1
|
Hansen D, Shandley S, Olaya J, Hauptman J, Auguste K, Ostendorf AP, Depositario-Cabacar DF, Wong-Kisiel LC, Reddy SB, McCormack MJ, Gonzalez-Giraldo E, Sullivan J, Pradeep J, Singh RK, Romanowski EF, McNamara NA, Ciliberto MA, Tatachar P, Shrey DW, Karakas C, Karia S, Kheder A, Gedela S, Alexander A, Eschbach K, Bolton J, Marashly A, Wolf S, McGoldrick P, Nangia S, Grinspan Z, Coryell J, Samanta D, Armstrong D, Perry MS. A multi-center comparison of surgical techniques for corpus Callosotomy in pediatric drug-resistant epilepsy. Epilepsia 2024; 65:422-429. [PMID: 38062633 DOI: 10.1111/epi.17853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Corpus callosotomy (CC) is used to reduce seizures, primarily in patients with generalized drug-resistant epilepsy (DRE). The invasive nature of the procedure contributes to underutilization despite its potential superiority to other palliative procedures. The goal of this study was to use a multi-institutional epilepsy surgery database to characterize the use of CC across participating centers. METHODS Data were acquired from the Pediatric Epilepsy Research Consortium (PERC) Surgery Database, a prospective observational study collecting data on children 0-18 years referred for surgical evaluation of DRE across 22 U.S. pediatric epilepsy centers. Patient, epilepsy, and surgical characteristics were collected across multiple CC modalities. Outcomes and complications were recorded and analyzed statistically. RESULTS Eighty-three patients undergoing 85 CC procedures at 14 participating epilepsy centers met inclusion criteria. Mean age at seizure onset was 2.3 years (0-9.4); mean age for Phase I evaluation and surgical intervention were 9.45 (.1-20) and 10.46 (.2-20.6) years, respectively. Generalized seizure types were the most common (59%). Complete CC was performed in 88%. The majority of CC procedures (57%) were via open craniotomy, followed by laser interstitial thermal therapy (LiTT) (20%) and mini-craniotomy/endoscopic (mc/e) (22%). Mean operative times were significantly longer for LiTT, whereas mean estimated blood loss was greater in open cases. Complications occurred in 11 cases (13%) and differed significantly between surgical techniques (p < .001). There was no statistically significant difference in length of postoperative stay across approaches. Mean follow-up was 12.8 months (range 1-39). Favorable Engel outcomes were experienced by 37 (78.7%) of the patients who underwent craniotomy, 10 (58.8%) with LiTT, and 12 (63.2%) with mc/e; these differences were not statistically significant. SIGNIFICANCE CC is an effective surgical modality for children with DRE. Regardless of surgical modality, complication rates are acceptable and seizure outcomes generally favorable. Newer, less-invasive, surgical approaches may lead to increased adoption of this efficacious therapeutic option for pediatric DRE.
Collapse
Affiliation(s)
- Daniel Hansen
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Sabrina Shandley
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Joffre Olaya
- Children's Hospital of Orange County, Orange, California, USA
| | - Jason Hauptman
- Division of Pediatric Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Kurtis Auguste
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Dewi F Depositario-Cabacar
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Lily C Wong-Kisiel
- Department of Neurology, Divisions of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shilpa B Reddy
- Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA
| | - Michael J McCormack
- Department of Pediatric Neurology, Vanderbilt University, Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA
| | - Ernesto Gonzalez-Giraldo
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA
| | - Joseph Sullivan
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, California, USA
| | - Javarayee Pradeep
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rani K Singh
- Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Erin Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nancy A McNamara
- Department of Pediatrics, Division of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael A Ciliberto
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Priya Tatachar
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois, USA
| | - Daniel W Shrey
- Children's Hospital of Orange County, Orange, California, USA
| | - Cemal Karakas
- Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Samir Karia
- Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Ammar Kheder
- Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Allyson Alexander
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Krista Eschbach
- Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ahmad Marashly
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Steven Wolf
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | | | | | - Jason Coryell
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Oregon Health Science Center, Portland, Oregon, USA
| | - Debopam Samanta
- Department of Neurology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Dallas Armstrong
- Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - M Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, Texas, USA
| |
Collapse
|
2
|
Coryell J, Singh R, Ostendorf AP, Eisner M, Alexander A, Eschbach K, Shrey DW, Olaya J, Ciliberto MA, Karakas C, Karia S, McNamara N, Romanowski EF, Kheder A, Pradeep J, Reddy SB, McCormack MJ, Bolton J, Wolf S, McGoldrick P, Hauptman JS, Samanta D, Tatachar P, Sullivan J, Auguste K, Gonzalez-Giraldo E, Marashly A, Depositario-Cabacar DF, Wong-Kisiel LC, Perry S. Epilepsy surgery in children with genetic etiologies: A prospective evaluation of current practices and outcomes. Seizure 2023; 113:6-12. [PMID: 38189708 DOI: 10.1016/j.seizure.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE This study assesses current practices and outcomes of epilepsy surgery in children with a genetic etiology. It explores the pre-surgical workup, types of surgeries, and post-surgical outcomes in a broad array of disorders. METHODS Patients ≤18 years who completed epilepsy surgery and had a known genetic etiology prior to surgical intervention were extrapolated from the Pediatric Epilepsy Research Consortium (PERC) surgery database, across 18 US centers. Data were assessed univariably by neuroimaging and EEG results, genetic group (structural gene, other gene, chromosomal), and curative intent. Outcomes were based on a modified International League Against Epilepsy (ILAE) outcome score. RESULTS Of 81 children with genetic epilepsy, 72 % had daily seizures when referred for surgery evaluation, which occurred a median of 2.2 years (IQR 0.3, 5.2) after developing drug resistance. Following surgery, 68 % of subjects had >50 % seizure reduction, with 33 % achieving seizure freedom [median follow-up 11 months (IQR 6, 17). Seizure freedom was most common in the monogenic structural group, but significant palliation was present across all groups. Presence of a single EEG focus was associated with a greater likelihood of seizure freedom (p=0.02). SIGNIFICANCE There are meaningful seizure reductions following epilepsy surgery in the majority of children with a genetic etiology, even in the absence of a single structural lesion and across a broad spectrum of genetic causes. These findings highlight the need for expedited referral for epilepsy surgery and support of a broadened view of which children may benefit from epilepsy surgery, even when the intent is palliative.
Collapse
Affiliation(s)
- Jason Coryell
- Department of Pediatrics, Oregon Health & Sciences University, CDRC-P, 707 SW Gaines Rd, Portland, OR 97239, USA.
| | - Rani Singh
- Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, NC, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Allyson Alexander
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Krista Eschbach
- Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Joffre Olaya
- Children's Hospital of Orange County, Orange, CA, USA
| | - Michael A Ciliberto
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cemal Karakas
- Department of Neurology, Division of Child Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, USA
| | - Samir Karia
- Department of Neurology, Division of Child Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, KY, USA
| | - Nancy McNamara
- Department of Pediatrics, Section of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erin Fedak Romanowski
- Department of Pediatrics, Section of Pediatric Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ammar Kheder
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Javarayee Pradeep
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shilpa B Reddy
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Michael J McCormack
- Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Steven Wolf
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
| | - Jason S Hauptman
- Division of Pediatric Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, WA, USA
| | - Debopam Samanta
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Priya Tatachar
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Joseph Sullivan
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, CA, USA
| | - Kurtis Auguste
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, CA, USA
| | - Ernesto Gonzalez-Giraldo
- University of California San Francisco Weill Institute for Neurosciences, Benioff Children's Hospital, San Francisco, CA, USA
| | - Ahmad Marashly
- Department of Neurology, Johns Hopkins, Baltimore, MD, USA
| | - Dewi F Depositario-Cabacar
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Lily C Wong-Kisiel
- Department of Neurology, Divisions of Child Neurology and Epilepsy, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Scott Perry
- Jane and John Justin Institute for Mind Health, Cook Children's Medical Center, Fort Worth, TX, USA
| |
Collapse
|
3
|
Knupp KG, Coryell J, Singh RK, Gaillard WD, Shellhaas RA, Koh S, Mitchell WG, Harini C, Millichap JJ, May A, Dlugos D, Nickels K, Mytinger JR, Keator C, Yozawitz E, Singhal N, Lockrow J, Thomas JF, Juarez-Colunga E. Comparison of Cosyntropin, Vigabatrin, and Combination Therapy in New-Onset Infantile Spasms in a Prospective Randomized Trial. J Child Neurol 2022; 37:186-193. [PMID: 35044272 DOI: 10.1177/08830738211073400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: In a randomized trial, we aimed to evaluate the efficacy of cosyntropin injectable suspension, 1 mg/mL, compared to vigabatrin for infantile spasms syndrome. An additional arm was included to assess the efficacy of combination therapy (cosyntropin and vigabatrin) compared with cosyntropin monotherapy. Methods: Children (2 months to 2 years) with new-onset infantile spasms syndrome and hypsarhythmia were randomized into 3 arms: cosyntropin, vigabatrin, and cosyntropin and vigabatrin combined. Daily seizures and adverse events were recorded, and EEG was repeated at day 14 to assess for resolution of hypsarhythmia. The primary outcome measure was the composite of resolution of hypsarhythmia and absence of clinical spasms at day 14. Fisher exact test was used to compare outcomes. Results: 37 children were enrolled and 34 were included in the final efficacy analysis (1 withdrew prior to treatment and 2 did not return seizure diaries). Resolution of both hypsarhythmia and clinical spasms was achieved in in 9 of 12 participants (75%) treated with cosyntropin, 1/9 (11%) vigabatrin, and 5/13 (38%) cosyntropin and vigabatrin combined. The primary comparison of cosyntropin versus vigabatrin was significant (64% [95% confidence interval 21, 82], P < .01). Adverse events were reported in all 3 treatment arms: 31 (86%) had an adverse event, 7 (19%) had a serious adverse event, and 15 (42%) had an adverse event of special interest with no difference between treatment arms. Significance: This randomized trial was underpowered because of incomplete enrollment, yet it demonstrated that cosyntropin was more effective for short-term outcomes than vigabatrin as initial treatment for infantile spasms.
