copy number variations (CNVs) and phenotype spectrum of infantile epileptic spasms syndrome (IESS) in a Chinese cohort. The CNVs were identified by genomic copy number variation sequencing. The CNVs and clinical data were analyzed. 74 IESS children with CNVs were enrolled. 35 kinds of CNVs were identified. There were 11 deletions and 5 duplications not reported previously in IESS, including 2 CNVs not reported in epilepsy. 87.8% were de novo, 9.5% were inherited from mother and 2.7% from father. Mosaicism occurred in one patient with Xq21.31q25 duplication. 16.2% (12/74) were 1p36 deletion, and 20.3% (15/74) were 15q11-q13 duplication. The age of seizure onset ranged from 17 days to 24 months. Seizure types included epileptic spasms, focal seizures, tonic seizures, and myoclonic seizures. All patients displayed developmental delay. Additional features included craniofacial anomaly, microcephaly, congenital heart defects, and hemangioma. 29.7% of patients were seizure-free for more than 12 months, and 70.3% still had seizures after trying 2 or more anti-seizure medications. In conclusion, CNVs is a prominent etiology of IESS. 1p36 deletion and 15q duplication occurred most frequently. CNV detection should be performed in patients with IESS of unknown causes, especially in children with craniofacial anomalies and microcephaly.
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Affiliation(s)
- Miaomiao Cheng
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ling Bai
- Research and Development Center, Beijing USCI Medical Laboratory Co., Ltd, Beijing, China
| | - Ying Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Wenwei Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xueyang Niu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yi Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Quanzhen Tan
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qixi Wu
- Research and Development Center, Beijing USCI Medical Laboratory Co., Ltd, Beijing, China
| | - Han-Qing Zhao
- Research and Development Center, Beijing USCI Medical Laboratory Co., Ltd, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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5
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Ohshiro I, Okanishi T, Ohta R, Ohta K, Arai Y, Kanai S, Fujimoto A, Maegaki Y. Three Patients of the Early Onset Epileptic Spasms without Hypsarrhythmia. Neuropediatrics 2024; 55:250-254. [PMID: 38565197 DOI: 10.1055/a-2298-0747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Epileptic spasms without hypsarrhythmia occur when patients do not display hypsarrhythmia on electroencephalogram (EEG) at the onset and throughout the clinical course. We report three patients of epileptic spasms in patients with early onset, all of whom experienced other types of seizures.We detail three patients (two boys and one girl) of epileptic spasms without hypsarrhythmia, occurring between 1 and 3 months of age, with no abnormalities detected on neurometabolic analysis and brain magnetic resonance imaging. Long-term video-EEG monitoring revealed epileptic spasms with focal onset seizures in two patients, and epileptic spasms followed by generalized tonic-clonic seizures in one patient. Hypsarrhythmia was never observed in repeated EEG examinations. Two patients achieved seizure freedom and improved development through treatment with topiramate alone or in combination with valproate, without requiring hormonal therapies or vigabatrin. The remaining patient achieved seizure freedom following administration of antiseizure medications, including topiramate, after a trial of adrenocorticotropic hormone therapy.We report the cases of three patients with early onset epileptic spasms without hypsarrhythmia. All patients achieved seizure freedom after topiramate treatment. Topiramate may be considered as a relatively effective antiseizure medication for early onset epileptic spasms without hypsarrhythmia.
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Affiliation(s)
- Ikko Ohshiro
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryo Ohta
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kento Ohta
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuto Arai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Sotaro Kanai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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Wan L, Ge W, Liu G, He W, Liang Y, Dun S, Yan H, Chen J, Zhu G, Gao J, Shi X, Wang J, Hu L, Zhang B, Zou L, Yang G. Exhaustive clinical examination of etiology and initial response to first-line treatment in 577 children with infantile epileptic spasm syndrome children: A 5-year retrospective observational study. Ann Clin Transl Neurol 2024; 11:2049-2062. [PMID: 38858527 PMCID: PMC11330233 DOI: 10.1002/acn3.52125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE Employing whole-exome sequencing (WES) technology to investigate the etiology of infantile epileptic spasm syndrome (IESS), and determining whether different etiologies exhibit phenotypic variations, while elucidating the potential associated factors, might improve short-term responses to first-line treatment. METHODS We retrospectively evaluated patients with IESS admitted for treatment between January 2018 and June 2023. Clinical phenotypic differences among etiological classifications and clinical manifestations were analyzed. Variable selection using the best subset method was performed, followed by logistic regression analysis to identify the factors influencing treatment response. RESULTS A total of 577 patients were included; 412 completed trio-WES. Magnetic resonance imaging abnormalities were detected in 387 patients (67.1%). Patients with etiology as structural abnormalities were likelier to have non-spasms at the initial seizure onset. A total of 532 patients completed the first-line treatment; 273 patients received it for the first time at our hospital (initial response rates: 30.1% and 42.1%, respectively). The response group had a lower proportion of early-onset seizures (≤3 months) than the no-response group (11.3% vs. 23.7%, p < 0.01 and 11.3% vs. 21.5%, p = 0.03, respectively). Logistic regression analysis indicated that earlier initiation of first-line treatment was associated with a higher likelihood of an initial response. However, the etiological classification did not have a significant impact on the initial response. INTERPRETATION IESS patients with structural abnormalities are more likely to present with non-spasm seizures at initial onset. Early initiation of first-line treatment is crucial; however, initial responses may be less favorable when seizures occur in early infancy.
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Affiliation(s)
- Lin Wan
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
| | - Wenrong Ge
- Department of Pediatrics, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Guoyin Liu
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
| | - Wen He
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
| | - Yan Liang
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
| | - Shuo Dun
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
| | - Huimin Yan
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
| | - Jian Chen
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
| | - Gang Zhu
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
| | - Jing Gao
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
| | - Xiuyu Shi
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
| | - Jing Wang
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
| | - Linyan Hu
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design CenterBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Liping Zou
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Guang Yang
- Senior Department of PediatricsThe Seventh Medical Center of PLA General HospitalBeijingChina
- Department of PediatricsThe First Medical Centre, Chinese PLA General HospitalBeijingChina
- Medical School of Chinese People's Liberation ArmyBeijingChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
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7
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Mir A, AlQahtani M, Amer F, AlBaradie R, AlOtaibi W, AlGhamdi F, Khallaf H, Bashir S, Costain G, Aljouda L, Housawi Y. Diagnostic evaluation of patients with epileptic spasms in the era of next-generation sequencing. Epileptic Disord 2024. [PMID: 38949266 DOI: 10.1002/epd2.20259] [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: 01/02/2024] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Epileptic spasms (ES) can be caused by a variety of etiologies. However, in almost half of cases, the etiology is unidentified. With the advent of next-generation sequencing (NGS), the recognition of genetic etiologies has increased. METHODS We retrospectively reviewed the medical records of patients with ES who were evaluated in the comprehensive epilepsy program at King Fahad Specialist Hospital Dammam between 2009 and 2022. RESULTS Our data show that in 57.7% of patients with ES, the etiology was unidentified after a standard clinical evaluation and neuroimaging. Of these patients, n = 25 (35.2%) received a genetic diagnosis after some form of genetic testing, and 3.1% of patients from specialized metabolic work indicated the need for genetic testing to confirm the diagnosis. Karyotyping led to a diagnosis in 3.6% of patients, and chromosomal microarray led to a diagnosis in 7.1%. An NGS epilepsy gene panel (EP) was done for 45 patients, leading to a diagnosis in 24.4% (n = 11). Exome sequencing was done for 27 patients, including n = 14 with non-diagnostic panel testing; it led to a diagnosis in 37.3% (n = 10). Exome sequencing led to a diagnosis in 61.5% of patients without a previous panel test and in only two patients who had previously had a negative panel testing. SIGNIFICANCE In this article, we present the diagnostic evaluations of ES for a cohort of 123 patients and discuss the yield and priority of NGS for evaluating ES. Our findings suggest that exome sequencing has a higher diagnostic yield for determining the etiology of ES in patients for whom the etiology is still unclear after an appropriate clinical assessment and a brain MRI.
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Affiliation(s)
- Ali Mir
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed AlQahtani
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fawzia Amer
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
- Department of Pediatric Neurology and Metabolic, Cairo University Children Hospital, Cairo, Egypt
| | - Raidah AlBaradie
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Wajd AlOtaibi
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Fouad AlGhamdi
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hamoud Khallaf
- Genetic and Metabolic Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shahid Bashir
- Neuroscience Centre, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Gregory Costain
- Program in Genetics and Genome Biology, Division of Clinical and Metabolic Genetics, SickKids Research Institute and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Liali Aljouda
- Program in Genetics and Genome Biology, Division of Clinical and Metabolic Genetics, SickKids Research Institute and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yousef Housawi
- Genetic and Metabolic Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Macdonald-Laurs E, Dzau W, Warren AEL, Coleman M, Mignone C, Stephenson SEM, Howell KB. Identification and treatment of surgically-remediable causes of infantile epileptic spasms syndrome. Expert Rev Neurother 2024; 24:661-680. [PMID: 38814860 DOI: 10.1080/14737175.2024.2360117] [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: 04/01/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Infantile epileptic spasms syndrome (IESS) is a common developmental and epileptic encephalopathy with poor long-term outcomes. A substantial proportion of patients with IESS have a potentially surgically remediable etiology. Despite this, epilepsy surgery is underutilized in this patient group. Some surgically remediable etiologies, such as focal cortical dysplasia and malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE), are under-diagnosed in infants and young children. Even when a surgically remediable etiology is recognised, for example, tuberous sclerosis or focal encephalomalacia, epilepsy surgery may be delayed or not considered due to diffuse EEG changes, unclear surgical boundaries, or concerns about operating in this age group. AREAS COVERED In this review, the authors discuss the common surgically remediable etiologies of IESS, their clinical and EEG features, and the imaging techniques that can aid in their diagnosis. They then describe the surgical approaches used in this patient group, and the beneficial impact that early epilepsy surgery can have on developing brain networks. EXPERT OPINION Epilepsy surgery remains underutilized even when a potentially surgically remediable cause is recognized. Overcoming the barriers that result in under-recognition of surgical candidates and underutilization of epilepsy surgery in IESS will improve long-term seizure and developmental outcomes.
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Affiliation(s)
- Emma Macdonald-Laurs
- Department of Neurology, The Royal Children's Hospital, Parkville, VIC, Australia
- Neurosciences Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Winston Dzau
- Neurosciences Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Aaron E L Warren
- Department of Medicine (Austin Health), The University of Melbourne, Melbourne, VIC, Australia
- Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA
| | - Matthew Coleman
- Neurosciences Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Cristina Mignone
- Department of Medical Imaging, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Sarah E M Stephenson
- Neurosciences Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Katherine B Howell
- Department of Neurology, The Royal Children's Hospital, Parkville, VIC, Australia
- Neurosciences Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
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Li J, Ping AA, Zhou Y, Su T, Li X, Xu S. Interictal EEG features as computational biomarkers of West syndrome. Front Pediatr 2024; 12:1406772. [PMID: 38903771 PMCID: PMC11188363 DOI: 10.3389/fped.2024.1406772] [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: 03/25/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Background West syndrome (WS) is a devastating epileptic encephalopathy with onset in infancy and early childhood. It is characterized by clustered epileptic spasms, developmental arrest, and interictal hypsarrhythmia on electroencephalogram (EEG). Hypsarrhythmia is considered the hallmark of WS, but its visual assessment is challenging due to its wide variability and lack of a quantifiable definition. This study aims to analyze the EEG patterns in WS and identify computational diagnostic biomarkers of the disease. Method Linear and non-linear features derived from EEG recordings of 31 WS patients and 20 age-matched controls were compared. Subsequently, the correlation of the identified features with structural and genetic abnormalities was investigated. Results WS patients showed significantly elevated alpha-band activity (0.2516 vs. 0.1914, p < 0.001) and decreased delta-band activity (0.5117 vs. 0.5479, p < 0.001), particularly in the occipital region, as well as globally strengthened theta-band activity (0.2145 vs. 0.1655, p < 0.001) in power spectrum analysis. Moreover, wavelet-bicoherence analysis revealed significantly attenuated cross-frequency coupling in WS patients. Additionally, bi-channel coherence analysis indicated minor connectivity alterations in WS patients. Among the four non-linear characteristics of the EEG data (i.e., approximate entropy, sample entropy, permutation entropy, and wavelet entropy), permutation entropy showed the most prominent global reduction in the EEG of WS patients compared to controls (1.4411 vs. 1.5544, p < 0.001). Multivariate regression results suggested that genetic etiologies could influence the EEG profiles of WS, whereas structural factors could not. Significance A combined global strengthening of theta activity and global reduction of permutation entropy can serve as computational EEG biomarkers for WS. Implementing these biomarkers in clinical practice may expedite diagnosis and treatment in WS, thereby improving long-term outcomes.
