Abnormal EEG features are a hallmark of epilepsy, and abnormal frequency and network features are apparent in EEGs from people with idiopathic generalised epilepsy in both ictal and interictal states. Here, we characterise differences in the resting-state EEG of individuals with juvenile myoclonic epilepsy and assess factors influencing the heterogeneity of EEG features. We collected EEG data from 147 participants with juvenile myoclonic epilepsy through the Biology of Juvenile Myoclonic Epilepsy study. 95 control EEGs were acquired from two independent studies (Chowdhury et al. (2014) and EU-AIMS Longitudinal European Autism Project). We extracted frequency and functional network-based features from 10-20 s epochs of resting-state EEG, including relative power spectral density, peak alpha frequency, network topology measures and brain network ictogenicity: a computational measure of the propensity of networks to generate seizure dynamics. We tested for differences between epilepsy and control EEGs using univariate, multivariable and receiver operating curve analysis. Additionally, we explored the heterogeneity of EEG features within and between cohorts by testing for associations with potentially influential factors such as age, sex, epoch length and time, as well as testing for associations with clinical phenotypes including anti-seizure medication, and seizure characteristics in the epilepsy cohort. P-values were corrected for multiple comparisons. Univariate analysis showed significant differences in power spectral density in delta (2-5 Hz) (p = 0.0007, hedges’ g = 0.55) and low-alpha (6-9 Hz) (p = 2.9 × 10−8, g = 0.80) frequency bands, peak alpha frequency (p = 0.000007, g = 0.66), functional network mean degree (p = 0.0006, g = 0.48) and brain network ictogenicity (p = 0.00006, g = 0.56) between epilepsy and controls. Since age (p = 0.009) and epoch length (p = 1.7 × 10−8) differed between the two groups and were potential confounders, we controlled for these covariates in multivariable analysis where disparities in EEG features between epilepsy and controls remained. Receiver operating curve analysis showed low-alpha power spectral density was optimal at distinguishing epilepsy from controls, with an area under the curve of 0.72. Lower average normalized clustering coefficient and shorter average normalized path length were associated with poorer seizure control in epilepsy patients. To conclude, individuals with juvenile myoclonic epilepsy have increased power of neural oscillatory activity at low-alpha frequencies, and increased brain network ictogenicity compared to controls, supporting evidence from studies in other epilepsies with considerable external validity. In addition, the impact of confounders on different frequency-based and network-based EEG features observed in this study highlights the need for careful consideration and control of these factors in future EEG research in idiopathic generalised epilepsy particularly for their use as biomarkers.

There are several important relapsing demyelinating syndromes (RDS) that may present in childhood, of which paediatric-onset multiple sclerosis is the most common. These are rare conditions, so recognising presentations and referring early to specialist services is important to enable prompt diagnosis and effective treatment. Understanding of RDS is rapidly evolving, with many new and effective treatments that aim to reduce relapses and disability accumulation. A holistic and child-focused approach to management is key to supporting patients and families, with thought given to early detection of cognitive and psychological issues to provide appropriate support.

The challenge was to make these care pathways available to all within the system. Our primary aim was to provide families and healthcare professionals with consistent evidencedbased information through home, primary and secondary care. Methods Across these healthcare settings no single IT solution existed to communicate these pathways to all. We set out to develop our own: prioritising secure, robust and safe technical programming whilst delivering an accessible user-friendly interface. This led to the use of smartphone technology.Comprehensive integrated-care pathways were devised for all six high-volume conditions. Pathways were reformulated into algorithms suitable for app format. Outcome tools included data on app usage, data dashboard to monitor 'zeroday length of stay admissions' for the six conditions and qualitative feedback from stakeholders. Results 24 months quantitative data from in-built analytic programme as a measure of usage and retention:-Total unique user events: 7937 (69% parents/carers; 14% primary care; 17% secondary care). Retention: 16% of users revisited app within 1 month with an average number of 2.5 sessions per user.Admission dashboard data to monitor admissions for 6 high-volume conditions: key data is presented in table 1. Data demonstrates 15% reduction in total admissions, with fever and minor infection showing the greatest reduction.Abstract G105 Table 1 % change in admissions from 12 months before to 12 months

ResultsOf the 965 vEEGs undertaken during the study period, 103 were performed following a first unprovoked epileptic seizure (median age: 7 years; range: 1 month-17 years). Out of 103, 18 had neurodevelopmental problem, 21 had a family history of epilepsy and 14 of prior febrile seizure. Seizure semiology included tonic-clonic, (n=52), focal (n=12), focal with secondary generalization (n=16), autonomic (n=6), atonic (n=1), myoclonic (n=1), and uncertain (n=15) seizure types. vEEG outcomes included normal (n=50, 48.5%), nonepileptic events recorded (n=6, 5.8%), and suggestive of an epilepsy syndrome (n=47, 45.6%). Excluding the 6 patients with non-epileptic events, the remaining 97 were divided into two sub-groups (Group A: 1 month to 12 years[n-74], Group B: 12 years -17 years [n-23]). Epilepsy syndrome identified: Group A -41%, Group B -71%. In group B, EEG was supportive of epilepsy syndrome in 17 (73.9%) Table 1. Abstract G184(P) Table 1 EEG value outcome in our series