Collapse
Affiliation(s)
- Kelly G Knupp
- Pediatrics and Neurology, 12225University of Colorado, Anschutz Campus, Aurora, CO, USA
| | - Jason Coryell
- Department of Pediatrics and Neurology, 89020Oregon Health and Sciences University, Portland, Oregon, USA
| | - Rani K Singh
- Department of Pediatrics, Division of Pediatric Neurology, Atrium Health/Levine Children's Hospital, Charlotte, NC, USA
| | - William D Gaillard
- Department of Pediatrics and Neurology, George Washington University, Washington, DC, USA
| | - Renée A Shellhaas
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sookyong Koh
- Department of Pediatrics, Children's Hospital, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Wendy G Mitchell
- Neurology Division, Keck School of Medicine, 8785University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - John J Millichap
- Department of Pediatrics and Neurology, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Alison May
- Department of Neurology, Morgan Stanley Children's Hospital, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Dennis Dlugos
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Cynthia Keator
- Jane and John Justin Neurosciences, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Department of Pediatrics, 550033Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nilika Singhal
- Department of Neurology, Division of Epilepsy, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Jason Lockrow
- Division of Pediatric Neurology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jacob F Thomas
- School of Medicine, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
4
|
Perry MS, Shandley S, Perelman M, Singh RK, Wong-Kisiel L, Sullivan J, Gonzalez-Giraldo E, Romanowski EF, McNamara NA, Marashly A, Ostendorf AP, Alexander A, Eschbach K, Bolton J, Wolf S, McGoldrick P, Depositario-Cabacar DF, Ciliberto MA, Gedela S, Sannagowdara K, Karia S, Shrey DW, Tatachar P, Nangia S, Grinspan Z, Reddy SB, Shital P, Coryell J. Surgical evaluation in children <3 years of age with drug-resistant epilepsy: Patient characteristics, diagnostic utilization, and potential for treatment delays. Epilepsia 2021; 63:96-107. [PMID: 34778945 DOI: 10.1111/epi.17124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/06/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Drug-resistant epilepsy (DRE) occurs at higher rates in children <3 years old. Epilepsy surgery is effective, but rarely utilized in young children despite developmental benefits of early seizure freedom. The present study aims to identify unique patient characteristics and evaluation strategies in children <3 years old who undergo epilepsy surgery evaluation as a means to assess contributors and potential solutions to health care disparities in this group. METHODS The Pediatric Epilepsy Research Consortium Epilepsy Surgery Database, a multicentered, cross-sectional collaboration of 21 US pediatric epilepsy centers, collects prospective data on children <18 years of age referred for epilepsy surgery evaluation. We compared patient characteristics, diagnostic utilization, and surgical treatment between children <3 years old and those older undergoing initial presurgical evaluation. We evaluated patient characteristics leading to delayed referral (>1 year) after DRE diagnosis in the very young. RESULTS The cohort included 437 children, of whom 71 (16%) were <3 years of age at referral. Children evaluated before the age of 3 years more commonly had abnormal neurological examinations (p = .002) and daily seizures (p = .001). At least one ancillary test was used in 44% of evaluations. Fifty-nine percent were seizure-free following surgery (n = 34), with 35% undergoing limited focal resections. Children with delayed referrals more often had focal aware (p < .001) seizures and recommendation for palliative surgeries (p < .001). SIGNIFICANCE There are relatively few studies of epilepsy surgery in the very young. Surgery is effective, but may be disproportionally offered to those with severe presentations. Relatively low utilization of ancillary testing may contribute to reduced surgical therapy for those without evident lesions on magnetic resonance imaging. Despite this, a sizeable portion of patients have favorable outcome after focal epilepsy surgery resections.
Collapse
Affiliation(s)
- Michael Scott Perry
- Justin Neuroscience Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Sabrina Shandley
- Justin Neuroscience Center, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Max Perelman
- Doernbecher Children's Hospital, Oregon Health Science Center, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Rani K Singh
- Division of Neurology, Department of Pediatrics, Atrium Health/Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Lily Wong-Kisiel
- Divisions of Child Neurology and Epilepsy, Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joseph Sullivan
- Benioff Children's Hospital, University of California, San Francisco Weill Institute for Neurosciences, San Francisco, California, USA
| | - Ernesto Gonzalez-Giraldo
- Benioff Children's Hospital, University of California, San Francisco Weill Institute for Neurosciences, San Francisco, California, USA
| | - Erin Fedak Romanowski
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nancy A McNamara
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ahmad Marashly
- Division of Pediatric Neurology, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Allyson Alexander
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Krista Eschbach
- Department of Neurology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeffrey Bolton
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Steven Wolf
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians of New York and Connecticut, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
| | - Dewi F Depositario-Cabacar
- Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Michael A Ciliberto
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kumar Sannagowdara
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samir Karia
- Department of Neurology, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Daniel W Shrey
- Children's Hospital of Orange County, Orange, California, USA
| | - Priya Tatachar
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | | | | | - Shilpa B Reddy
- Department of Pediatric Neurology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee, USA
| | - Patel Shital
- Department of Pediatric Neurology, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason Coryell
- Doernbecher Children's Hospital, Oregon Health Science Center, Oregon Health and Sciences University, Portland, Oregon, USA
| |
Collapse
|
5
|
Grinspan ZM, Knupp KG, Patel AD, Yozawitz EG, Wusthoff CJ, Wirrell EC, Valencia I, Singhal NS, Nordli DR, Mytinger JR, Mitchell WG, Keator CG, Loddenkemper T, Hussain SA, Harini C, Gaillard WD, Fernandez IS, Coryell J, Chu CJ, Berg AT, Shellhaas RA. Comparative Effectiveness of Initial Treatment for Infantile Spasms in a Contemporary US Cohort. Neurology 2021; 97:e1217-e1228. [PMID: 34266919 PMCID: PMC8480478 DOI: 10.1212/wnl.0000000000012511] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of initial treatment for infantile spasms. METHODS The National Infantile Spasms Consortium prospectively followed up children with new-onset infantile spasms that began at age 2 to 24 months at 23 US centers (2012-2018). Freedom from treatment failure at 60 days required no second treatment for infantile spasms and no clinical spasms after 30 days of treatment initiation. We managed treatment selection bias with propensity score weighting and within-center correlation with generalized estimating equations. RESULTS Freedom from treatment failure rates were as follows: adrenocorticotropic hormone (ACTH) 88 of 190 (46%), oral steroids 42 of 95 (44%), vigabatrin 32 of 87 (37%), and nonstandard therapy 4 of 51 (8%). Changing from oral steroids to ACTH was not estimated to affect response (observed 44% estimated to change to 44% [95% confidence interval 34%-54%]). Changing from nonstandard therapy to ACTH would improve response from 8% to 39% (17%-67%), and changing to oral steroids would improve response from 8% to 38% (15%-68%). There were large but not statistically significant estimated effects of changing from vigabatrin to ACTH (29% to 42% [15%-75%]), from vigabatrin to oral steroids (29% to 42% [28%-57%]), and from nonstandard therapy to vigabatrin (8% to 20% [6%-50%]). Among children treated with vigabatrin, those with tuberous sclerosis complex (TSC) responded more often than others (62% vs 29%; p < 0.05). DISCUSSION Compared to nonstandard therapy, ACTH and oral steroids are superior for initial treatment of infantile spasms. The estimated effectiveness of vigabatrin is between that of ACTH/oral steroids and nonstandard therapy, although the sample was underpowered for statistical confidence. When used, vigabatrin worked best for TSC. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for children with new-onset infantile spasms, ACTH or oral steroids were superior to nonstandard therapies.