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Affiliation(s)
- Jiaqing Li
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An-an Ping
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yalan Zhou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tangfeng Su
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Sanqing Xu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Bashiri FA, Hundallah K, Al-Baradie R, Al-Otaibi A, Ismayl O, AlMalik ME, Muthaffar OY, Futaisi AA, Kurdi D, Tawari AA, AlSowat D, Shafi SA, Ali A, AlHajjar LM, Aldakhil A. Diagnosis and management of infantile epileptic spasms syndrome (IESS) in Gulf Cooperation Council (GCC) countries: Expert consensus statement. Seizure 2024; 117:174-182. [PMID: 38432081 DOI: 10.1016/j.seizure.2024.02.015] [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: 12/06/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
Despite the availability of international recommendations for the management of Infantile Epileptic Spasms Syndrome (IESS), there is a lack of recommendations adapted to the local context of clinical practice of pediatric neurology in the Gulf Cooperation Council (GCC) countries. By an initiative from the Saudi Pediatric Neurology Society (SPNS), a literature review was performed and an expert panel comprised of 13 pediatric neurologists from all GCC countries (Saudi Arabia, Kuwait, Bahrain, Oman, Qatar, and the United Arab Emirates) was subsequently convened to discuss all issues related to the management and diagnosis practices of IESS in the GCC. The overall aim of this consensus document was to develop practical recommendations to support the care of patients with IESS in the GCC and to reflect on how clinical management approaches compare with those adopted internationally.
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Affiliation(s)
- Fahad A Bashiri
- Pediatric Neurology Division, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Khalid Hundallah
- Pediatric Neurology Division, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh 13317, Saudi Arabia.
| | - Raidah Al-Baradie
- Neuroscience Center, King Fahd Specialist Hospital, PO Box 15215, Dammam 314444, Kingdom of Saudi Arabia.
| | - Ali Al-Otaibi
- Pediatric Neurology Division, Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, As Sulimaniyah, Riyadh 12231, Saudi Arabia.
| | - Omar Ismayl
- Department of Child Neurology, Sheikh Khalifah Medical City, Al Karamah Street, Abu Dhabi, United Arab Emirates.
| | - Mohamed Elhadi AlMalik
- Department of Pediatric Neurology, Mediclinic Al Jowhara Hospital, Al Ain City, United Arab Emirates.
| | - Osama Y Muthaffar
- Pediatric Neurology Division, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Amna Al Futaisi
- Pediatric Neurology Division, Child Health Department, College of Medicine and Health Sciences, Sultan Qaboos University, P.O.Box 35, P.C 123 Al Khoud, Sultanate of Oman.
| | - Daniah Kurdi
- Pediatric Neurology Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia.
| | - Asmaa Al Tawari
- Pediatric Neurology Division, Department of Pediatrics, Al Sabah Hospital, Ministry of Health, Sabah Health Region, Shuwaikh Industrial, State of Kuwait.
| | - Daad AlSowat
- Pediatric Neurology Division, Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia.
| | - Shatha Al Shafi
- Neurology Division, Epilepsy and EEG Fellowship Program, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh 13317, Saudi Arabia.
| | - Ayman Ali
- Pediatric Neurology Division, Department of Pediatrics, AlSalam Specialist Hospital, Riffa 80278, Bahrain.
| | - Lynn M AlHajjar
- Itkan Health Consulting Group, Al Olaya, Riyadh 12221, Saudi Arabia.
| | - Abdullah Aldakhil
- Itkan Health Consulting Group, Al Olaya, Riyadh 12221, Saudi Arabia.
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11
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Yüksel MF, Doğulu N, Yıldırım M, Köse E, Bektaş Ö, Eminoğlu FT, Teber S. Metabolic etiologies in children with infantile epileptic spasm syndrome: Experience at a tertiary pediatric neurology center. Brain Dev 2024:S0387-7604(24)00042-1. [PMID: 38493042 DOI: 10.1016/j.braindev.2024.03.003] [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: 01/07/2024] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Infantile epileptic spasm syndrome (IESS), including West syndrome (WS) and infantile spasm (IS), causes a challenging prognosis, particularly when associated with metabolic etiologies. METHODS This study, conducted at a tertiary pediatric neurology center, explored the prevalence and clinical features of inborn errors of metabolism in 112 children with IESS over 10 years. RESULTS Most patients presented with seizures, primarily flexor spasms, and the median age at onset was 5 months. Comprehensive clinical evaluation and neuroimaging revealed structural-acquired causes as the most common etiology. Notably, inborn errors of metabolism were identified in 5.4 % of cases, with six distinct diagnoses including nonketotic hyperglycinemia, pyridoxine-dependent epilepsy, primary coenzyme Q10 deficiency 7, congenital disorder of glycosylation type IIM, 6-pyruvoyl tetrahydrobiopterin synthase deficiency, and argininosuccinate lyase deficiency. The prevalence of inborn errors of metabolism in this cohort was consistent with global variations reported in the literature. Genetic testing, including karyotype analysis and whole exome sequencing, was performed in a subset of cases with no clear diagnosis, revealing abnormalities in approximately 50 % of cases. Adrenocorticotropic hormone emerged as the most frequently prescribed antiseizure medication. CONCLUSION This study provides insight into the diagnostic challenges associated with IESS and highlights the importance of metabolic investigations, especially in cases without a clear etiology. The findings emphasize the need for further genetic and metabolic studies to enhance prognostic accuracy and guide potential treatment options for children with IESS, particularly in populations with high rates of consanguinity.
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Affiliation(s)
- Merve Feyza Yüksel
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Neslihan Doğulu
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Engin Köse
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
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12
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Chen M, Yan L, Deng Y, Chen J, Xie L, Hu Y, Hong S, Jiang L. Clinical and electroencephalographic characteristics of 34 infant with onset of epileptic spasms before three months of age. Epilepsy Behav 2023; 149:109530. [PMID: 37952415 DOI: 10.1016/j.yebeh.2023.109530] [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: 07/08/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
Epileptic spasms (ES) occur mostly between age 3 months and 24 months. ES beginning before 3 months of age were called early-onset ES in previous studies. The aim of this study was to identify clinical and electroencephalographic characteristics of patients with ES onset before 3 months of age. In total, 34 ES patients were retrospectively identified at Children's Hospital of Chongqing Medical University from January 1, 2020 to October 1, 2022. Our patients had diverse etiologies, including genetic (32.3 %), genetic-structural (11.8 %), structural-acquired (11.8 %), structural-congenital (8.8 %), and metabolic (5.9 %), with 29.4 % of patients having unknown etiology. Some patients experienced ES in clusters (either symmetrical or flexional) that occurred most often during awakening after sleep, and a minority of ES were characterized as isolated or asymmetrical, occurred during sleep, and could also manifest as relatively subtle. Approximately 35.3 % of patients also experienced other seizure types concurrently, including 10 focal seizures and 2 generalized seizures, and only half of the focal seizures had structural causes. The other seizure types occurred alone or sequentially with ES. Interictal electroencephalography revealed hypsarrhythmia or its variants, multifocal discharge, or burst suppression. 18 patients had no seizures lasting for more than 2 months, however, at the last follow-up visit, 5 of them had relapsed. All patients had different degrees of psychomotor retardation.
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Affiliation(s)
- Min Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China
| | - Lisi Yan
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China
| | - Yu Deng
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China.
| | - Lingling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; Ministry of Education Key Laboratory of Child Development and Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders (Chongqing), No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China; China International Science and Technology Cooperation base of Child Development and Critical Disorders, No. 136 Zhongshan 2nd Road, Yuhng District, Chongqing 400014, China; Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan 2nd Road, Yuhang District, Chongqing 400014, China
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Nagarajan B, Gowda VK, Yoganathan S, Sharawat IK, Srivastava K, Vora N, Badheka R, Danda S, Kalane U, Kaur A, Madaan P, Mehta S, Negi S, Panda PK, Rajadhyaksha S, Saini AG, Saini L, Shah S, Srinivasan VM, Suthar R, Thomas M, Vyas S, Sankhyan N, Sahu JK. Landscape of genetic infantile epileptic spasms syndrome-A multicenter cohort of 124 children from India. Epilepsia Open 2023; 8:1383-1404. [PMID: 37583270 PMCID: PMC10690684 DOI: 10.1002/epi4.12811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE Literature on the genotypic spectrum of Infantile Epileptic Spasms Syndrome (IESS) in children is scarce in developing countries. This multicentre collaboration evaluated the genotypic and phenotypic landscape of genetic IESS in Indian children. METHODS Between January 2021 and June 2022, this cross-sectional study was conducted at six centers in India. Children with genetically confirmed IESS, without definite structural-genetic and structural-metabolic etiology, were recruited and underwent detailed in-person assessment for phenotypic characterization. The multicentric data on the genotypic and phenotypic characteristics of genetic IESS were collated and analyzed. RESULTS Of 124 probands (60% boys, history of consanguinity in 15%) with genetic IESS, 105 had single gene disorders (104 nuclear and one mitochondrial), including one with concurrent triple repeat disorder (fragile X syndrome), and 19 had chromosomal disorders. Of 105 single gene disorders, 51 individual genes (92 variants including 25 novel) were identified. Nearly 85% of children with monogenic nuclear disorders had autosomal inheritance (dominant-55.2%, recessive-14.2%), while the rest had X-linked inheritance. Underlying chromosomal disorders included trisomy 21 (n = 14), Xq28 duplication (n = 2), and others (n = 3). Trisomy 21 (n = 14), ALDH7A1 (n = 10), SCN2A (n = 7), CDKL5 (n = 6), ALG13 (n = 5), KCNQ2 (n = 4), STXBP1 (n = 4), SCN1A (n = 4), NTRK2 (n = 4), and WWOX (n = 4) were the dominant single gene causes of genetic IESS. The median age at the onset of epileptic spasms (ES) and establishment of genetic diagnosis was 5 and 12 months, respectively. Pre-existing developmental delay (94.3%), early age at onset of ES (<6 months; 86.2%), central hypotonia (81.4%), facial dysmorphism (70.1%), microcephaly (77.4%), movement disorders (45.9%) and autistic features (42.7%) were remarkable clinical findings. Seizures other than epileptic spasms were observed in 83 children (66.9%). Pre-existing epilepsy syndrome was identified in 21 (16.9%). Nearly 60% had an initial response to hormonal therapy. SIGNIFICANCE Our study highlights a heterogenous genetic landscape and phenotypic pleiotropy in children with genetic IESS.
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Affiliation(s)
- Balamurugan Nagarajan
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Vykuntaraju K. Gowda
- Department of Pediatric NeurologyIndira Gandhi Institute of Child HealthBengaluruIndia
| | - Sangeetha Yoganathan
- Pediatric Neurology Unit, Department of Neurological SciencesChristian Medical CollegeVelloreIndia
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of PediatricsAll India Institute of Medical SciencesRishikeshIndia
| | - Kavita Srivastava
- Pediatric Neurology Unit, Department of PediatricsBharati Vidyapeeth Deemed University Medical CollegePuneIndia
| | - Nitish Vora
- Royal Institute of Child NeurosciencesAhmedabadIndia
| | - Rahul Badheka
- Royal Institute of Child NeurosciencesAhmedabadIndia
| | - Sumita Danda
- Department of Medical GeneticsChristian Medical CollegeVelloreIndia
| | - Umesh Kalane
- Pediatric Neurology Division, Department of PediatricsAll India Institute of Medical SciencesRishikeshIndia
| | - Anupriya Kaur
- Genetics and Metabolic Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Priyanka Madaan
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
- Department of Pediatric NeurologyAmrita Institute of Medical SciencesFaridabadIndia
| | - Sanjiv Mehta
- Royal Institute of Child NeurosciencesAhmedabadIndia
| | - Sandeep Negi
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of PediatricsAll India Institute of Medical SciencesRishikeshIndia
| | - Surekha Rajadhyaksha
- Pediatric Neurology Unit, Department of PediatricsBharati Vidyapeeth Deemed University Medical CollegePuneIndia
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Lokesh Saini
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
- Department of PediatricsAll India Institute of Medical SciencesJodhpurIndia
| | | | | | - Renu Suthar
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Maya Thomas
- Pediatric Neurology Unit, Department of Neurological SciencesChristian Medical CollegeVelloreIndia
| | - Sameer Vyas
- Division of Neuroimaging and Interventional Neuroradiology, Department of Radiodiagnosis and ImagingPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
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Latzer IT, Blau N, Ferreira CR, Pearl PL. Clinical and biochemical footprints of inherited metabolic diseases. XV. Epilepsies. Mol Genet Metab 2023; 140:107690. [PMID: 37659319 DOI: 10.1016/j.ymgme.2023.107690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
We provide a comprehensive overview of inherited metabolic disorders (IMDs) in which epilepsy is a prominent manifestation. Our unique database search has identified 256 IMDs associated with various types of epilepsies, which we classified according to the classic pathophysiology-based classification of IMDs, and according to selected seizure-related factors (neonatal seizures, infantile spasms, myoclonic seizures, and characteristic EEG patterns) and treatability for the underlying metabolic defect. Our findings indicate that inherited metabolic epilepsies are more likely to present in the neonatal period, with infantile spasms or myoclonic seizures. Additionally, the ∼20% of treatable inherited metabolic epilepsies found by our search were mainly associated with the IMD groups of "cofactor and mineral metabolism" and "Intermediary nutrient metabolism." The information provided by this study, including a comprehensive list of IMDs with epilepsy stratified according to age of onset, and seizure type and characteristics, along with an overview of the key clinical features and proposed diagnostic and therapeutic approaches, may benefit any epileptologist and healthcare provider caring for individuals with metabolic conditions.
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Affiliation(s)
- Itay Tokatly Latzer
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Nenad Blau
- Division of Metabolism, University Children's Hospital, Zürich, Switzerland.
| | - Carlos R Ferreira
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Phillip L Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Rao CK, Nordli DR, Cousin JJ, Takacs DS, Sheth RD. The Effect of Smartphone Video on Lead Time to Diagnosis of Infantile Spasms. J Pediatr 2023; 258:113387. [PMID: 36931494 DOI: 10.1016/j.jpeds.2023.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To assess whether access to smartphone video capture of infantile spasms at initial presentation is associated with improved time to diagnosis and treatment. METHODS We conducted a collaborative retrospective cohort study of 80 consecutive infants with confirmed infantile epileptic spasms syndrome initially presenting from 2015 to 2021 at 2 US pediatric centers. Statistical methods used included Mann-Whitney U test to assess the difference in lead times to electroencephalogram (EEG), diagnosis, and treatment between groups with and without video capture. A χ2 analysis was used to assess differences in demographics, clinical characteristics, and treatment outcomes between groups. Multivariate regression analysis was used to account for etiology types and infantile spasms capture on EEG. RESULTS Patients with smartphone video infantile spasms capture initially presented a median of 9 days earlier (P = .02), had their first EEG 16 days earlier (P = .007), and were diagnosed and started treatment 17 days earlier (P = .006 and P = .008, respectively) compared with the nonvideo group. The video group had a 25% greater response to initial standard treatment (P = .02) and a 21% greater freedom from infantile spasms at long-term follow-up (P = .03), although this long-term outcome lost statistical significance after adjustment for etiology type (P = .07) and EEG capture of infantile spasms (P = .059). CONCLUSION Our findings suggest a benefit of smartphone video capture of infantile spasms in reduced time to diagnosis and initial standard treatment, which are associated with improved treatment response rates. Substantial differences in lead times and treatment response highlight the clinical importance of pediatricians recommending caregivers to obtain smartphone video of events concerning for infantile spasms.
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Affiliation(s)
- Chethan K Rao
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medical Science Florida, Jacksonville, FL; Division of Neurology, Nemours Children's Health, Jacksonville, FL; Division of Child Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Douglas R Nordli
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medical Science Florida, Jacksonville, FL; Division of Neurology, Nemours Children's Health, Jacksonville, FL
| | - Joshua J Cousin
- Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, TX; Department of Pediatrics and Neurology, Baylor College of Medicine, Houston, TX
| | - Danielle S Takacs
- Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, TX; Department of Pediatrics and Neurology, Baylor College of Medicine, Houston, TX
| | - Raj D Sheth
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medical Science Florida, Jacksonville, FL; Division of Neurology, Nemours Children's Health, Jacksonville, FL.
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16
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Sahu JK, Madaan P, Prakash K. The landscape of infantile epileptic spasms syndrome in South Asia: peculiarities, challenges, and way forward. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100170. [PMID: 37384052 PMCID: PMC10306027 DOI: 10.1016/j.lansea.2023.100170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 06/30/2023]
Abstract
Infantile Epileptic Spasms Syndrome (IESS), commonly known as West syndrome, is the most common cause of infantile-onset epileptic encephalopathy. There is a peculiar epidemiological profile of IESS in South Asia. Specific features identified were a preponderance of acquired structural aetiology, male gender dominance, a long treatment lag, limited availability of adrenocorticotropic hormone (ACTH) and vigabatrin, and use of carboxymethyl cellulose derivative of ACTH. Because of the significant disease burden and limited resources, there are distinctive challenges to the optimal care of children with IESS in the South Asian region. Also, there are unique opportunities to bridge these challenges and improve outcomes. This review provides an overview of the landscape of IESS in South Asia and highlights its peculiarities, various challenges, and way forward.
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Affiliation(s)
- Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Madaan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Pediatric Neurology, Amrita Institute of Medical Sciences, Faridabad, India
| | - Kiran Prakash
- Department of Physiology, Government Medical College and Hospital, Chandigarh, India
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17
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Raga SV, Essajee F, Solomons R, Van Toorn R, Wilmshurst JM. Epileptic spasms: A South African overview of aetiologies, interventions, and outcomes. Dev Med Child Neurol 2023; 65:526-533. [PMID: 36229895 DOI: 10.1111/dmcn.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/28/2022]
Abstract
AIM To better understand the aetiologies of epileptic spasms in infants, as well as the safety and efficacy of high dose corticosteroids in tuberculosis and human immunodeficiency virus (HIV) endemic resource-limited settings. METHOD This was a retrospective analysis of infants with epileptic spasms managed at the tertiary referral centres in the Western Cape, South Africa. RESULTS Of 175 children with epileptic spasms, the median age at onset was 6 months (interquartile range 4-8 months). Structural aetiologies were most common (115 out of 175 [66%]), with two-thirds related to perinatal insults. A lead time to treatment (LTTT) of less than 1 month was more likely in the epileptic encephalopathy/developmental and epileptic encephalopathy (DEE) group: 58 out of 92 (63%), compared to 28 out of 76 (37%) of those with developmental encephalopathy (p = 0.001). Failure to recognize preceding developmental delay was common. Ninety-nine children (57%) received first line hormonal therapy such as adrenocorticotropic hormone. A total of 111 out of 172 children (65%) from the developmental encephalopathy and epileptic encephalopathy/DEE groups had clinical and/or electroencephalogram resolution of spasms within 14 days. In our population, children in whom an aetiology could not be identified were statistically more likely to have moderate to profound developmental delay at 1 year of age: 33 out of 44 (p = 0.001). Based on reported incidence of epileptic spasms, 23 to 58 cases per annum would be expected but a far smaller proportion presented to our centres. INTERPRETATION Whilst this is the largest cohort of infants with epileptic spasms from sub-Saharan Africa, the study size is less than expected; this may reflect misdiagnosis and failure of referral pathways. Despite a reported shorter LTTT, infants with DEE had worse developmental outcomes compared to international studies. Hormonal therapy was safe and effective in our setting, despite exposure to high levels of tuberculosis and HIV. WHAT THIS PAPER ADDS The number of unreferred cases of epileptic spasms in South Africa remains high. Caregivers and health care workers in primary care facilities often fail to recognize developmental delay. The burden of disease from hypoxic-ischaemic encephalopathy remains high in our resource-limited setting. Hormonal treatment (e.g. adrenocorticotropic hormone) was safe and effective despite the high prevalence of human immunodeficiency virus and tuberculosis.
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Affiliation(s)
- Sharika V Raga
- Paediatric Neurology Division, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Farida Essajee
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Regan Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ronald Van Toorn
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jo M Wilmshurst
- Paediatric Neurology Division, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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18
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Gettings JV, Shafi S, Boyd J, Snead OC, Rutka J, Drake J, McCoy B, Jain P, Whitney R, Go C. The Epilepsy Surgery Experience in Children With Infantile Epileptic Spasms Syndrome at a Tertiary Care Center in Canada. J Child Neurol 2023; 38:113-120. [PMID: 36788207 DOI: 10.1177/08830738231151993] [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] [Indexed: 02/16/2023]
Abstract
BACKGROUND Infantile epileptic spasms syndrome is an epileptic encephalopathy, characterized by spasms, hypsarrhythmia, and developmental regression. Appropriately selected patients with infantile epileptic spasms syndrome may be candidates for epilepsy surgery. METHODS This is a single-center retrospective case series of children 0-18 years with a current or previous diagnosis of infantile epileptic spasms syndrome with a lesion on magnetic resonance imaging (MRI) and/or positron emission tomography scan who underwent epilepsy surgery at The Hospital for Sick Children (HSC) in Toronto, Canada. The records of 223 patients seen in the infantile epileptic spasms syndrome clinic were reviewed. RESULTS Nineteen patients met inclusion criteria. The etiology of infantile epileptic spasms syndrome was encephalomalacia in 6 patients (32%), malformations of cortical development in 12 patients (63%), and atypical hypoglycemic injury in 1 patient (5%). Nine patients (47%) underwent hemispherectomy, and 10 patients (53%) underwent lobectomy/lesionectomy. Three patients (16%) underwent a second epilepsy surgery. Fifteen patients (79%) were considered ILAE seizure outcome class 1 (completely seizure free; no auras) at their most recent follow-up visit. The percentage of patients who were ILAE class 1 at most recent follow-up decreased with increasing duration of epilepsy prior to surgery. Developmental outcome after surgery was improved in 14 of 19 (74%) and stable in 5 of 19 (26%) patients. CONCLUSIONS Our study found excellent seizure freedom rates and improved developmental outcomes following epilepsy surgery in patients with a history of infantile epileptic spasms syndrome with a structural lesion detected on MRI brain. Patients who undergo surgery earlier have improved seizure freedom rates and improved developmental outcomes.
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Affiliation(s)
- Jennifer V Gettings
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada
| | - Shatha Shafi
- Division of Neurology, Department of Pediatrics, 37853Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Jennifer Boyd
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada
| | - James Rutka
- Division of Neurosurgery, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada
| | - James Drake
- Division of Neurosurgery, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada
| | - Bláthnaid McCoy
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada
| | - Robyn Whitney
- Division of Neurology, Department of Paediatrics, McMaster Children's Hospital (McMaster University), Hamilton, ON, Canada
| | - Cristina Go
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children (University of Toronto), Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics, British Columbia Children's Hospital (University of British Columbia), Toronto, Ontario, Canada
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Sakpichaisakul K, Boonkrongsak R, Lertbutsayanukul P, Iemwimangsa N, Klumsathian S, Panthan B, Trachoo O. Epileptic spasms related to neuronal differentiation factor 2 (NEUROD2) mutation respond to combined vigabatrin and high dose prednisolone therapy. BMC Neurol 2022; 22:461. [PMID: 36494631 PMCID: PMC9733267 DOI: 10.1186/s12883-022-02992-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epileptic spasms are a devastating form of early infantile epileptic encephalopathy (EIEE) with various etiologies. Early diagnosis and a shorter lead time to treatment are crucial to stop the seizures and optimize the neurodevelopmental outcome. Genetic testing has become an integral part of epilepsy care that directly guides management and family planning and discovers new targeted treatments. Neuronal differentiation Factor 2 (NEUROD2) variants have recently been a cause of neurodevelopmental disorders (NDDs) and EIEEs with distinctive features. However, there is limited information about the clinical and electroencephalographic response of epileptic spasm treatment in NEUROD2-related NDD syndrome. CASE PRESENTATION We report a female patient of Southeast Asian ethnicity with global developmental delay and epileptic spasms commencing in the first few months of life. A novel de novo heterozygous pathogenic NEUROD2 variant, p. E130Q, was subsequently identified by whole-exome sequencing. Electroencephalogram before treatment showed multifocal independent spikes predominantly in both posterior head regions and demonstrated marked improvement following combined vigabatrin and high-dose prednisolone treatment. However, multiple courses of relapse occurred after weaning off the antiseizure medication. CONCLUSIONS We propose that epileptic spasms related to de novo NEUROD2 pathogenic variant respond well to combined vigabatrin and high-dose prednisolone therapy. These findings may imply the benefit of using combination therapy to treat epileptic spasms in NEUROD2-related NDD syndrome.