Collapse
Affiliation(s)
- Zachary M Grinspan
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor.
| | - Kelly G Knupp
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Anup D Patel
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Elissa G Yozawitz
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Courtney J Wusthoff
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Elaine C Wirrell
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Ignacio Valencia
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Nilika S Singhal
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Douglas R Nordli
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - John R Mytinger
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Wendy G Mitchell
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Cynthia G Keator
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Tobias Loddenkemper
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Shaun A Hussain
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Chellamani Harini
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - William D Gaillard
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Ivan S Fernandez
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Jason Coryell
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Catherine J Chu
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Anne T Berg
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| | - Renee A Shellhaas
- From Weill Cornell Medicine (Z.M.G.), New York, NY; University of Colorado Anschutz Medical Campus (K.G.K.), Aurora; Nationwide Children's Hospital (A.D.P., J.R.M.), Ohio State University, Columbus; Montefiore Medicine (E.G.Y.), Bronx, NY; Stanford University (C.J.W.), Palo Alto, CA; Mayo Clinic (E.W.), Rochester, MN; Drexel University College of Medicine (I.V.), Philadelphia, PA; University of California San Francisco (N.S.S.); University of Chicago Medicine (D.R.N.), IL; Children's Hospital of Los Angeles (W.M.), CA; Cook Children's Hospital (C.G.K.), Fort Worth, TX; Boston Children's Hospital (T.L., C.H., I.S.F.), MA; University of California Los Angeles (S.A.H.); Children's National Hospital (W.D.G.), Washington, DC; Oregon Health Services University (J.C.), Portland; Massachusetts General Hospital (C.J.C.), Boston; Lurie Children's Hospital (A.T.B.), Chicago, IL; and University of Michigan (R.A.S.), Ann Arbor
| |
Collapse
|
6
|
Grinspan ZM, Patel AD, Shellhaas RA, Berg AT, Axeen ET, Bolton J, Clarke DF, Coryell J, Gaillard WD, Goodkin HP, Koh S, Kukla A, Mbwana JS, Morgan LA, Singhal NS, Storey MM, Yozawitz EG, Abend NS, Fitzgerald MP, Fridinger SE, Helbig I, Massey SL, Prelack MS, Buchhalter J. Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system. Epilepsia 2021; 62:198-216. [PMID: 33368200 PMCID: PMC10508354 DOI: 10.1111/epi.16733] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Common data elements (CDEs) are standardized questions and answer choices that allow aggregation, analysis, and comparison of observations from multiple sources. Clinical CDEs are foundational for learning health care systems, a data-driven approach to health care focused on continuous improvement of outcomes. We aimed to create clinical CDEs for pediatric epilepsy. METHODS A multiple stakeholder group (clinicians, researchers, parents, caregivers, advocates, and electronic health record [EHR] vendors) developed clinical CDEs for routine care of children with epilepsy. Initial drafts drew from clinical epilepsy note templates, CDEs created for clinical research, items in existing registries, consensus documents and guidelines, quality metrics, and outcomes needed for demonstration projects. The CDEs were refined through discussion and field testing. We describe the development process, rationale for CDE selection, findings from piloting, and the CDEs themselves. We also describe early implementation, including experience with EHR systems and compatibility with the International League Against Epilepsy classification of seizure types. RESULTS Common data elements were drafted in August 2017 and finalized in January 2020. Prioritized outcomes included seizure control, seizure freedom, American Academy of Neurology quality measures, presence of common comorbidities, and quality of life. The CDEs were piloted at 224 visits at 10 centers. The final CDEs included 36 questions in nine sections (number of questions): diagnosis (1), seizure frequency (9), quality of life (2), epilepsy history (6), etiology (8), comorbidities (2), treatment (2), process measures (5), and longitudinal history notes (1). Seizures are categorized as generalized tonic-clonic (regardless of onset), motor, nonmotor, and epileptic spasms. Focality is collected as epilepsy type rather than seizure type. Seizure frequency is measured in nine levels (all used during piloting). The CDEs were implemented in three vendor systems. Early clinical adoption included 1294 encounters at one center. SIGNIFICANCE We created, piloted, refined, finalized, and implemented a novel set of clinical CDEs for pediatric epilepsy.
Collapse
Affiliation(s)
- Zachary M Grinspan
- Departments of Population Health Sciences and Pediatrics, Weill Cornell Medicine, New York, NY
| | - Anup D Patel
- Division of Neurology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Renée A Shellhaas
- Department of Pediatrics (Pediatric Neurology), Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anne T Berg
- Division of Neurology, Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern Feinberg School of Medicine, United States of America
| | - Erika T Axeen
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Jeffrey Bolton
- Harvard Medical School, Boston, MA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
| | - David F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas
| | - Jason Coryell
- Departments of Pediatrics and Neurology, Oregon Health and Sciences University, Portland, Oregon
| | - William D Gaillard
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | - Howard P Goodkin
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Emory Children’s Center, 2015 Uppergate Drive NE, Atlanta, GA
| | | | - Juma S Mbwana
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | | | - Nilika S Singhal
- Departments of Pediatrics and Neurology, Seattle Children’s Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA
| | - Margaret M Storey
- Department of History, College of Liberal Arts & Social Sciences, DePaul University, Chicago, IL
| | - Elissa G Yozawitz
- Saul Korey Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Nicholas S Abend
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Mark P Fitzgerald
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Sara E Fridinger
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Shavonne L Massey
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Marisa S Prelack
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Jeffrey Buchhalter
- Department of Neurology, St Joseph’s Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
7
|
Abstract
Investigators from Children’s Hospital at Westmead, University of Sydney, performed a retrospective review (2006-2012) of the diagnostic yield of array comparative genomic hybridization (aCGH) among 555 children with diverse neurologic phenotypes in whom a genetic etiology was suspected [1].
Collapse
Affiliation(s)
- Jason Coryell
- Departments of Pediatrics and Neurology, Oregon Health & Sciences University, Portland, OR
| |
Collapse
|
8
|
Berg AT, Wusthoff C, Shellhaas RA, Loddenkemper T, Grinspan ZM, Saneto RP, Knupp KG, Patel A, Sullivan JE, Kossoff EH, Chu CJ, Massey S, Valencia I, Keator C, Wirrell EC, Coryell J, Millichap JJ, Gaillard WD. Immediate outcomes in early life epilepsy: A contemporary account. Epilepsy Behav 2019; 97:44-50. [PMID: 31181428 PMCID: PMC8107814 DOI: 10.1016/j.yebeh.2019.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 01/31/2023]
Abstract
RATIONALE Early-life epilepsies (ELEs) include some of the most challenging forms of epilepsy to manage. Given recent diagnostic and therapeutic advances, a contemporary assessment of the immediate short-term outcomes can provide a valuable framework for identifying priorities and benchmarks for evaluating quality improvement efforts. METHODS Children with newly diagnosed epilepsy and onset <3 years were prospectively recruited through 17 US hospitals, from 2012 to 2015 and followed for 1 year after diagnosis. Short-term outcome included mortality, drug resistance, evolution of nonsyndromic epilepsy to infantile spasms (IS) and from IS to other epilepsies, and developmental decline. Multivariable analyses assessed the risk of each outcome. RESULTS Seven hundred seventy-five children were recruited, including 408 (53%) boys. Median age at onset was 7.5 months (interquartile range (IQR): 4.2-16.5), and 509 (66%) had onset in the first year of life. Of 22 deaths that occurred within one year of epilepsy diagnosis, 21 were children with epilepsy onset in infancy (<12 months). Of 680 children followed ≥6 months, 239 (35%) developed drug-resistant seizures; 34/227 (15%) infants with nonsyndromic epilepsy developed IS, and 48/210 (23%) initially presenting with IS developed additional seizure types. One hundred of 435 (23%) with initially typical development or only mild/equivocal delays at seizure onset, had clear developmental impairment within one year after initial diagnosis. Each outcome had a different set of predictors; however, younger age and impaired development at seizure onset were broadly indicative of poorer outcomes. Type of epilepsy and early identification of underlying cause were not reliable predictors of these outcomes. CONCLUSION Early-life epilepsies carry a high risk of poor outcome which is evident shortly after epilepsy diagnosis. Onset in infancy and developmental delay is associated with an especially high risk, regardless of epilepsy type. The likelihood of poor outcomes is worrisome regardless of specific clinical profiles.