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Affiliation(s)
- Kullasate Sakpichaisakul
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, 10400, Thailand
| | - Rachata Boonkrongsak
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, 10400, Thailand
| | | | - Nareenart Iemwimangsa
- Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sommon Klumsathian
- Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | | | - Objoon Trachoo
- Centre for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Ratchathewi, Bangkok, 10400, Thailand.
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20
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Le JT, Ballester-Rosado CJ, Frost JD, Swann JW. Neurobehavioral deficits and a progressive ictogenesis in the tetrodotoxin model of epileptic spasms. Epilepsia 2022; 63:3078-3089. [PMID: 36179064 PMCID: PMC9742150 DOI: 10.1111/epi.17428] [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: 06/29/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Our goal was to determine whether animals with a history of epileptic spasms have learning and memory deficits. We also used continuous (24/7) long-term electroencephalographic (EEG) recordings to evaluate the evolution of epileptiform activity in the same animals over time. METHODS Object recognition memory and object location memory tests were undertaken, as well as a matching to place water maze test that evaluated working memory. A retrospective analysis was undertaken of long-term video/EEG recordings from rats with epileptic spasms. The frequency and duration of the ictal events of spasms were quantified. RESULTS Rats with a history of epileptic spasms showed impairment on the three behavioral tests, and their scores on the object recognition memory and matching to place water maze tests indicated neocortical involvement in the observed impaired cognition. Analysis of EEG recordings unexpectedly showed that the ictal events of spasms and their accompanying behaviors progressively increased in duration over a 2-week period soon after onset, after which spasm duration plateaued. At the same time, spasm frequency remained unchanged. Soon after spasm onset, ictal events were variable in wave form but became more stereotyped as the syndrome evolved. SIGNIFICANCE Our EEG findings are the first to demonstrate progressive ictogenesis for epileptic spasms. Furthermore, in demonstrating cognitive deficits in the tetrodotoxin model, we have met a criterion for an animal model of West syndrome. Animal models will allow in-depth studies of spasm progression's potential role in cognitive regression and may elucidate why early treatment is considered essential for improved neurodevelopmental outcomes in children.
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Affiliation(s)
- John T. Le
- The Cain Foundation Laboratories, the Jan and Dan Neurological Research Institute, Texas Children’s Hospital, Houston Texas
- Department of Pediatrics, Baylor College of Medicine, Houston Texas
| | - Carlos J. Ballester-Rosado
- The Cain Foundation Laboratories, the Jan and Dan Neurological Research Institute, Texas Children’s Hospital, Houston Texas
- Department of Pediatrics, Baylor College of Medicine, Houston Texas
| | - James D. Frost
- Department of Neurology, Baylor College of Medicine, Houston Texas
| | - John W. Swann
- The Cain Foundation Laboratories, the Jan and Dan Neurological Research Institute, Texas Children’s Hospital, Houston Texas
- Department of Pediatrics, Baylor College of Medicine, Houston Texas
- Department of Neuroscience, Baylor College of Medicine, Houston Texas
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21
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Jiang Y, Zou N, Luo Y, Cheng M, Liao S, Hong S, Liang X, Zhong M, Li T, Jiang L. Cohort study of infantile epileptic spasms syndrome: etiological analysis and treatment of corticosteroids. Seizure 2022; 101:120-126. [DOI: 10.1016/j.seizure.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/24/2022] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
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22
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Ballester-Rosado CJ, Le JT, Lam TT, Mohila CA, Lam S, Anderson AE, Frost JD, Swann JW. A Role for Insulin-like Growth Factor 1 in the Generation of Epileptic Spasms in a murine model. Ann Neurol 2022; 92:45-60. [PMID: 35467038 PMCID: PMC9233100 DOI: 10.1002/ana.26383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Infantile spasms are associated with a wide variety of clinical conditions, including perinatal brain injuries. We have created a model in which prolonged infusion of tetrodotoxin (TTX) into the neocortex, beginning in infancy, produces a localized lesion and reproduces the behavioral spasms, electroencephalogram (EEG) abnormalities, and drug responsiveness seen clinically. Here, we undertook experiments to explore the possibility that the growth factor IGF-1 plays a role in generating epileptic spasms. METHODS We combined long-term video EEG recordings with quantitative immunohistochemical and biochemical analyses to unravel IGF-1's role in spasm generation. Immunohistochemistry was undertaken in surgically resected tissue from infantile spasms patients. We used viral injections in neonatal conditional IGF-1R knock-out mice to show that an IGF-1-derived tripeptide (1-3)IGF-1, acts through the IGF-1 receptor to abolish spasms. RESULTS Immunohistochemical methods revealed widespread loss of IGF-1 from cortical neurons, but an increase in IGF-1 in the reactive astrocytes in the TTX-induced lesion. Very similar changes were observed in the neocortex from patients with spasms. In animals, we observed reduced signaling through the IGF-1 growth pathways in areas remote from the lesion. To show the reduction in IGF-1 expression plays a role in spasm generation, epileptic rats were treated with (1-3)IGF-1. We provide 3 lines of evidence that (1-3)IGF-1 activates the IGF-1 signaling pathway by acting through the receptor for IGF-1. Treatment with (1-3)IGF-1 abolished spasms and hypsarrhythmia-like activity in the majority of animals. INTERPRETATION Results implicate IGF-1 in the pathogenesis of infantile spasms and IGF-1 analogues as potential novel therapies for this neurodevelopmental disorder. ANN NEUROL 2022;92:45-60.
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Affiliation(s)
- Carlos J. Ballester-Rosado
- The Cain Foundation Laboratories, the Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John T. Le
- The Cain Foundation Laboratories, the Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Trang T. Lam
- The Cain Foundation Laboratories, the Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Carrie A. Mohila
- Department of Pathology and Immunology, Baylor College of Medicine
- Department of Pathology, Texas Children’s Hospital, Houston, Texas, USA
| | - Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Anne E. Anderson
- The Cain Foundation Laboratories, the Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - James D. Frost
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - John W. Swann
- The Cain Foundation Laboratories, the Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
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23
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Demarest S, Calhoun J, Eschbach K, Yu HC, Mirsky D, Angione K, Shaikh TH, Carvill GL, Benke TA, Gunti J, Vanderveen G. Whole-exome sequencing and adrenocorticotropic hormone therapy in individuals with infantile spasms. Dev Med Child Neurol 2022; 64:633-640. [PMID: 35830182 DOI: 10.1111/dmcn.15109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022]
Abstract
AIM To identify additional genes associated with infantile spasms using a cohort with defined infantile spasms. METHOD Whole-exome sequencing (WES) was performed on 21 consented individuals with infantile spasms and their unaffected parents (a trio-based study). Clinical history and imaging were reviewed. Potentially deleterious exonic variants were identified and segregated. To refine potential candidates, variants were further prioritized on the basis of evidence for relevance to disease phenotype or known associations with infantile spasms, epilepsy, or neurological disease. RESULTS Likely pathogenic de novo variants were identified in NR2F1, GNB1, NEUROD2, GABRA2, and NDUFAF5. Suggestive dominant and recessive candidate variants were identified in PEMT, DYNC1I1, ASXL1, RALGAPB, and STRADA; further confirmation is required to support their relevance to disease etiology. INTERPRETATION This study supports the utility of WES in uncovering the genetic etiology in undiagnosed individuals with infantile spasms with an overall yield of five out of 21. High-priority candidates were identified in an additional five individuals. WES provides additional support for previously described disease-associated genes and expands their already broad mutational and phenotypic spectrum.
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Affiliation(s)
- Scott Demarest
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Jeff Calhoun
- Ken and Ruth Davee Department of Neurology, Northwestern University, School of Medicine, Chicago, IL, USA
| | - Krista Eschbach
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Hung-Chun Yu
- Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - David Mirsky
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Radiology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Katie Angione
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Tamim H Shaikh
- Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Gemma L Carvill
- Ken and Ruth Davee Department of Neurology, Northwestern University, School of Medicine, Chicago, IL, USA.,Department of Pharmacology, Northwestern University, School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University, School of Medicine, Chicago, IL, USA
| | - Tim A Benke
- Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Pharmacology, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Neurology, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Otolaryngology, University of Colorado, School of Medicine, Aurora, CO, USA
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24
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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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25
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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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Hutchinson ML, Nash KB, Abend NS, Moharir M, Wells E, Messer RD, Palaganas J, Helbig I, Wietstock SO, Suslovic W, Gonzalez AK, Kaufman MC, Press CA, Piantino J. Multicenter Study of the Impact of COVID-19 Shelter-In-Place on Tertiary Hospital-based Care for Pediatric Neurologic Disease. Neurohospitalist 2022; 12:218-226. [PMID: 35414846 PMCID: PMC8814588 DOI: 10.1177/19418744211063075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective To describe changes in hospital-based care for children with neurologic diagnoses during the initial 6 weeks following regional Coronavirus 2019 Shelter-in-Place orders. Methods This retrospective cross-sectional study of 7 US and Canadian pediatric tertiary care institutions included emergency and inpatient encounters with a neurologic primary discharge diagnosis code in the initial 6 weeks of Shelter-in-Place (COVID-SiP), compared to the same period during the prior 3 years (Pre-COVID). Patient demographics, encounter length, and neuroimaging and electroencephalography use were extracted from the medical record. Results 27,900 encounters over 4 years were included. Compared to Pre-COVID, there was a 54% reduction in encounters during Shelter-in-Place. COVID-SiP patients were younger (median 5 years vs 7 years). The incidence of encounters for migraine fell by 72%, and encounters for acute diagnoses of status epilepticus, infantile spasms, and traumatic brain injury dropped by 53%, 55%, and 56%, respectively. There was an increase in hospital length of stay, relative utilization of intensive care, and diagnostic testing (long-term electroencephalography, brain MRI, and head CT (all P<.01)). Conclusion During the initial 6 weeks of SiP, there was a significant decrease in neurologic hospital-based encounters. Those admitted required a high level of care. Hospital-based neurologic services are needed to care for acutely ill patients. Precise factors causing these shifts are unknown and raise concern for changes in care seeking of patients with serious neurologic conditions. Impacts of potentially delayed diagnosis or treatment require further investigation.
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Affiliation(s)
- Melissa L. Hutchinson
- Department of Pediatrics, Neurology
Division, The Ohio State University College of
Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kendall B. Nash
- Departments of Neurology and
Pediatrics, Division of Child Neurology, University of California, San
Francisco, Benioff Children’s Hospital San Francisco, San Francisco,
CA, USA
| | - Nicholas S. Abend
- Departments of Neurology and
Pediatrics, Children’s Hospital of Philadelphia
and the University of Pennsylvania, Philadelphia PA, USA
| | - Mahendranath Moharir
- Division of Neurology, Department
of Pediatrics, The Hospital for Sick Children and
University of Toronto, Ontario, Canada
| | - Elizabeth Wells
- Center for Neuroscience and
Behavioral Medicine, Children’s National Hospital and the
George Washington University School of Medicine and Health
Sciences, Washington, DC, USA
| | - Ricka D. Messer
- Department of Pediatrics, Section
of Child Neurology, University of Colorado, Aurora, CO, USA
| | - Jamie Palaganas
- Department of Pediatrics, Division
of Child Neurology, Weill Cornell Medicine, New York Presbyterian
Hospital, New York, NY, USA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of
Philadelphia, Philadelphia PA, USA
| | - Sharon O. Wietstock
- The Epilepsy NeuroGenetics
Initiative (ENGIN), Department of Biomedical and Health Informatics (DBHi),
Department of Neurology, University of
Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - William Suslovic
- Department of Neurology, Children’s National
Hospital, Washington, DC, USA
| | - Alexander K. Gonzalez
- The Epilepsy NeuroGenetics
Initiative (ENGIN). Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of
Philadelphia, Philadelphia PA, USA 1
| | - Michael C. Kaufman
- The Epilepsy NeuroGenetics
Initiative (ENGIN). Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of
Philadelphia, Philadelphia PA, USA 1
| | - Craig A. Press
- Departments of Neurology and
Pediatrics, Children’s Hospital of Philadelphia
and the University of Pennsylvania, Philadelphia PA, USA
| | - Juan Piantino
- Department of Pediatrics, Section
of Child Neurology, Oregon Health & Science
University, Portland, OR, USA,Juan A. Piantino, Department of Pediatrics,
Section of Child Neurology, Oregon Health & Science University, MCR CDRC-P
707 SW Gaines St, Portland, OR 97239, USA.
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Perry LD, Hogg SL, Bowdin S, Ambegaonkar G, Parker AP. Fifteen-minute consultation: The efficient investigation of infantile and childhood epileptic encephalopathies in the era of modern genomics. Arch Dis Child Educ Pract Ed 2022; 107:80-87. [PMID: 33414255 DOI: 10.1136/archdischild-2020-320606] [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: 09/01/2020] [Revised: 11/05/2020] [Accepted: 12/09/2020] [Indexed: 11/03/2022]
Abstract
The investigation of children presenting with infantile and childhood epileptic encephalopathies (ICEE) is challenging due to diverse aetiologies, overlapping phenotypes and the relatively low diagnostic yield of MRI, electroencephalography (EEG) and biochemical investigations. Careful history and thorough examination remain essential as these may identify an acquired cause or indicate more targeted investigation for a genetic disorder. Whole exome sequencing (WES) with analysis of a panel of candidate epilepsy genes has increased the diagnostic yield. Whole genome sequencing (WGS), particularly as a trio with both parents' DNA, is likely to supersede WES. Modern genomic investigation impacts on the timing and necessity of other testing. We propose a structured approach for children presenting with ICEE where there is diagnostic uncertainty, emphasising the importance of WGS or, if unavailable, WES early in the investigative process. We note the importance of expert review of all investigations, including radiology, neurophysiology and biochemistry, to confirm the technique used was appropriate as well as the results. It is essential to counsel families on the risks associated with the procedures, the yield of the procedures, findings that are difficult to interpret and implication of 'negative' results. Where children remain without a diagnosis despite comprehensive investigation, we note the importance of ongoing multidisciplinary care.
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Affiliation(s)
- Luke Daniel Perry
- Developmental Neurosciences, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Sarah Louise Hogg
- Biochemical Genetics Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sarah Bowdin
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gautam Ambegaonkar
- Paediatric Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alasdair Pj Parker
- Paediatric Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Wang H, Zhu Y, Cao D, Chen H, Ding X, Zeng Q, Zou H, Liao J. Successful medical treatment of west syndrome with a KCNA2 variant: a case report. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-021-00069-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
West syndrome is a devastating disorder characterized by a triad of epileptic spasms, abnormal electroencephalography (EEG), and developmental arrest or psychomotor delay. In addition to early diagnosis, knowing the etiology of the condition is also important for its treatment. Among various etiologies, the genetic factors, especially mutations of ion channel genes, are very common and strongly linked to West syndrome.
Case presentation
A boy who had epileptic spasms from the age of 4 months was diagnosed with West syndrome based on the clinical manifestation and EEG results in Shenzhen Children’s Hospital in June 2019. Trios whole-exome sequencing (WES) test and protein structural model prediction were performed. We also reviewed the clinical and genetic features of this syndrome and the mechanisms of action of topiramate (TPM) by literature search in databases of Online Mendelian Inheritance in Man, Clinical Genome Resource, PubMed, Chinese National Knowledge Infrastructure and Wanfang database using keywords “KCNA2” “West syndrome” and “Topiramate” by December 2020. The relationship between the effect of TPM and the pathogenesis of the KCNA2 variant was also assessed. The WES test revealed c.244C > T/p. Arg82Cys varaint of KCNA2 (NM_004974.3) in this patient, and Sanger sequencing identified this was a de novo mutation. As far as we know, this is the first report of the c.244C > T/p. Arg82Cys variant in KCNA2, which was likely a pathogenic mutation. The seizures were successfully controlled for 10 months by TPM after failure of sodium valproate, large doses of vitamin B6, and adrenocorticotropic hormone. We speculate that the therapeutic effect of TPM in this patient is partially due to the inhibition of carbonic anhydrase.
Conclusions
Mutations in the KCNA2 gene should be considered for patients with West syndrome. The TPM treatment is probably effective for KCNA2-associated disorders.
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Chourasia N, Yuskaitis CJ, Libenson MH, Bergin AM, Liu S, Zhang B, Poduri A, Harini C. Infantile spasms: assessing the diagnostic yield of an institutional guideline and the impact of etiology on long-term treatment response. Epilepsia 2022; 63:1164-1176. [PMID: 35211955 DOI: 10.1111/epi.17209] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neuroimaging and genetic testing have been proposed for diagnostic evaluation of infantile spasms (IS), establishing etiology in ~60% of multicenter IS cohorts. A retrospective analysis of the yield of diagnostic etiology following an institutionally established guideline for investigation/treatment of IS was conducted, and the association between etiological subgroups and sustained response to standard treatment was evaluated. METHODS Etiology of IS, neuroimaging, and genetic results were extracted from clinical records. Etiology was categorized as acquired or non-acquired, the latter including syndromic patients, non-syndromic patients with confirmed etiology, and unknown cases. Regression analyses, using clinical variables including subtypes of etiology, were conducted to determine which factors correlated with favorable (spasms freedom at last follow-up after ≤ 2 standard treatments) versus unfavorable treatment outcome (refractory spasms despite two standard treatments or relapse). RESULTS We included 127 IS patients (60% males) with a follow-up of 2.4 years (range 0.6-5 years). All patients had neuroimaging, and 95% of patients in the non-acquired category (103 of 108 patients) had genetic testing. Etiology was identified in 103/127 (81%, CI-0.73-0.86). At last follow-up, 42 (33%) patients had favorable treatment outcome. No difference in treatment response was observed between acquired and non-acquired etiologies. Among patients with non-acquired etiologies, developmental delay prior to spasms onset increased the odds of unfavorable treatment outcome (p=0.014) while a clearly recognizable dysmorphic/syndromic etiology was associated with a lower risk for treatment failure (p=0.034). In non-acquired etiology without a recognizable dysmorphic/syndrome but with a genetic etiology, unfavorable treatment outcome was more likely (p=0.043). SIGNIFICANCE Rigorous evaluation with neuroimaging and genetic testing yields an etiological diagnosis in most patients with IS. Among patients with a non-acquired etiology, those with recognizable dysmorphic/syndromic diagnosis had a higher likelihood of a favorable treatment outcome, while the absence of such a finding, when associated with an identifiable genetic diagnosis, was associated with unfavorable treatment outcomes.
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Affiliation(s)
- Nitish Chourasia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA.,Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children's Hospital (author's current location), Memphis, TN, USA
| | - Christopher J Yuskaitis
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Mark H Libenson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Ann M Bergin
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Shanshan Liu
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Annapurna Poduri
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
| | - Chellamani Harini
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital (study performed), Boston, MA, USA
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Saleh DA, Hassan A. Clinical profile, treatment modalities, and outcomes in patients with infantile spasms: A retrospective study from the United Arab of Emirates (UAE). Epilepsy Behav 2022; 127:108519. [PMID: 34999500 DOI: 10.1016/j.yebeh.2021.108519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/18/2021] [Accepted: 12/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infantile spasms (IS) are an epileptic encephalopathy where the prognosis is generally poor, with most patients exhibiting psychomotor retardation or intractable epilepsy. However, it is claimed that early and aggressive treatment is related to better response rate and outcome, especially in patients with idiopathic IS. OBJECTIVE To investigate different treatment modalities and outcomes in patients with IS attending a pediatric neurology clinic at a specialized neurology center in Abu Dhabi, United Arab Emirates. METHODS Retrospective chart review was done for detailed history, demographic data, etiology, neuro-diagnostic workup, treatment modalities, and the outcomes for all patients diagnosed with IS from September 2014 to September 2019. RESULTS Three treatment modalities were identified as 1st line- Prednisolone United Kingdom Infantile Spasms Study (UKISS) (N = 15, 46.8%), Anti-Seizure Medications (ASMs) (N = 12, 37.5%), and Vigabatrin (N = 5, 15.6%). The complete response rate to Vigabatrin as a 1st line treatment showed the highest statistical significance (X2 = 7.34, p = 0.007). Patients with idiopathic IS showed a comparable response to treatment to those with symptomatic IS. Additional response to 2nd line treatment with Prednisolone UKISS protocol (25%) and Vigabatrin (15%) was noted in patients who showed partial or no response to the 1st line treatment. None of our patients received Adrenocorticotropic Hormone as treatment. All patients with desirable final outcomes were with idiopathic IS and none were symptomatic. CONCLUSION More than a third of our patients showed poor treatment response whenever they were not offered treatment according to the current available protocols. This indicates an urgent need for having a unified treatment protocol that takes into consideration the availability of medications, professional expertise as well as diagnostic workup outside major tertiary care centers in our region.
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Affiliation(s)
- Dina Amin Saleh
- Division of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE; Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abeera Hassan
- Division of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
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Matsuura R, Hamano SI, Daida A, Horiguchi A, Nonoyama H, Kubota J, Ikemoto S, Hirata Y, Koichihara R, Kikuchi K. Serum matrix metallopeptidase-9 and tissue inhibitor of metalloproteinase-1 levels may predict response to adrenocorticotropic hormone therapy in patients with infantile spasms. Brain Dev 2022; 44:114-121. [PMID: 34429218 DOI: 10.1016/j.braindev.2021.08.003] [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: 06/29/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether serum matrix metallopeptidase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels predict response to adrenocorticotropic hormone (ACTH) therapy in patients with infantile spasms. METHODS We prospectively evaluated patients with infantile spasms who were referred to Saitama Children's Medical Center from January 2011 to December 2020. We measured Q-albumin and serum MMP-9 and TIMP-1 levels before ACTH therapy. Patients were divided into three groups based on the etiology of their infantile spasms: those with an unknown etiology and normal development (unknown-normal group); those with a structural and acquired etiology (structural-acquired group); and those with a structural and congenital, genetic, metabolic, or unknown etiology with developmental delay (combined-congenital group). Responders were defined as those having complete cessation of spasms for more than 3 months with the resolution of hypsarrhythmia on electroencephalography during ACTH therapy. RESULTS We collected serum from 36 patients with West syndrome and five patients with infantile spasms without hypsarrhythmia before ACTH therapy. Twenty-three of 41 patients (56.1%) were responders, including 8/8 (100%) in the unknown-normal group, 6/9 (66.7%) in the structural-acquired group, and 9/24 (37.5%) in the combined-congenital group. The serum MMP-9 level and MMP-9/TIMP-1 ratio were significantly higher in responders than in nonresponders (P = 0.001 for both). CONCLUSION A therapeutic response to ACTH was associated with a higher serum MMP-9 level and higher MMP-9/TIMP-1 ratio in patients with infantile spasms. Therefore, these biomarkers may predict responses to ACTH therapy in this patient population.