Collapse
Affiliation(s)
- Anne T. Berg
- Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America,Corresponding author at: Ann & Robert H. Lurie Children’s Hospital of Chicago, Neurology – Epilepsy Division, 225 East Chicago Ave, Box 29, Chicago, IL 60611-2605, United States of America. (A.T. Berg)
| | - Courtney Wusthoff
- Division of Child Neurology, Stanford University, Palo Alto, CA, United States of America
| | - Renée A. Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Zachary M. Grinspan
- Weill Cornell Medicine, New York Presbyterian Hospital, Health Information Technology Evaluation Collaborative, New York, NY, United States of America
| | - Russell P. Saneto
- Division of Pediatric Neurology, Seattle Children’s Hospital, Department of Neurology, University of Washington, Seattle, WA, United States of America
| | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Anup Patel
- Department of Pediatrics, The Ohio State University; Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Joseph E. Sullivan
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Eric H. Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, MD, United States of America
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Shavonne Massey
- Departments of Neurology and Pediatrics, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ignacio Valencia
- Section of Neurology, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Cynthia Keator
- Cook Children’s Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, TX, United States of America
| | - Elaine C. Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Jason Coryell
- Departments of Pediatrics & Neurology, Oregon Health & Sciences University, Portland, OR, United States of America
| | - John J. Millichap
- Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC, United States of America
| |
Collapse
|
9
|
Coryell J, Gaillard WD, Shellhaas RA, Grinspan ZM, Wirrell EC, Knupp KG, Wusthoff CJ, Keator C, Sullivan JE, Loddenkemper T, Patel A, Chu CJ, Massey S, Novotny EJ, Saneto RP, Berg AT. Neuroimaging of Early Life Epilepsy. Pediatrics 2018; 142:peds.2018-0672. [PMID: 30089657 PMCID: PMC6510984 DOI: 10.1542/peds.2018-0672] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We assessed the adherence to neuroimaging guidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS Of 725 children (93.5%) with neuroimaging, 714 had an MRI (87% with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40%) and included: an acquired injury in 97 (13.4%), malformations of cortical development in 56 (7.7%), and other diffuse disorders of brain development in 51 (7.0%). Neuroimaging was abnormal in 160 of 262 (61%) children with abnormal development at diagnosis versus 113 of 463 (24%) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40%), spasms (47%), or unclear semiology (42%). In children without spasms or focal semiology with typical development, 29 of 185 (16%) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44%) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.
Collapse
Affiliation(s)
- Jason Coryell
- Departments of Pediatrics, Oregon Health and Sciences University, Portland, Oregon,Departments of Neurology, Oregon Health and Sciences University, Portland, Oregon
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | | | - Zachary M. Grinspan
- Health Information Technology Evaluation Collaborative, Weill Cornell Medicine and New York–Presbyterian Hospital, New York, New York
| | | | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Cynthia Keator
- Jane and John Justin Neurosciences Center, Cook Children’s Health Care System, Fort Worth, Texas
| | - Joseph E. Sullivan
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Anup Patel
- Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shavonne Massey
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Departments of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edward J. Novotny
- Departments of Division of Pediatric Neurology, Neurology, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington,Departments of Pediatrics, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington,Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Russel P. Saneto
- Departments of Division of Pediatric Neurology, Neurology, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Anne T. Berg
- Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
10
|
Butler KM, Moody OA, Schuler E, Coryell J, Alexander JJ, Jenkins A, Escayg A. De novo variants in GABRA2 and GABRA5 alter receptor function and contribute to early-onset epilepsy. Brain 2018; 141:2392-2405. [PMID: 29961870 PMCID: PMC6061692 DOI: 10.1093/brain/awy171] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/02/2018] [Accepted: 05/04/2018] [Indexed: 01/19/2023] Open
Abstract
GABAA receptors are ligand-gated anion channels that are important regulators of neuronal inhibition. Mutations in several genes encoding receptor subunits have been identified in patients with various types of epilepsy, ranging from mild febrile seizures to severe epileptic encephalopathy. Using whole-genome sequencing, we identified a novel de novo missense variant in GABRA5 (c.880G > C, p.V294L) in a patient with severe early-onset epilepsy and developmental delay. Targeted resequencing of 279 additional epilepsy patients identified 19 rare variants from nine GABAA receptor genes, including a novel de novo missense variant in GABRA2 (c.875C > A, p.T292K) and a recurrent missense variant in GABRB3 (c.902C > T, p.P301L). Patients with the GABRA2 and GABRB3 variants also presented with severe epilepsy and developmental delay. We evaluated the effects of the GABRA5, GABRA2 and GABRB3 missense variants on receptor function using whole-cell patch-clamp recordings from human embryonic kidney 293T cells expressing appropriate α, β and γ subunits. The GABRA5 p.V294L variant produced receptors that were 10-times more sensitive to GABA but had reduced maximal GABA-evoked current due to increased receptor desensitization. The GABRA2 p.T292K variant reduced channel expression and produced mutant channels that were tonically open, even in the absence of GABA. Receptors containing the GABRB3 p.P301L variant were less sensitive to GABA and produced less GABA-evoked current. These results provide the first functional evidence that de novo variants in the GABRA5 and GABRA2 genes contribute to early-onset epilepsy and developmental delay, and demonstrate that epilepsy can result from reduced neuronal inhibition via a wide range of alterations in GABAA receptor function.
Collapse
Affiliation(s)
- Kameryn M Butler
- Department of Human Genetics, Emory University, Atlanta, Georgia, 30322, USA
- Genetics and Molecular Biology Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, 30322, USA
| | - Olivia A Moody
- Departments of Anesthesiology and Pharmacology, Emory University, Atlanta, Georgia, 30322, USA
- Neuroscience Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, 30322, USA
| | - Elisabeth Schuler
- Department for Pediatric Metabolic Medicine and Neurology, University Children’s Hospital, Heidelberg, 69120, Germany
| | - Jason Coryell
- Departments of Pediatrics and Neurology, School of Medicine, Oregon Health & Sciences University, Portland, Oregon, 97239, USA
| | - John J Alexander
- Department of Human Genetics, Emory University, Atlanta, Georgia, 30322, USA
- EGL Genetics, Tucker, Georgia, 30084, USA
| | - Andrew Jenkins
- Departments of Anesthesiology and Pharmacology, Emory University, Atlanta, Georgia, 30322, USA
| | - Andrew Escayg
- Department of Human Genetics, Emory University, Atlanta, Georgia, 30322, USA
| |
Collapse
|
11
|
Grinspan ZM, Shellhaas RA, Coryell J, Sullivan JE, Wirrell EC, Mytinger JR, Gaillard WD, Kossoff EH, Valencia I, Knupp KG, Wusthoff C, Keator C, Ryan N, Loddenkemper T, Chu CJ, Novotny EJ, Millichap J, Berg AT. Comparative Effectiveness of Levetiracetam vs Phenobarbital for Infantile Epilepsy. JAMA Pediatr 2018; 172:352-360. [PMID: 29435578 PMCID: PMC5875334 DOI: 10.1001/jamapediatrics.2017.5211] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE More than half of infants with new-onset epilepsy have electroencephalographic and clinical features that do not conform to known electroclinical syndromes (ie, nonsyndromic epilepsy). Levetiracetam and phenobarbital are the most commonly prescribed medications for epilepsy in infants, but their comparative effectiveness is unknown. OBJECTIVE To compare the effectiveness of levetiracetam vs phenobarbital for nonsyndromic infantile epilepsy. DESIGN, SETTING, AND PARTICIPANTS The Early Life Epilepsy Study-a prospective, multicenter, observational cohort study conducted from March 1, 2012, to April 30, 2015, in 17 US medical centers-enrolled infants with nonsyndromic epilepsy and a first afebrile seizure between 1 month and 1 year of age. EXPOSURES Use of levetiracetam or phenobarbital as initial monotherapy within 1 year of the first seizure. MAIN OUTCOMES AND MEASURES The binary outcome was freedom from monotherapy failure at 6 months, defined as no second prescribed antiepileptic medication and freedom from seizures beginning within 3 months of initiation of treatment. Outcomes were adjusted for demographics, epilepsy characteristics, and neurologic history, as well as for observable selection bias using propensity score weighting and for within-center correlation using generalized estimating equations. RESULTS Of the 155 infants in the study (81 girls and 74 boys; median age, 4.7 months [interquartile range, 3.0-7.1 months]), those treated with levetiracetam (n = 117) were older at the time of the first seizure than those treated with phenobarbital (n = 38) (median age, 5.2 months [interquartile range, 3.5-8.2 months] vs 3.0 months [interquartile range, 2.0-4.4 months]; P < .001). There were no other significant bivariate differences. Infants treated with levetiracetam were free from monotherapy failure more often than those treated with phenobarbital (47 [40.2%] vs 6 [15.8%]; P = .01). The superiority of levetiracetam over phenobarbital persisted after adjusting for covariates, observable selection bias, and within-center correlation (odds ratio, 4.2; 95% CI, 1.1-16; number needed to treat, 3.5 [95% CI, 1.7-60]). CONCLUSIONS AND RELEVANCE Levetiracetam may have superior effectiveness compared with phenobarbital for initial monotherapy of nonsyndromic epilepsy in infants. If 100 infants who received phenobarbital were instead treated with levetiracetam, 44 would be free from monotherapy failure instead of 16 by the estimates in this study. Randomized clinical trials are necessary to confirm these findings.
Collapse
Affiliation(s)
- Zachary M. Grinspan
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York,Department of Pediatrics, Weill Cornell Medicine, New York, New York,New York–Presbyterian Komansky Children’s Hospital, New York, New York
| | - Renée A. Shellhaas
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
| | - Jason Coryell
- Department of Pediatrics, Oregon Health & Sciences University, Portland,Department of Neurology, Oregon Health & Sciences University, Portland
| | | | | | - John R. Mytinger
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC
| | - Eric H. Kossoff
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland,Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ignacio Valencia
- Section of Neurology, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kelly G. Knupp
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora,Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Courtney Wusthoff
- Division of Child Neurology, Stanford University, Palo Alto, California
| | - Cynthia Keator
- Comprehensive Epilepsy Program, Jane and John Justin Neuroscience Center, Cook Children’s Medical Center, Fort Worth, Texas
| | - Nicole Ryan
- Division of Neurology, The Children’s Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Edward J. Novotny
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Department of Neurology, University of Washington, Seattle,Department of Pediatrics, University of Washington, Seattle,Center for Integrative Brain Research, University of Washington, Seattle
| | - John Millichap
- Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne T. Berg
- Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
12
|
Berg AT, Chakravorty S, Koh S, Grinspan ZM, Shellhaas RA, Saneto RP, Wirrell EC, Coryell J, Chu CJ, Mytinger JR, Gaillard WD, Valencia I, Knupp KG, Loddenkemper T, Sullivan JE, Poduri A, Millichap JJ, Keator C, Wusthoff C, Ryan N, Dobyns WB, Hegde M. Why West? Comparisons of clinical, genetic and molecular features of infants with and without spasms. PLoS One 2018. [PMID: 29518120 PMCID: PMC5843222 DOI: 10.1371/journal.pone.0193599] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Infantile spasms are the defining seizures of West syndrome, a severe form of early life epilepsy with poorly-understood pathophysiology. We present a novel comparative analysis of infants with spasms versus other seizure-types and identify clinical, etiological, and molecular-genetic factors preferentially predisposing to spasms. We compared ages, clinical etiologies, and associated-genes between spasms and non-spasms groups in a multicenter cohort of 509 infants (<12months) with newly-diagnosed epilepsy. Gene ontology and pathway enrichment analysis of clinical laboratory-confirmed pathogenic variant-harboring genes was performed. Pathways, functions, and cellular compartments between spasms and non-spasms groups were compared. Spasms onset age was similar in infants initially presenting with spasms (6.1 months) versus developing spasms as a later seizure type (6.9 months) but lower in the non-spasms group (4.7 months, p<0.0001). This pattern held across most etiological categories. Gestational age negatively correlated with spasms onset-age (r = -0.29, p<0.0001) but not with non-spasm seizure age. Spasms were significantly preferentially associated with broad developmental and regulatory pathways, whereas motor functions and pathways including cellular response to stimuli, cell motility and ion transport were preferentially enriched in non-spasms. Neuronal cell-body organelles preferentially associated with spasms, while, axonal, dendritic, and synaptic regions preferentially associated with other seizures. Spasms are a clinically and biologically distinct infantile seizure type. Comparative clinical-epidemiological analyses identify the middle of the first year as the time of peak expression regardless of etiology. The inverse association with gestational age suggests the preterm brain must reach a certain post-conceptional, not just chronological, neurodevelopmental stage before spasms manifest. Clear differences exist between the biological pathways leading to spasms versus other seizure types and suggest that spasms result from dysregulation of multiple developmental pathways and involve different cellular components than other seizure types. This deeper level of understanding may guide investigations into pathways most critical to target in future precision medicine efforts.
Collapse
Affiliation(s)
- Anne T. Berg
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- * E-mail:
| | - Samya Chakravorty
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Sookyong Koh
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States of America
| | - Zachary M. Grinspan
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, United States of America
- Department Pediatrics, Weill Cornell Medicine, New York, NY, United States of America
- New York Presbyterian Hospital, New York, NY, United States of America
| | - Renée A. Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - Russell P. Saneto
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA, United States of America
- Department of Neurology, University of Washington, Seattle, WA, United States of America
| | - Elaine C. Wirrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Jason Coryell
- Departments of Pediatrics & Neurology, Oregon Health & Sciences University, Portland, OR, United States of America
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
| | - John R. Mytinger
- Department of Pediatrics, the Ohio State University, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - William D. Gaillard
- Department of Neurology, Children's National Health System, George Washington University School of Medicine, Washington, D.C., United States of America
| | - Ignacio Valencia
- Section of Neurology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Joseph E. Sullivan
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
| | - Annapurna Poduri
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - John J. Millichap
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Cynthia Keator
- Cook Children’s Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, TX, United States of America
| | - Courtney Wusthoff
- Division of Child Neurology, Stanford University, Palo Alto, CA, United States of America
| | - Nicole Ryan
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - William B. Dobyns
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA, United States of America
- Department of Neurology, University of Washington, Seattle, WA, United States of America
- Center for Integrative Brain Research, University of Washington, Seattle, WA, United States of America
- Seattle Children's Research Institute, University of Washington, Seattle, WA, United States of America
- Pediatrics University of Washington, Seattle, WA, United States of America
| | - Madhuri Hegde
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States of America
| |
Collapse
|
13
|
Shellhaas RA, Berg AT, Grinspan ZM, Wusthoff CJ, Millichap JJ, Loddenkemper T, Coryell J, Saneto RP, Chu CJ, Joshi SM, Sullivan JE, Knupp KG, Kossoff EH, Keator C, Wirrell EC, Mytinger JR, Valencia I, Massey S, Gaillard WD. Initial Treatment for Nonsyndromic Early-Life Epilepsy: An Unexpected Consensus. Pediatr Neurol 2017; 75:73-79. [PMID: 28807611 PMCID: PMC5863237 DOI: 10.1016/j.pediatrneurol.2017.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE There are no evidence-based guidelines on the preferred approach to treating early-life epilepsy. We examined initial therapy selection in a contemporary US cohort of children with newly diagnosed, nonsyndromic, early-life epilepsy (onset before age three years). METHODS Seventeen pediatric epilepsy centers participated in a prospective cohort study of children with newly diagnosed epilepsy with onset under 36 months of age. Details regarding demographics, seizure types, and initial medication selections were obtained from medical records. RESULTS About half of the 495 enrolled children with new-onset, nonsyndromic epilepsy were less than 12 months old at the time of diagnosis (n = 263, 53%) and about half (n = 260, 52%) had epilepsy with focal features. Of 464 who were treated with monotherapy, 95% received one of five drugs: levetiracetam (n = 291, 63%), oxcarbazepine (n = 67, 14%), phenobarbital (n = 57, 12%), topiramate (n = 16, 3.4%), and zonisamide (n = 13, 2.8%). Phenobarbital was prescribed first for 50 of 163 (31%) infants less than six months old versus seven of 300 (2.3%) of children six months or older (P < 0.0001). Although the first treatment varied across study centers (P < 0.0001), levetiracetam was the most commonly prescribed medication regardless of epilepsy presentation (focal, generalized, mixed/uncertain). Between the first and second treatment choices, 367 (74%) of children received levetiracetam within the first year after diagnosis. CONCLUSIONS Without any specific effort, the pediatric epilepsy community has developed an unexpectedly consistent approach to initial treatment selection for early-life epilepsy. This suggests that a standard practice is emerging and could be utilized as a widely acceptable basis of comparison in future drug studies.
Collapse
Affiliation(s)
- Renée A. Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan,Communications should be addressed to: Dr. Shellhaas; C.S. Mott Children’s Hospital, room 12-733, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4279.