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Affiliation(s)
- Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Atsuro Daida
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Ayumi Horiguchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan
| | - Hazuki Nonoyama
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Jun Kubota
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Satoru Ikemoto
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
| | - Reiko Koichihara
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama, Japan; Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, Japan
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Menon R, Chandrasekharan S, Nanda S, Nair J, Radhakrishnan A, Cherian A, Thomas S. Does Etiology and Hypsarrhythmia Subtype Influence Outcome in West Syndrome? Challenges Encountered from a Referral Center Perspective. Neurol India 2022; 70:188-196. [DOI: 10.4103/0028-3886.336325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Peng P, Kessi M, Mao L, He F, Zhang C, Chen C, Pang N, Yin F, Pan Z, Peng J. Etiologic Classification of 541 Infantile Spasms Cases: A Cohort Study. Front Pediatr 2022; 10:774828. [PMID: 35330882 PMCID: PMC8940518 DOI: 10.3389/fped.2022.774828] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore the etiology of infantile spasms (IS) in a large Chinese cohort based on the United States National Infantile Spasms Consortium (NISC) classification. METHODS In the present study, we recruited IS patients diagnosed at a single center (Xiangya Hospital, Central South University) between Jan 2010 and Aug 2019. Thereafter, we collected their clinical and genetic information retrospectively. Their underlying etiologies were classified according to the NISC classification and then compared in different scenarios to understand their distribution. RESULTS A total of 541 patients with IS from 18 provinces were included in this study. The underlying etiology was identified in 53.2% of the cases: structural-acquired, 25.3%; genetic, 12.9%; genetic-structural, 7.2%; structural-congenital, 5.0%; metabolic, 2.4%; infections, 0.4% and immune, 0%. Whole-exome sequencing (WES) provided the highest diagnostic yield (26.9%). In structural-acquired IS, the proportion of hypoglycemic brain injuries was significant, second only to hypoxic-ischemic encephalopathy. There was no patient discovered to have Down syndrome. STXBP1, CDKL5, TSC2, KCNQ2, IRF2BPL, and TSC1 were the most frequently implicated genes. Genetic causes were found to be the most common cause of IS in the early onset group, while structural-acquired etiologies were common in males and preterm babies. Patients with pre-spasm seizures were associated with a higher proportion of identified causes than those without. Non-acquired structural etiologies were more common in patients without hypsarrhythmia than in those with hypsarrhythmia. SIGNIFICANCE The most prevalent cause of IS was structural acquired followed by genetic causes. When brain MRI fails to detect the etiology, we propose WES as the next step. Structural-acquired IS and cases with genetic disorders are characteristic of the Chinese cohort, however, the etiology differs with the patient's age of onset, gestation age at birth, sex, and the presence/absence of both pre-spasm seizures, and hypsarrhythmia.
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Affiliation(s)
- Pan Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Leilei Mao
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Ciliu Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Nan Pang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Zou Pan
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
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Weingarten MM, Cokley JA, Moffett B, DiCarlo S, Misra SN. Trends and Costs Associated With the Diagnosis and Treatment of Infantile Spasms: A 10-Year Multicenter Retrospective Review. J Pediatr Pharmacol Ther 2021; 27:29-37. [PMID: 35002556 PMCID: PMC8717615 DOI: 10.5863/1551-6776-27.1.29] [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: 12/08/2020] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Early treatment of infantile spasms (IS) may be imperative for improvement of neurodevelopmental outcomes. Existing studies have led to inconclusive recommendations with variation in treatment. Our objective was to determine the national average cost, initial diagnostic workup, treatments, and hospital length of stay for patients with IS. METHODS This retrospective cohort study was designed to review data of patients < 2 years from 43 non-profit institutions. Data obtained included patient demographics, length of stay, admission cost, and treatments used from 2004 to 2014. Cost data were collected and adjusted to 2014 dollars, the year data were analyzed. RESULTS A total of 6183 patients met study criteria (n = 3382, 55% male). Three-quarters of patients (n = 4684, 76%) had an electroencephalogram, 56.4% had brain imaging (n = 3487), and 17% (n = 1050) underwent a lumbar puncture. Medication for IS was initiated during inpatient hospital stay in two-thirds of all patients (n = 4139, 67%). Most patients were initiated on corticotropin (n = 2066, 33%) or topiramate (n = 1804, 29%). Average length of stay was 5.8 days with an average adjusted cost of $18,348. Over time there was an 86.6% increase in cost from an average $12,534.54 (2004) to $23,391.20 (2014), a significant change (p < 0.01). This correlated with an increase in average length of stay. CONCLUSIONS Variability exists in diagnostic workup and pharmacotherapy initiated for IS, which may lead to differences in the cost of hospital stay. Further studies may help determine contributing factors to increased cost and improve health care utilization for IS patients.
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Affiliation(s)
| | - Jon A. Cokley
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX (JAC, BM, SD)
| | - Brady Moffett
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX (JAC, BM, SD)
| | - Shannon DiCarlo
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX (JAC, BM, SD)
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Wanigasinghe J, Sahu JK, Madaan P, Fatema K, Linn K, Chand P, Poudel P, Hamed E, Mynak ML, Hassan S. Classifying etiology of infantile spasms syndrome in resource-limited settings: A study from the South Asian region. Epilepsia Open 2021; 6:736-747. [PMID: 34653320 PMCID: PMC8633471 DOI: 10.1002/epi4.12548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Etiological classification of infantile spasms syndrome (ISS) is important, considering the influence on prognosis based on the presence or absence of a known etiology. This study was performed to describe the limitations and difficulties experienced within the South Asian region when classifying the etiology of ISS according to the current recommendation. Method Data on healthcare indices and facilities related to management of ISS for the nine countries in the South Asian region were gathered by the South Asian West Syndrome Research Group. A Google survey was performed among three hundred and thirty pediatric neurologists in the region. The capacity within each country for investigating etiology of ISS according to current described benchmarks was evaluated. The difficulties experienced in this regard and the potential solutions were investigated. Results One hundred and sixty pediatric neurologists (response rate 48%) from Bangladesh (19/25), India (94/255), Myanmar (11/11), Nepal (6/8), Pakistan (19/25), and from Sri Lanka (7/8) responded. Three countries had no pediatric neurology services. Fifty‐six percent attempted to classify ISS etiology according to classification outlined by International League Against Epilepsy in 2017. The facilities to perform metabolic, genetic, and immunological investigations were very limited. Lack of funding for investigations and poor laboratory support were the two most frequent barriers encountered. Sixty percent indicated that a separate classification is suitable for low‐income setting; 78% suggested inclusion of separate category as “incompletely investigated” as an alternative solution to mitigate the barrier of achieving a better understanding of the etiological subtypes seen more frequently in this region. Significance The resources in South Asian region are limited to meet the recommendations for investigating etiology of ISS. Including the etiological subcategory “incompletely investigated” is proposed as an alternative to understand the true proportions of children in this region, with a definite known etiology and those with an unknown etiology.
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Affiliation(s)
| | - Jitendra Kumar Sahu
- Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Madaan
- Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanij Fatema
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kyaw Linn
- Yangon Children Hospital, Yangon, Myanmar
| | | | | | - Esmatullah Hamed
- French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Mimi L Mynak
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Nepal
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Trollmann R, Borggräfe I, Müller-Felber W, Brandl U. Pädiatrische epileptische Enzephalopathien mit Manifestation oberhalb des Neugeborenenalters: ein Up-date. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1528-3511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungEntwicklungs-und epileptische Enzephalopathien manifestieren sich überwiegend bereits im Säuglings-und frühen Kleinkindesalter. Mit der neuen ILAE-Klassifikation der Epilepsien konnten epileptische Enzephalopathien sowohl hinsichtlich des elektroklinischen Phänotyps als auch des ätiologischen Spektrums und assoziierter Komorbiditäten genauer definiert werden. Einige elektroklinischer Entitäten wie das West-Syndrom oder das Dravet-Syndrom können auf der Basis ihres Genotyps inzwischen als spezifische Enzephalopathien klassifiziert werden. Das EEG stellt eine wichtige Zusatzdiagnostik in der Abklärung einer epileptischen Enzephalopathie dar. Es hat einen besonderen Stellenwert für die Diagnose von Komplikationen wie z. B. subklinischer Anfälle oder eines Status epilepticus sowie für ein adäquates Therapiemonitoring. Der Betrag fasst anhand ausgewählter pädiatrischer Epilepsiesyndrome aktuelle Aspekte zur Komplexität der pädiatrischen epileptischen Enzephalopathien und den Stellenwert der EEG-Diagnostik zusammen.
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Affiliation(s)
- Regina Trollmann
- Abteilung Neuropädiatrie und Sozialpädiatrisches Zentrum, Kinder-und Jugendklinik am Universitätsklinikum, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Ingo Borggräfe
- Abteilung für Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, Dr. von Haunersches Kinderspital, LMU Klinikum München, München
- Interdisziplinäres Epilepsiezentrum, LMU Klinikum München, München
| | - Wolfgang Müller-Felber
- Abteilung für Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, Dr. von Haunersches Kinderspital, LMU Klinikum München, München
| | - Ulrich Brandl
- Klinik für Neuropädiatrie, Universitätsklinikum Jena, Jena
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Erdemir G, Pestana-Knight E, Honomichl R, Thompson NR, Lachhwani D, Kotagal P, Wyllie E, Gupta A, Bingaman WE, Moosa ANV. Surgical candidates in children with epileptic spasms can be selected without invasive monitoring: A report of 70 cases. Epilepsy Res 2021; 176:106731. [PMID: 34339941 DOI: 10.1016/j.eplepsyres.2021.106731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Prior surgical series in children with drug-resistant epileptic spasms have reported use of intracranial EEG monitoring in up to two-third of patients. We report outcome after epilepsy surgery for drug-resistant epileptic spasms in a cohort of children without the use of intracranial EEG monitoring in any of the patients. METHODS Medical records of all consecutive children aged 5 years or under who had epilepsy surgery for epileptic spasms at Cleveland Clinic between 2000 and 2018 were reviewed. Post-operative seizure outcome and predictors of prognosis of seizure outcome were analyzed. RESULTS Seventy children with active epileptic spasms underwent surgical resections during the study period. Mean age at seizure onset was 6.8 (+9.31) months and median age at surgery was 18.5 months. An epileptogenic lesion was identified on brain MRI in all patients; 17 (24%) had bilateral abnormalities. Etiologies included malformations of cortical development (58%), perinatal infarct/encephalomalacia (39%), and tumor (3%). None of the patients had intracranial EEG. Surgical procedures included hemispherectomy (44%), lobectomy/ lesionectomy (33%), and multilobar resections (23%). Twelve children needed repeat surgery; six (50%) became seizure free after the second surgery. At six months follow-up, 73% (51/70) were seizure-free since surgery. At a mean follow-up of 4.7 years, 60% (42/70) had Engel 1 outcome. In those with seizure recurrence, 17 (60%) reported improvement. Shorter epilepsy duration (p = 0.05) and lobar or sub-lobar epileptogenic lesions (p = 0.02) predicted favorable seizure outcome at 6 months after surgery. For long term outcome, patients with bilateral abnormalities on MRI (p = 0.001), and multilobar extent on MRI (p = 0.02) were at higher risk for recurrence. SIGNIFICANCE Children with drug-resistant epileptic spasms secondary to an epileptogenic lesion detected on MRI could be selected for epilepsy surgery without undergoing intracranial EEG monitoring. A surgical selection paradigm without intracranial monitoring may allow early surgery without the risks of invasive monitoring.
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Affiliation(s)
- Gozde Erdemir
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States; Division of Pediatric Neurology, University of Maryland, Baltimore, MD, United States
| | | | - Ryan Honomichl
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nicolas R Thompson
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Deepak Lachhwani
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States
| | - Prakash Kotagal
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States
| | - Elaine Wyllie
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States
| | - Ajay Gupta
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States
| | | | - Ahsan N V Moosa
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, 44195, United States.