| | - Anne T. Berg
- Epilepsy Center, Lurie Children’s Hospital; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Zachary M. Grinspan
- Weill Cornell Medicine; New York Presbyterian Hospital; Health Information Technology Evaluation Collaborative, New York, New York
| | | | - John J. Millichap
- Epilepsy Center, Lurie Children’s Hospital; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jason Coryell
- Departments of Pediatrics & Neurology, Oregon Health & Sciences University, Portland, Oregon
| | - Russell P. Saneto
- Division of Pediatric Neurology, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sucheta M. Joshi
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Joseph E. Sullivan
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eric H. Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Cynthia Keator
- Cook Children’s Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, Texas
| | | | - John R. Mytinger
- Department of Pediatrics, the Ohio State University; Nationwide Children’s Hospital, Columbus, Ohio
| | - Ignacio Valencia
- Section of Neurology, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Shavonne Massey
- Departments of Neurology and Pediatrics, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, District of Columbia
| |
Collapse
|
14
|
Berg AT, Coryell J, Saneto RP, Grinspan ZM, Alexander JJ, Kekis M, Sullivan JE, Wirrell EC, Shellhaas RA, Mytinger JR, Gaillard WD, Kossoff EH, Valencia I, Knupp KG, Wusthoff C, Keator C, Dobyns WB, Ryan N, Loddenkemper T, Chu CJ, Novotny EJ, Koh S. Early-Life Epilepsies and the Emerging Role of Genetic Testing. JAMA Pediatr 2017; 171:863-871. [PMID: 28759667 PMCID: PMC5710404 DOI: 10.1001/jamapediatrics.2017.1743] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Early-life epilepsies are often a consequence of numerous neurodevelopmental disorders, most of which are proving to have genetic origins. The role of genetic testing in the initial evaluation of these epilepsies is not established. OBJECTIVE To provide a contemporary account of the patterns of use and diagnostic yield of genetic testing for early-life epilepsies. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort, children with newly diagnosed epilepsy with an onset at less than 3 years of age were recruited from March 1, 2012, to April 30, 2015, from 17 US pediatric hospitals and followed up for 1 year. Of 795 families approached, 775 agreed to participate. Clinical diagnosis of the etiology of epilepsy were characterized based on information available before genetic testing was performed. Added contributions of cytogenetic and gene sequencing investigations were determined. EXPOSURES Genetic diagnostic testing. MAIN OUTCOMES AND MEASURES Laboratory-confirmed pathogenic variant. RESULTS Of the 775 patients in the study (367 girls and 408 boys; median age of onset, 7.5 months [interquartile range, 4.2-16.5 months]), 95 (12.3%) had acquired brain injuries. Of the remaining 680 patients, 327 (48.1%) underwent various forms of genetic testing, which identified pathogenic variants in 132 of 327 children (40.4%; 95% CI, 37%-44%): 26 of 59 (44.1%) with karyotyping, 32 of 188 (17.0%) with microarrays, 31 of 114 (27.2%) with epilepsy panels, 11 of 33 (33.3%) with whole exomes, 4 of 20 (20.0%) with mitochondrial panels, and 28 of 94 (29.8%) with other tests. Forty-four variants were identified before initial epilepsy presentation. Apart from dysmorphic syndromes, pathogenic yields were highest for children with tuberous sclerosis complex (9 of 11 [81.8%]), metabolic diseases (11 of 14 [78.6%]), and brain malformations (20 of 61 [32.8%]). A total of 180 of 446 children (40.4%), whose etiology would have remained unknown without genetic testing, underwent some testing. Pathogenic variants were identified in 48 of 180 children (26.7%; 95% CI, 18%-34%). Diagnostic yields were greater than 15% regardless of delay, spasms, and young age. Yields were greater for epilepsy panels (28 of 96 [29.2%]; P < .001) and whole exomes (5 of 18 [27.8%]; P = .02) than for chromosomal microarray (8 of 101 [7.9%]). CONCLUSIONS AND RELEVANCE Genetic investigations, particularly broad sequencing methods, have high diagnostic yields in newly diagnosed early-life epilepsies regardless of key clinical features. Thorough genetic investigation emphasizing sequencing tests should be incorporated into the initial evaluation of newly presenting early-life epilepsies and not just reserved for those with severe presentations and poor outcomes.
Collapse
Affiliation(s)
- Anne T. Berg
- Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jason Coryell
- Department of Pediatrics, Oregon Health & Science University, Portland,Department of Neurology, Oregon Health & Science University, Portland
| | - Russell P. Saneto
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Department of Neurology, University of Washington, Seattle
| | - Zachary M. Grinspan
- Department of Pediatrics, Weill Cornell Medicine, New York, New York,Department of Pediatrics, New York Presbyterian Hospital, New York, New York,Health Information Technology Evaluation Collaborative, New York, New York
| | | | - Mariana Kekis
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | | | | | | | - John R. Mytinger
- Department of Pediatrics, The Ohio State University, Columbus,Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System, George Washington University School of Medicine, Washington, DC
| | - Eric H. Kossoff
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland,Department of Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ignacio Valencia
- Section of Neurology, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kelly G. Knupp
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora,Department of Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Courtney Wusthoff
- Division of Child Neurology, Stanford University, Palo Alto, California
| | - Cynthia Keator
- Cook Children’s Health Care System, Jane and John Justin Neurosciences Center, Fort Worth, Texas
| | - William B. Dobyns
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | - Nicole Ryan
- Department of Neurology, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Pediatrics, The Children’s Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Edward J. Novotny
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, Washington,Department of Neurology, University of Washington, Seattle,Department of Pediatrics, University of Washington, Seattle,Center for Integrative Brain Research, University of Washington, Seattle,Seattle Children’s Research Institute, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | - Sookyong Koh
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| |
Collapse
|
15
|
Knupp KG, Leister E, Coryell J, Nickels KC, Ryan N, Juarez-Colunga E, Gaillard WD, Mytinger JR, Berg AT, Millichap J, Nordli DR, Joshi S, Shellhaas RA, Loddenkemper T, Dlugos D, Wirrell E, Sullivan J, Hartman AL, Kossoff EH, Grinspan ZM, Hamikawa L. Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort. Epilepsia 2016; 57:1834-1842. [PMID: 27615012 DOI: 10.1111/epi.13557] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Infantile spasms (IS) represent a severe epileptic encephalopathy presenting in the first 2 years of life. Recommended first-line therapies (hormonal therapy or vigabatrin) often fail. We evaluated response to second treatment for IS in children in whom the initial therapy failed to produce both clinical remission and electrographic resolution of hypsarhythmia and whether time to treatment was related to outcome. METHODS The National Infantile Spasms Consortium established a multicenter, prospective database enrolling infants with new diagnosis of IS. Children were considered nonresponders to first treatment if there was no clinical remission or persistence of hypsarhythmia. Treatment was evaluated as hormonal therapy (adrenocorticotropic hormone [ACTH] or oral corticosteroids), vigabatrin, or "other." Standard treatments (hormonal and vigabatrin) were compared to all other nonstandard treatments. We compared response rates using chi-square tests and multivariable logistic regression models. RESULTS One hundred eighteen infants were included from 19 centers. Overall response rate to a second treatment was 37% (n = 44). Children who received standard medications with differing mechanisms for first and second treatment had higher response rates than other sequences (27/49 [55%] vs. 17/69 [25%], p < 0.001). Children receiving first treatment within 4 weeks of IS onset had a higher response rate to second treatment than those initially treated later (36/82 [44%] vs. 8/34 [24%], p = 0.040). SIGNIFICANCE Greater than one third of children with IS will respond to a second medication. Choosing a standard medication (ACTH, oral corticosteroids, or vigabatrin) that has a different mechanism of action appears to be more effective. Rapid initial treatment increases the likelihood of response to the second treatment.
Collapse
Affiliation(s)
- Kelly G Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Erin Leister
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Jason Coryell
- Departments of Pediatrics and Neurology, School of Medicine, Oregon Health & Sciences University, Portland, Oregon, U.S.A
| | - Katherine C Nickels
- Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Nicole Ryan
- Division of Neurology, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - William D Gaillard
- Center For Neuroscience, Children's National Health System, Washington, District of Columbia, U.S.A
| | - John R Mytinger
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - John Millichap
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Douglas R Nordli
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Sucheta Joshi
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Renée A Shellhaas
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Dennis Dlugos
- Division of Neurology, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Elaine Wirrell
- Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph Sullivan
- Departments of Pediatrics and Neurology, University of California San Francisco, San Francisco, California, U.S.A
| | - Adam L Hartman
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Zachary M Grinspan
- Departments of Pediatrics and Healthcare Policy & Research, Weill Cornell Medical Center, New York, New York, U.S.A
| | - Lorie Hamikawa
- Department of Neurology, University of Washington, Seattle, Washington, U.S.A
| | | |
Collapse
|
16
|
Knupp KG, Coryell J, Nickels KC, Ryan N, Leister E, Loddenkemper T, Grinspan Z, Hartman AL, Kossoff EH, Gaillard WD, Mytinger JR, Joshi S, Shellhaas RA, Sullivan J, Dlugos D, Hamikawa L, Berg AT, Millichap J, Nordli DR, Wirrell E. Response to treatment in a prospective national infantile spasms cohort. Ann Neurol 2016; 79:475-84. [PMID: 26704170 DOI: 10.1002/ana.24594] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Infantile spasms are seizures associated with a severe epileptic encephalopathy presenting in the first 2 years of life, and optimal treatment continues to be debated. This study evaluates early and sustained response to initial treatments and addresses both clinical remission and electrographic resolution of hypsarrhythmia. Secondarily, it assesses whether response to treatment differs by etiology or developmental status. METHODS The National Infantile Spasms Consortium established a multicenter, prospective database enrolling infants with new diagnosis of infantile spasms. Children were considered responders if there was clinical remission and resolution of hypsarrhythmia that was sustained at 3 months after first treatment initiation. Standard treatments of adrenocorticotropic hormone (ACTH), oral corticosteroids, and vigabatrin were considered individually, and all other nonstandard therapies were analyzed collectively. Developmental status and etiology were assessed. We compared response rates by treatment group using chi-square tests and multivariate logistic regression models. RESULTS Two hundred thirty infants were enrolled from 22 centers. Overall, 46% of children receiving standard therapy responded, compared to only 9% who responded to nonstandard therapy (p < 0.001). Fifty-five percent of infants receiving ACTH as initial treatment responded, compared to 39% for oral corticosteroids, 36% for vigabatrin, and 9% for other (p < 0.001). Neither etiology nor development significantly modified the response pattern by treatment group. INTERPRETATION Response rate varies by treatment choice. Standard therapies should be considered as initial treatment for infantile spasms, including those with impaired development or known structural or genetic/metabolic etiology. ACTH appeared to be more effective than other standard therapies.
Collapse
Affiliation(s)
- Kelly G Knupp
- Departments of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jason Coryell
- Departments of Pediatrics and Neurology, School of Medicine, Oregon Health & Sciences University, Portland, OR
| | | | - Nicole Ryan
- Division of Neurology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Erin Leister
- Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA
| | | | - Adam L Hartman
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, MD
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, MD
| | | | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Ohio State University, Nationwide Children's Hospital, Columbus, OH
| | - Sucheta Joshi
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, MI
| | - Renée A Shellhaas
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, MI
| | - Joseph Sullivan
- Departments of Pediatrics and Neurology, University of San Francisco, San Francisco, CA
| | - Dennis Dlugos
- Division of Neurology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lorie Hamikawa
- Department of Neurology, University of Washington, Seattle, WA
| | - 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
| | - John Millichap
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Douglas R Nordli
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elaine Wirrell
- Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
17
|
Morgan NV, Westaway SK, Morton JEV, Gregory A, Gissen P, Sonek S, Cangul H, Coryell J, Canham N, Nardocci N, Zorzi G, Pasha S, Rodriguez D, Desguerre I, Mubaidin A, Bertini E, Trembath RC, Simonati A, Schanen C, Johnson CA, Levinson B, Woods CG, Wilmot B, Kramer P, Gitschier J, Maher ER, Hayflick SJ. PLA2G6, encoding a phospholipase A2, is mutated in neurodegenerative disorders with high brain iron. Nat Genet 2006; 38:752-4. [PMID: 16783378 PMCID: PMC2117328 DOI: 10.1038/ng1826] [Citation(s) in RCA: 365] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 05/23/2006] [Indexed: 11/09/2022]
Abstract
Neurodegenerative disorders with high brain iron include Parkinson disease, Alzheimer disease and several childhood genetic disorders categorized as neuroaxonal dystrophies. We mapped a locus for infantile neuroaxonal dystrophy (INAD) and neurodegeneration with brain iron accumulation (NBIA) to chromosome 22q12-q13 and identified mutations in PLA2G6, encoding a calcium-independent group VI phospholipase A2, in NBIA, INAD and the related Karak syndrome. This discovery implicates phospholipases in the pathogenesis of neurodegenerative disorders with iron dyshomeostasis.
Collapse
Affiliation(s)
- Neil V Morgan
- Section of Medical & Molecular Genetics, University of Birmingham School of Medicine, Edgbaston, Birmingham B15 2TT, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Hayflick SJ, Hartman M, Coryell J, Gitschier J, Rowley H. Brain MRI in neurodegeneration with brain iron accumulation with and without PANK2 mutations. AJNR Am J Neuroradiol 2006; 27:1230-3. [PMID: 16775270 PMCID: PMC2099458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with a clinical diagnosis of neurodegeneration with brain iron accumulation (NBIA, formerly called Hallervorden-Spatz syndrome) often have mutations in PANK2, the gene encoding pantothenate kinase 2. We investigated correlations between brain MR imaging changes, mutation status, and clinical disease features. METHODS Brain MRIs from patients with NBIA were reviewed by 2 neuroradiologists for technical factors, including signal intensity abnormalities in specific brain regions, presence and location of atrophy, presence of white matter abnormality, contrast enhancement, and other comments. PANK2 genotyping was performed by polymerase chain reaction amplification of patient genomic DNA followed by automated nucleotide sequencing. RESULTS Sixty-six MR imaging examinations from 49 NBIA patients were analyzed, including those from 29 patients with mutations in PANK2. All patients with mutations had the specific pattern of globus pallidus central hyperintensity with surrounding hypointensity on T2-weighted images, known as the eye-of-the-tiger sign. This sign was not seen in any studies from patients without mutations. Even before the globus pallidus hypointensity developed, patients with mutations could be distinguished by the presence of isolated globus pallidus hyperintensity on T2-weighted images. Radiographic evidence for iron deposition in the substantia nigra was absent early in disease associated with PANK2 mutations. MR imaging abnormalities outside the globus pallidus, including cerebral or cerebellar atrophy, were more common and more severe in mutation-negative patients. No specific MR imaging changes could be distinguished among the mutation-negative patients. CONCLUSION MR imaging signal intensity abnormalities in the globus pallidus can distinguish patients with mutations in PANK2 from those lacking a mutation, even in the early stages of disease.
Collapse
Affiliation(s)
- S J Hayflick
- Department of Molecular and Medical Genetics, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | | | | | | | | |
Collapse
|
19
|
Egan RA, Weleber RG, Hogarth P, Gregory A, Coryell J, Westaway SK, Gitschier J, Das S, Hayflick SJ. Neuro-ophthalmologic and electroretinographic findings in pantothenate kinase-associated neurodegeneration (formerly Hallervorden-Spatz syndrome). Am J Ophthalmol 2005; 140:267-74. [PMID: 16023068 PMCID: PMC2169522 DOI: 10.1016/j.ajo.2005.03.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2004] [Revised: 03/03/2005] [Accepted: 03/04/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The onset of pantothenate kinase-associated neurodegeneration (PKAN) occurs in the first and second decade of life and a pigmentary retinal degeneration is a feature of the disorder. Since the neuro-ophthalmologic and electroretinographic (ERG) features have never been well delineated, we describe them in 16 patients with PKAN. DESIGN Observational case series. METHODS Sixteen patients with genetic and neuroimaging-confirmed PKAN were examined. Ten underwent neuro-ophthalmologic examination and all had ERGs. RESULTS Of the 10 who underwent neuro-ophthalmologic examination, all showed saccadic pursuits and eight showed hypometric or slowed vertical saccades. Seven of eight had inability to suppress the vestibulo-ocular reflex; two patients could not cooperate. Two had square wave jerks and four had poor convergence. Vertical optokinetic responses were abnormal in five, and two patients had blepharospasm. Eight patients had sectoral iris paralysis and partial loss of the pupillary ruff consistent with Adie's pupils in both eyes. Only four of 10 examined patients showed a pigmentary retinopathy, but 11 of 16 had abnormal ERGs ranging from mild cone abnormalities to severe rod-cone dysfunction. No patient had optic atrophy. The PANK2 mutations of all of the patients were heterogeneous. CONCLUSIONS Adie's-like pupils, abnormal vertical saccades, and saccadic pursuits were very common. These findings suggest that mid-brain degeneration occurs in PKAN more frequently than previously thought. ERG abnormalities were present in approximately 70% and no patient had optic atrophy. Although genotype-ocular phenotype correlations could not be established, allelic differences probably contributed to the variable clinical expression of retinopathy and other clinical characteristics in these patients.
Collapse
Affiliation(s)
- Robert A Egan
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland 97201, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Pantothenate kinase-associated neurodegeneration (PKAN) (MIM 234200; Hallervorden-Spatz syndrome) is a degenerative, autosomal recessive disorder in childhood, currently without specific treatment. In contrast to variable clinical features, T2-weighted magnetic resonance images show a characteristic 'eye-of-the-tiger sign' in the globus pallidus due to excess iron deposition. Recently a defect in pantothenate kinase, the key regulatory enzyme in the synthesis of coenzyme A from pantothenate, has been identified as the cause of the disease. We report a 12-year-old boy with progressive rigidity, dystonia, impaired voluntary movement, dysarthria, and mental deterioration. Over 10 years the boy had been misdiagnosed with clumsiness, emotional and behavioural deficits, and attention deficit disorder, before neuroimaging was performed showing the characteristic 'eye-of-the-tiger sign'. Molecular analyses confirmed two mutations in the PANK2 gene [coding sequence of a gene that has homology to murine pantothenate kinase-1]. We conclude that in progressive childhood dystonia, PKAN should be considered and magnetic resonance imaging performed early. The newly described defect of the pantothenate kinase enzyme enables a novel therapeutic approach to be considered, based on the mutation analyses of the PANK2 gene, as well as the prenatal diagnosis of this disorder.
Collapse
Affiliation(s)
- Jörg Klepper
- Department of Paediatrics and Paediatric Neurology, University of Essen, Germany.
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
The purpose of this study was to determine the validity of the Development Edition (pilot version) of the Pediatric Evaluation of Disability Inventory (PEDI) in groups of disabled and nondisabled children. The PEDI is a new functional assessment instrument for the evaluation of disabled children aged 6 months to 7 years. The PEDI has been developed to identify functional status and change along three dimensions: 1) functional skill level, 2) caregiver assistance, and 3) modifications or adaptive equipment used. The PEDIs were administered as a parental-report questionnaire, and the results were compared with data obtained by the Battelle Developmental Inventory Screening Test (BDIST). The BDIST is a standardized assessment with developmental and adaptive content. Subjects were 20 children between the ages of 2 and 8 years with arthritic conditions and spina bifida and 20 nondisabled children matched for age and sex. All subjects' scores on the BDIST cognitive domain were no greater than 1.50 standard deviations below the mean for their age group. Concurrent validity was supported by moderately high Pearson product-moment correlations between BDIST and PEDI summary scores (r = .70-.80). Construct validity was supported by significant differences between the disabled and nondisabled groups' PEDI scores and by discriminant analysis identifying the PEDI scores as better group discriminators than the BDIST scores. Results validate the Developmental Edition of the PEDI and support the further development and standardization of the final version. Use of the PEDI in clinical pediatric physical therapy practice is discussed.