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Akman O, Briggs SW, Mowrey WB, Moshé SL, Galanopoulou AS. Antiepileptogenic effects of rapamycin in a model of infantile spasms due to structural lesions. Epilepsia 2021; 62:1985-1999. [PMID: 34212374 DOI: 10.1111/epi.16975] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Infantile spasms may evolve into persistent epilepsies including Lennox-Gastaut syndrome. We compared adult epilepsy outcomes in models of infantile spasms due to structural etiology (multiple-hit model) or focal cortical inflammation and determined the anti-epileptogenic effects of pulse-rapamycin, previously shown to stop spasms in multiple-hit rats. METHODS Spasms were induced in 3-day-old male rats via right intracerebral doxorubicin/lipopolysaccharide (multiple-hit model) infusions. Controls and sham rats were used. Separate multiple-hit rats received pulse-rapamycin or vehicle intraperitoneally between postnatal days 4 and 6. In adult mice, video-EEG (electroencephalography) scoring for seizures and sleep and histology were done blinded to treatment. RESULTS Motor-type seizures developed in 66.7% of multiple-hit rats, usually from sleep, but were reduced in the pulse-rapamycin-treated group (20%, p = .043 vs multiple-hit) and rare in other groups (0-9.1%, p < .05 vs multiple-hit). Spike-and-wave bursts had a slower frequency in multiple-hit rats (5.4-5.8Hz) than in the other groups (7.6-8.3Hz) (p < .05); pulse rapamycin had no effect on the hourly spike-and-wave burst rates in adulthood. Rapamycin, however, reduced the time spent in slow-wave-sleep (17.2%), which was increased in multiple-hit rats (71.6%, p = .003). Sham rats spent more time in wakefulness (43.7%) compared to controls (30.6%, p = .043). Multiple-hit rats, with or without rapamycin treatment, had right more than left corticohippocampal, basal ganglia lesions. There was no macroscopic pathology in the other groups. SIGNIFICANCE Structural corticohippocampal/basal ganglia lesions increase the risk for post-infantile spasms epilepsy, Lennox-Gastaut syndrome features, and sleep dysregulation. Pulse rapamycin treatment for infantile spasms has anti-epileptogenic effects, despite the structural lesions, and decreases the time spent in slow wave sleep.
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Affiliation(s)
- Ozlem Akman
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA
| | - Stephen W Briggs
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Bronx, New York, USA
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA.,Isabelle Rapin Division of Child Neurology, Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Bronx, New York, USA.,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Laboratory of Developmental Epilepsy, Bronx, New York, USA.,Isabelle Rapin Division of Child Neurology, Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Bronx, New York, USA
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Choi HS, Ko A, Kim SH, Lee ST, Choi JR, Lee JS, Kim HD, Kang HC. Disparate treatment outcomes according to presence of pathogenic mutations in West syndrome. Epilepsia 2021; 62:1656-1664. [PMID: 34008866 DOI: 10.1111/epi.16924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE It has been known that West syndrome (WS) patients with an unknown etiology have better clinical outcomes than patients with an identified etiology of any kind. However, after the exponential discovery of genes with mutations responsible for developmental and epileptic encephalopathy (DEE), a significant proportion of patients with a previously unknown etiology have been reclassified as having a genetic etiology, requiring reinvestigation of this concept. Therefore, this study investigated clinical outcomes of WS patients with genetic and unknown etiologies. METHODS Patients diagnosed with WS without structural or metabolic abnormalities were included in this study. The DEE gene panel, comprising 172 genes, was performed for all patients. All patients were treated using the same treatment protocol for vigabatrin and high-dose prednisolone add-on therapy. Favorable responders were defined as patients who were seizure-free and whose electroencephalogram showed Burden of Amplitudes and Epileptiform Discharges scores of 2 or less. RESULTS Of the 58 patients included in the study, 17 (29.3%) patients had an identified genetic etiology. There was no significant difference in rates of favorable response at 1 and 3 months after treatment, but significantly higher proportions of patients exhibited favorable responses among those with an unknown etiology at long-term follow-up (41.2% vs. 78.0%, p = .006 at 6 months; 29.4% vs. 65.9%, p = .011 at 1 year; 23.5 vs. 65.9%, p = .003 at 2 years). Moreover, the mental, psychomotor, and social age quotients of the patients with an identified genetic etiology were reduced to a significantly greater degree since diagnosis compared with those of the patients with an unknown etiology. SIGNIFICANCE WS patients with genetic and unknown etiologies did not initially exhibit significantly different response rates to the vigabatrin and high-dose prednisolone add-on treatment. However, patients with a genetic etiology exhibited significantly higher relapse rates and significantly poorer long-term responses.
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Affiliation(s)
- Han Som Choi
- Department of Pediatrics, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, South Korea.,Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ara Ko
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, South Korea.,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Rak Choi
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Baumer FM, McNamara NA, Fine AL, Pestana-Knight E, Shellhaas RA, He Z, Arndt DH, Gaillard WD, Kelley SA, Nagan M, Ostendorf AP, Singhal NS, Speltz L, Chapman KE. Treatment Practices and Outcomes in Continuous Spike and Wave during Slow Wave Sleep: A Multicenter Collaboration. J Pediatr 2021; 232:220-228.e3. [PMID: 33484700 PMCID: PMC8934740 DOI: 10.1016/j.jpeds.2021.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/20/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine how continuous spike and wave during slow wave sleep (CSWS) is currently managed and to compare the effectiveness of current treatment strategies using a database from 11 pediatric epilepsy centers in the US. STUDY DESIGN This retrospective study gathered information on baseline clinical characteristics, CSWS etiology, and treatment(s) in consecutive patients seen between 2014 and 2016 at 11 epilepsy referral centers. Treatments were categorized as benzodiazepines, steroids, other antiseizure medications (ASMs), or other therapies. Two measures of treatment response (clinical improvement as noted by the treating physician; and electroencephalography improvement) were compared across therapies, controlling for baseline variables. RESULTS Eighty-one children underwent 153 treatment trials during the study period (68 trials of benzodiazepines, 25 of steroids, 45 of ASMs, 14 of other therapies). Children most frequently received benzodiazepines (62%) or ASMs (27%) as first line therapy. Treatment choice did not differ based on baseline clinical variables, nor did these variables correlate with outcome. After adjusting for baseline variables, children had a greater odds of clinical improvement with benzodiazepines (OR 3.32, 95%CI 1.57-7.04, P = .002) or steroids (OR 4.04, 95%CI 1.41-11.59, P = .01) than with ASMs and a greater odds of electroencephalography improvement after steroids (OR 3.36, 95% CI 1.09-10.33, P = .03) than after ASMs. CONCLUSIONS Benzodiazepines and ASMs are the most frequent initial therapy prescribed for CSWS in the US. Our data suggests that ASMs are inferior to benzodiazepines and steroids and support earlier use of these therapies. Multicenter prospective studies that rigorously assess treatment protocols and outcomes are needed.
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Affiliation(s)
- Fiona M Baumer
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA.
| | - Nancy A McNamara
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Anthony L Fine
- Department of Neurology, Divisions of Epilepsy & Child Neurology, Mayo Clinic, Rochester, MN
| | - Elia Pestana-Knight
- Epilepsy Center, Cleveland Clinic Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Renée A Shellhaas
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Zihuai He
- Department of Neurology, Stanford University School of Medicine, Palo Alto, CA
| | - Daniel H Arndt
- Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - William D Gaillard
- Center for Neuroscience, Children's National Hospital, George Washington University, Washington, DC
| | - Sarah A Kelley
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Margot Nagan
- Department of Pediatrics & Neurology, University of Colorado, Aurora, CO
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH
| | - Nilika S Singhal
- UCSF Weill Institute for Neurosciences, UCSF School of Medicine, San Francisco, CA
| | - Laura Speltz
- Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN
| | - Kevin E Chapman
- Department of Pediatrics & Neurology, University of Colorado, Aurora, CO
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Abstract
INTRODUCTION Focal cortical dysplasias (FCDs) represent the most common etiology in pediatric drug-resistant focal epilepsies undergoing surgical treatment. The localization, extent and histopathological features of FCDs are considerably variable. Somatic mosaic mutations of genes that encode proteins in the PI3K-AKTmTOR pathway, which also includes the tuberous sclerosis associated genes TSC1 and TSC2, have been implicated in FCD type II in a substantial subset of patients. Surgery is the principal therapeutic option for FCD-related epilepsy. Advanced neurophysiological and neuroimaging techniques have improved surgical outcome and reduced the risk of postsurgical deficits. Pharmacological MTOR inhibitors are being tested in clinical trials and might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease, used alone or in combination with surgery. AREAS COVERED This review will critically analyze the advances in the diagnosis and treatment of FCDs, with a special focus on the novel therapeutic options prompted by a better understanding of their pathophysiology. EXPERT OPINION Focal cortical dysplasia is a main cause of drug-resistant epilepsy, especially in children. Novel, personalized approaches are needed to more effectively treat FCD-related epilepsy and its cognitive consequences.
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Affiliation(s)
- Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
| | - Carmen Barba
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
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Long-term epilepsy control, motor function, cognition, sleep and quality of life in children with West syndrome. Epilepsy Res 2021; 173:106629. [PMID: 33862315 DOI: 10.1016/j.eplepsyres.2021.106629] [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: 10/17/2020] [Revised: 02/20/2021] [Accepted: 03/31/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess epilepsy, motor function, cognitive, sleep, and quality of life outcomes and their predictors in a follow-up cohort with West syndrome (WS) at ≥5 years of age. METHODS Cross-sectional evaluation in a follow-up cohort of WS (aged 5-14 years), between July 2018 and December 2019, was performed at a tertiary-care referral center in Northern India. 164 children were assessed in-person for epilepsy severity, functional status (gross motor and hand function), social quotient, behavioral comorbidities, sleep problems, and quality of life (QoL) using Early Childhood Epilepsy Severity Scale, Gross Motor Function Classification System, Manual Ability Classification System, Vineland Social Maturity Scale, Diagnostic and Statistical Manual of Mental disorders-5 criteria, Children's Sleep Habits Questionnaire, and PedsQL-Epilepsy module respectively. Furthermore, 238 children with the inability to visit the hospital were assessed through telephonic interview along with retrospective case record review for epilepsy control, gross and fine motor measures. RESULTS 402 children with WS (75 % boys) with regular follow-up were studied and the majority (80 %) had underlying structural etiology. The median age (interquartile range) of the cohort was 92 (78-107) months. Of these, 60 % had evolved to Lennox-Gastaut syndrome (LGS). The following long-term outcomes were observed: ongoing epilepsy (261/402), unfavorable motor status (130/402), moderate to profound intellectual disability (111/164), autistic spectrum disorder (42/164), attention-deficit hyperactivity disorder (18/164), poor sleep (135/164), and impaired QoL (115/164). Non-structural etiology (odds ratio [OR] = 3.8, 95 % confidence interval [CI]: 2.1-5.5, p=<0·0001) and older age (>5 months) at the onset of epileptic spasms (OR = 2·9, 95 % CI: 1.5-5.0, p=<0·0001) were associated with enduring seizure freedom for more than two years. CONCLUSION The present study revealed a preponderance of structural etiology and a high rate of transition to LGS. Early age at onset of spasms (before five months) and structural etiology were the predictors of unfavorable long-term epilepsy outcome. QoL was impaired in more than two-thirds of patients and it correlated significantly with cognitive, sleep, motor, and behavioral outcomes. However, the results of our study should be interpreted in the context of significant attrition of the original cohort.
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Lubbers L, Iyengar SS. A team science approach to discover novel targets for infantile spasms (IS). Epilepsia Open 2021; 6:49-61. [PMID: 33681648 PMCID: PMC7918303 DOI: 10.1002/epi4.12441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/28/2020] [Accepted: 10/24/2020] [Indexed: 12/20/2022] Open
Abstract
Infantile spasms (IS) is a devastating epilepsy syndrome that typically begins in the first year of life. Symptoms consist of stereotypical spasms, developmental delay, and electroencephalogram (EEG) that may demonstrate Hypsarhythmia. Current therapeutic approaches are not always effective, and there is no reliable way to predict which patient will respond to therapy. Given this disorder's complexity and the potential impact of a disease-modifying approach, Citizens United for Research in Epilepsy (CURE) employed a "team science" approach to advance the understanding of IS pathology and explore therapeutic modalities that might lead to the development of new ways to potentially prevent spasms and Hypsarhythmia. This approach was a first-of-its-kind collaborative initiative in epilepsy. The IS initiative funded 8 investigative teams over the course of 1-3 years. Projects included the following: discovery on the basic biology of IS, discovery of novel therapeutic targets, cross-validation of targets, discovery of biomarkers, and prognosis and treatment of IS. The combined efforts of a strong investigative team led to numerous advances in understanding the neural pathways underlying IS, testing of small molecules in preclinical models of IS and generated preliminary data on potential biomarkers. Thus far, the initiative has resulted in over 19 publications and subsequent funding for several investigators. Investigators reported that the IS initiative generally affected their research positively due to its collaborative and iterative nature. It also provided a unique opportunity to mentor junior investigators with an interest in translational research. Learnings included the need for a dedicated project manager and more transparent and real-time communication with investigators. The CURE IS initiative represents a unique approach to fund scientific discoveries on epilepsy. It brought together an interdisciplinary group of investigators-who otherwise would not have collaborated-to find transformative therapies for IS. Learnings from this initiative are being utilized for subsequent initiatives at CURE.