Collapse
Affiliation(s)
- A B Feldman
- Children's Hospital of Los Angeles, CA 90054-0700
| | | | | |
Collapse
|
22
|
Abstract
This study examines the acquisition of internal stability as it relates to the development of prehension in normal infants. Thirty-two subjects, 7 to 14 months of age, were observed grasping Cheerios from styrene surfaces that provided different amounts of support to the infants' hands. The subjects were scored on the grasp patterns they used and on their success in securing a Cherrio without dislodging the styrene surface from a platform. Success increased with age, thus demonstrating a developmental progression in the acquisition of upper extremity internal stability. Consistency of grasp also increased with age. Whereas the youngest infants (7 to 8 months old) reverted to immature grasp patterns on the less stable surfaces, the oldest infants (13 to 14 months old) used mature pincer grasp patterns consistently. Infants 10 to 11 months old seemed to be in a transitional stage between the variability of grasp seen in the youngest infants and the consistency achieved by the oldest group.
Collapse
Affiliation(s)
- A Hirschel
- Area Cooperative Educational Services, Hamden, Connecticut
| | | | | |
Collapse
|
23
|
Kluzik J, Fetters L, Coryell J. Quantification of control: a preliminary study of effects of neurodevelopmental treatment on reaching in children with spastic cerebral palsy. Phys Ther 1990; 70:65-76; discussion 76-8. [PMID: 2296614 DOI: 10.1093/ptj/70.2.65] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of neurodevelopmental treatment on reaching in children with spastic quadriplegia were studied using a method of analysis to quantify the qualitative term "smoothness." Hand position in three-dimensional space was recorded during a simple reaching task using the WATSMART (Waterloo Spatial Motion Analysis and Recording Technique) system in conjunction with videotaping. The number of accelerations and decelerations (movement units) were measured in addition to movement time, distance of path (directedness), and associated reactions. Each subject performed several reaches before and following one treatment session. Following treatment, reaches were significantly faster, smoother (fewer movement units), and more mature. This study supports the hypotheses that neurodevelopmental treatment can produce immediate changes in the kinematic properties of reaching and that kinematic data can be used to quantitatively describe components of movement (eg, smoothness) that have traditionally been described qualitatively.
Collapse
Affiliation(s)
- J Kluzik
- Department of Physical Therapy, Sargent College of Allied Health Professions, Boston University, MA 02215
| | | | | |
Collapse
|
24
|
Abstract
The purpose of this study was to determine whether Bayley Motor Scale scores were stable in infants during the first year of life, that is, whether each individual infant's score was essentially the same at each of the five test ages. Subjects were 15 low-risk and 8 high-risk infants with Bayley Scales of Infant Development Motor Scale scores at 2, 3, 4, 8, and 12 months. All high-risk and most low-risk infants also had outcome scores at either 24 or 36 months. For the group as a whole, and for all infants with "normal" outcomes, subjects did not change ranks over the six test ages (ie, high-scoring infants' ranks remained high and low-scoring infants' ranks remained low), but scores varied significantly from test to test. Scores of infants with "non-normal" outcomes did not vary significantly from test to test. The highest and lowest scores of 75% of the infants with normal outcomes and 57% of the infants with non-normal outcomes differed significantly. Four patterns of variations of Bayley Motor Scale scores over the five test ages of the first year after birth were identified. The first pattern included three infants with the most stable scores. The three remaining patterns were different from each other, but a consistent feature of each was a peak at 4 months. Finally, scores at 3 and 8 months were best able to correctly identify outcome. A single Bayley Motor Scale score may not reflect an infant's true abilities; some factor may be inflating scores at age 4 months.
Collapse
Affiliation(s)
- J Coryell
- Department of Physical Therapy, Sargent College of Allied Health Professions, Boston University, MA 02215
| | | | | | | |
Collapse
|
25
|
Abstract
Eight children for whom measures of head preference and hand visualization had been determined in infancy were evaluated by parent questionnaire for hand preference at ages 3.5-6 yr. All six infants who maintained their heads to the right became right-handed as predicted, while neither infant with a non-right head orientation developed handedness in the predicted direction, though neither became right-handed. Similarly, the five infants who had visualized their right hands more frequently than the left became right-handed children as predicted; of the three infants who did not visualize the right hand more frequently, none developed handedness as predicted. None of the infant measures correlated with childhood handedness. These results suggest support for the genetically based right shift factor proposed by ANNETT (Behav. Genet. 8, 227-249, 1978).
Collapse
|
26
|
Abstract
Models of the origin of left hand preference were tested with prospective data. Infants with and without a history of perinatal complications, matched for age, sex and parental handedness, were filmed at 6 weeks of age. Children with a history of perinatal complications lacked the rightward headturning bias of those children without a history of perinatal trauma. Children with a history of perinatal complications were also deviant with reference to the duration of a postural reflex and its degree of lateralization. Perinatal complications may delay the establishment of volitional hand use as well as increase the probability of left-handedness. The data were interpreted as supporting SATZ's (Cortex 8, 121-135, 1972) rather than BAKAN et al.'s (Neuropsychologia 11, 363-366, 1973) model of "pathological" left-handedness.
Collapse
|
27
|
Abstract
A rightward turning bias is the earliest human asymmetry and may be a precursor of handedness. Head-turning affects arm position as part of the Asymmetric Tonic Neck Reflex (ATNR). The hypothesis was tested that turning biases operate in coordination with the ATNR to promote handedness by measuring reflex behavior during turns in the preferred vs nonpreferred direction. Twenty infants were filmed during spontaneous movement and during the following factorial design: head turned left vs right; voluntarily vs passively; 30 degrees vs 70 degrees. The incidence, strength, and duration of the ATNR were least when the child turned toward his/her preferred side. When right-preference children turned rightward, the occurrence of the ATNR was no better than chance. Thus, a child can orient toward the right hand with minimal intrusion of the ATNR upon limb position, perhaps promoting right-handedness.
Collapse
|
28
|
Abstract
The purpose of this study was to determine whether the asymmetrical tonic neck reflex was present in normal 1- to 12-week-old infants. Twelve infants were observed seven times within the first 12 weeks: at the first and second week and every other week thereafter. Spontaneous behavior was videotaped while the infant lay supine. Infants maintained a head-turned posture during every visit. The asymmetrical tonic neck reflex was present: 1) in the infants' arms during every visit, at a maximum at the sixth week; 2) in their legs, with the longest duration of the response at the first week's visit; and 3) in both arms and legs, with no change throughout seven visits. There were more movements of the face arm than of the skull arm during the seven visits, and the additional movements were in the extension range. The face leg moved more than the skull leg, but only at the 6th, 8th, and 10th weeks. The study confirms that the asymmetrical tonic neck reflex can be observed in the posture and movement of normal infants and that the pattern of appearance of the reflex differs in arms and legs.
Collapse
|
29
|
Coryell J, Henderson A. Role of the asymmetrical tonic neck reflex in hand visualization in normal infants. Am J Occup Ther 1979; 33:255-60. [PMID: 443149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Fourteen infants were each videotaped 7 times within the first 12 weeks of life to determine whether or not the asymmetrical tonic neck reflex had a role in placing their hands within their fields of vision. Infants' arms were more frequently out of the reflex position. Hands were within the peripheral visual field more often than in the focal visual field or not within the visual field. The proportion of observations that hands were in a particular visual field varied in accordance with the presence or absence of the reflex. A higher proportion of reflex observations occurred in the focal visual field, whereas a higher proportion of observations made when the infants were not in the reflex position occurred in the peripheral visual field. Further, the proportion of focal field observations in the reflex position was greater than the proportion of observations out of the reflex position for the first six of the seven ages. This study confirms that when infants are in the asymmetrical tonic neck reflex position, their hands are more likely to be in a position in which they can be visualized.
Collapse
|
30
|
Coryell J. Children's lateralizations of images of the self, others, and objects. Am J Occup Ther 1975; 29:535-8. [PMID: 1163616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Each of 90 kindergarten, second, and fourth graders was shown photographs of himself, another person, and a symmetrical television set. He was asked to point to one side of the image as specified, on himself, the person, and the object. When the three pointing tasks were made nearly equivalent by providing on example for each task, by not requiring verbal labels, and by requiring roughly the same cognitive level of relational judgment, there was a significant difference among school grades and image responses. The response of pointing to the side of the image diagonally across from the side of the example occurred more often in older children and most often for the object in all three school grades.
Collapse
|