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Affiliation(s)
- Laura Lubbers
- Citizens United for Research in Epilepsy (CURE)ChicagoILUSA
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Lee CH, Le JT, Ballester-Rosado CJ, Anderson AE, Swann JW. Neocortical Slow Oscillations Implicated in the Generation of Epileptic Spasms. Ann Neurol 2021; 89:226-241. [PMID: 33068018 PMCID: PMC7855630 DOI: 10.1002/ana.25935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Epileptic spasms are a hallmark of severe seizure disorders. The neurophysiological mechanisms and the neuronal circuit(s) that generate these seizures are unresolved and are the focus of studies reported here. METHODS In the tetrodotoxin model, we used 16-channel microarrays and microwires to record electrophysiological activity in neocortex and thalamus during spasms. Chemogenetic activation was used to examine the role of neocortical pyramidal cells in generating spasms. Comparisons were made to recordings from infantile spasm patients. RESULTS Current source density and simultaneous multiunit activity analyses indicate that the ictal events of spasms are initiated in infragranular cortical layers. A dramatic pause of neuronal activity was recorded immediately prior to the onset of spasms. This preictal pause is shown to share many features with the down states of slow wave sleep. In addition, the ensuing interictal up states of slow wave rhythms are more intense in epileptic than control animals and occasionally appear sufficient to initiate spasms. Chemogenetic activation of neocortical pyramidal cells supported these observations, as it increased slow oscillations and spasm numbers and clustering. Recordings also revealed a ramp-up in the number of neocortical slow oscillations preceding spasms, which was also observed in infantile spasm patients. INTERPRETATION Our findings provide evidence that epileptic spasms can arise from the neocortex and reveal a previously unappreciated interplay between brain state physiology and spasm generation. The identification of neocortical up states as a mechanism capable of initiating epileptic spasms will likely provide new targets for interventional therapies. ANN NEUROL 2021;89:226-241.
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Affiliation(s)
- Chih-hong Lee
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
- The Cain Foundation Laboratories, The Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - John T. Le
- The Cain Foundation Laboratories, The Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Carlos J. Ballester-Rosado
- The Cain Foundation Laboratories, The Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Anne E. Anderson
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
- The Cain Foundation Laboratories, The Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - John W. Swann
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
- The Cain Foundation Laboratories, The Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Sharma S, Kaushik JS, Srivastava K, Goswami JN, Sahu JK, Vinayan KP, Mittal R. Association of Child Neurology (AOCN) — Indian Epilepsy Society (IES) Consensus Guidelines for the Diagnosis and Management of West Syndrome. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2097-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chu YJ, Chang CF, Weng WC, Fan PC, Shieh JS, Lee WT. Electroencephalography complexity in infantile spasms and its association with treatment response. Clin Neurophysiol 2021; 132:480-486. [PMID: 33450568 DOI: 10.1016/j.clinph.2020.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the potential of EEG multiscale entropy and complexity as biomarkers in infantile spasms. METHODS We collected EEG data retrospectively from 16 newly diagnosed patients, 16 age- and gender-matched healthy controls, and 15 drug-resistant patients. The multiscale entropy (MSE) and total EEG complexity before anti-epileptic drug (AED) treatment, before adrenocorticotropic hormone (ACTH) treatment, 14 days after ACTH therapy, and after 6 months of follow-up were calculated. RESULTS The total EEG complexity of 16 newly diagnosed infantile spasms patients was lower than the 16 healthy controls (median [IQR]: 351.5 [323.1-388.1] vs 461.6 [407.7-583.4]). The total EEG complexity before treatment was higher in the six patients with good response to AED than the 10 patients without response (median [IQR]: 410.0 [388.1-475.0] vs 344.5 [319.6-352.0]). The total EEG complexity before and after 14-days of ACTH therapy was not different between 13 ACTH therapy responders and nine non-responders. After 6-months follow-up, the total EEG complexity of ACTH therapy responders were higher than non-responders (median [IQR]: 598.5 [517.4-623.3] vs 448.6 [347.1-536.3]). CONCLUSIONS The total EEG complexity before AED and 6 months after ACTH are associated with spasm-freedom. SIGNIFICANCE The total EEG complexity is a potential biomarker to predict and monitor the treatment effect in infantile spasms.
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Affiliation(s)
- Yen-Ju Chu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chi-Feng Chang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Wen-Chin Weng
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pi-Chuan Fan
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan, Taiwan; Innovation Center for Biomedical and Healthcare Technology, Yuan Ze University, Taoyuan, Taiwan; Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan
| | - Wang-Tso Lee
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan.
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Daida A, Hamano SI, Hayashi K, Nonoyama H, Ikemoto S, Hirata Y, Matsuura R, Koichihara R, Yamanaka G, Kikuchi K. Comparison of adrenocorticotropic hormone efficacy between aetiologies of infantile spasms. Seizure 2020; 85:6-11. [PMID: 33360040 DOI: 10.1016/j.seizure.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We aimed to study the efficacy of adrenocorticotropic hormone (ACTH) treatment on infantile spasms with different aetiologies. In particular, we were interested in patients with structural-acquired aetiology. METHODS Patients with infantile spasms, who were treated with ACTH, were divided into three groups based on the aetiologies: unknown aetiology with normal development (unknown-normal), structural-acquired, and combined-congenital aetiologies that included genetic, metabolic, structural-congenital, or unknown aetiology with developmental delay. RESULTS Of the 107 patients included (58 males, 49 females), 25 patients had unknown-normal aetiology [median age at onset 5 months, standard deviation (SD) 3.12, range 2-16 months]; 20 patients had structural-acquired aetiology (median age at onset 6.5 months, SD 3.85 months, range 4-17 months); and 62 patients had combined-congenital aetiologies (median age at onset 5 months, SD 2.73 months, range 2-16 months). The efficacy of ACTH was 64.0 %, 65 %, and 30.6 % in the unknown-normal aetiology, structural-acquired aetiology, and combined-congenital aetiologies, respectively (p < 0.01). Multivariate analysis showed a statistically significant higher efficacy in the unknown-normal aetiology [Odds ratio (OR) 4.63, 95 % confidence interval (CI) 1.60-13.30] and structural-acquired aetiology (OR 3.41, 95 % CI 1.01-11.50) compared to that in the combined-congenital aetiologies. CONCLUSION Infantile spasms with structural-acquired aetiology had greater response to ACTH treatment than those with combined-congenital aetiologies. The efficacy of standard therapy of infantile spasms should be considered based on aetiology.
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Affiliation(s)
- Atsuro Daida
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan; Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, Japan.
| | - Shin-Ichiro Hamano
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji Chuo-ku, Tokyo, Japan
| | - Hazuki Nonoyama
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Satoru Ikemoto
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Yuko Hirata
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Ryuki Matsuura
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Reiko Koichihara
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
| | - Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Kenjiro Kikuchi
- Division of Neurology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama-city, Saitama, Japan
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Infantile spasms: Etiology, lead time and treatment response in a resource limited setting. Epilepsy Behav Rep 2020; 14:100397. [PMID: 33196034 PMCID: PMC7656466 DOI: 10.1016/j.ebr.2020.100397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/24/2020] [Accepted: 10/03/2020] [Indexed: 01/03/2023] Open
Abstract
Neonatal hypoglycemic brain injury was the commonest cause of Infantile Spasms (IS). Comprehensive genetic evaluation was performed in presumed genetic IS patients. Molecular diagnosis was achieved in 44% of presumed genetic patients. Longer lead time to treatment was significantly associated with resistant spasms.
This study explores the etiology and lead time to treatment for infantile spasm (IS) patients and their effect on treatment responsiveness, in a limited resource setting. Patients with IS onset age ≤12 months’, seen over 3 years were recruited retrospectively. Clinical information, neuroimaging and genetic results retrieved. Patients categorized into three primary etiological groups: Structural (including Structural Genetic), Genetic, and Unknown. The effect of etiology and lead time from IS onset to initiating appropriate treatment on spasm resolution, evaluated. Total 113 patients were eligible. Mean IS onset age was 6.86(±4.25) months (M: F 3.3:1). Patients were grouped into: Structural 85, Genetic 11 and Unknown 17. Etiology was ascertained in 94/113 (83.1%) with neonatal hypoglycemic brain injury (NHBI) being the most common (40/113, 36%). A genetic etiology identified in 17 (including 6 Structural Genetic, of which five had Tuberous Sclerosis). Structural group was less likely to be treatment resistant (p = 0.013, OR 0.30 [0.12–0.76]). Median treatment lead time – 60 days. Longer lead time to treatment was significantly associated with resistant spasms (χ2 for trend = 10.0, p = 0.0015). NHBI was the commonest underlying cause of IS. There was significant time lag to initiating appropriate treatment, affecting treatment responsiveness.
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Grinspan ZM, Mytinger JR, Baumer FM, Ciliberto MA, Cohen BH, Dlugos DJ, Harini C, Hussain SA, Joshi SM, Keator CG, Knupp KG, McGoldrick PE, Nickels KC, Park JT, Pasupuleti A, Patel AD, Shahid AM, Shellhaas RA, Shrey DW, Singh RK, Wolf SM, Yozawitz EG, Yuskaitis CJ, Waugh JL, Pearl PL. Management of Infantile Spasms During the COVID-19 Pandemic. J Child Neurol 2020; 35:828-834. [PMID: 32576057 PMCID: PMC7315378 DOI: 10.1177/0883073820933739] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Circumstances of the COVID-19 pandemic have mandated a change to standard management of infantile spasms. On April 6, 2020, the Child Neurology Society issued an online statement of immediate recommendations to streamline diagnosis and treatment of infantile spasms with utilization of telemedicine, outpatient studies, and selection of first-line oral therapies as initial treatment. The rationale for the recommendations and specific guidance including follow-up assessment are provided in this manuscript. These recommendations are indicated as enduring if intended to outlast the pandemic, and limited if intended only for the pandemic health care crisis but may be applicable to future disruptions of health care delivery.
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Affiliation(s)
| | | | | | | | - Bruce H. Cohen
- Children’s Hospital Medical Center of Akron, Akron, OH, USA
| | | | - Chellamani Harini
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Shaun A. Hussain
- University of California Los Angeles Mattel Children’s Hospital, Los Angeles, CA, USA
| | | | | | | | | | | | - Jun T. Park
- University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, USA
| | | | | | - Asim M. Shahid
- University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, USA
| | | | | | - Rani K. Singh
- Levine Children’s Hospital at Atrium Health System, Charlotte, NC, USA
| | | | | | | | - Jeff L. Waugh
- University of Texas Southwestern Medical Center Southwestern, Dallas, TX, USA
| | - Phillip L. Pearl
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA,Phillip L. Pearl, MD, Department of Neurology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, USA.
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Bhalla S, Skjei K. Fulminant vigabatrin toxicity during combination therapy with adrenocorticotropic hormone for infantile spasms: Three cases and review of the literature. Epilepsia 2020; 61:e159-e164. [PMID: 32944947 DOI: 10.1111/epi.16663] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
Abstract
Vigabatrin (VGB), adrenocorticotropic hormone (ACTH), and prednisone are first-line treatments for infantile spasms (IS). A recent study reported benefits from the use of combination VGB and hormonal therapy over hormonal treatment alone in IS. We describe three patients with IS who developed acute encephalopathy with extrapyramidal symptoms, vigabatrin-associated brain abnormalities on magnetic resonance imaging (VABAM), and death in one patient shortly after initiation of therapy with VGB and ACTH. A literature review supports increased risk of fulminant, symptomatic VABAM in patients receiving VGB in association with hormonal therapy, raising concerns regarding its safety in IS.
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Affiliation(s)
- Sonam Bhalla
- Department of Pediatrics, Division of Pediatric Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karen Skjei
- Department of Neurology, Division of Pediatric Neurology, University of Texas, Austin, Texas, USA
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