Application of High-Frequency Oscillations on Scalp EEG in Infant Spasm: A Prospective Controlled Study

Introduction Even though adrenocorticotropic hormone (ACTH) demonstrated powerful efficacy in the initially successful treatment of infantile spasms (IS), nearly one-half of patients whose spasms were once suppressed experienced relapse. There is currently no validated method for the prediction of the risk of relapse. The Burden of Amplitudes and Epileptiform Discharges (BASED) score is an electroencephalogram (EEG) grading scale for children with infantile spasms. We sought to determine whether an association exists between the BASED score after ACTH treatment and relapse after initial response with ACTH. Methods Children with IS who achieved initial response after ACTH treatment were selected as the study subjects. Those who experienced relapse within 12 months after ACTH treatment were categorized as the relapse group, and those who did not were categorized as the non-relapse group. Their general clinical data and EEG data (using BASED scoring) after ACTH treatment were collected, and compared between groups. Cox proportional hazards models were fit to determine factors associated with relapse. Results A total of 64 children with IS were enrolled in the study, of which 37 (57.8%) experienced a relapse, and the median duration after ACTH treatment was 3 (1.5, 6) months. The BASED score was significantly higher in the relapse group than in the non-relapse group. Cox modeling demonstrated that BASED score was independently associated with relapse. The patients with a score greater than or equal to 3 showed a high rate (89.3%) of relapse. The relapse group had stronger, more stable EEG functional networks than the non-relapse group, and there were obvious correlations between BASED score and functional connectivity. Conclusion This study suggests the BASED score after ACTH treatment has potential value as a predictor for relapse after initial response. Children with IS who have a BASED score greater than or equal to 3 after the initial response of ACTH carry a high risk of relapse within 1 year. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00347-7.

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“…Some previous studies suggested the EEG features could be associated with the relapse of IS [ 7 – 10 , 20 ]. Hayashi et al.…”

Section: Discussionmentioning

confidence: 99%

Assessing Risk for Relapse among Children with Infantile Spasms Using the Based Score after ACTH Treatment: A Retrospective Study

Wan

Lei²,

Liu

et al. 2022

Neurol Ther

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“…Scalp HFOs and FOs occurred more frequently in children with IS than in healthy controls ( 50 , 52 , 53 ) and more frequently during sleep than wakefulness in IS ( 52 ). The energy of gamma band events during sleep was also found to be higher in children with IS than healthy controls ( 51 ). Spatially, one study of IS reported that ripple rates were significantly higher than controls in the posterior parasagittal region and significantly lower in the frontal region ( 52 ), but a second study found the highest rates of gamma, ripple, and fast ripple events in the temporal and frontal lobes of children with IS ( 51 ).…”

Section: Computational Analysismentioning

confidence: 96%

“…Many studies have documented the occurrence of scalp HFOs and FOs during interictal periods, as well. These were most frequently studied using slow-wave sleep EEG, with detection of events in the gamma and ripple frequency bands ( 50 , 51 , 54 , 55 ), the ripple band ( 52 ), or the ripple and fast ripple bands ( 53 ). Scalp HFOs and FOs occurred more frequently in children with IS than in healthy controls ( 50 , 52 , 53 ) and more frequently during sleep than wakefulness in IS ( 52 ).…”

Section: Computational Analysismentioning

confidence: 99%

EEG biomarkers for the diagnosis and treatment of infantile spasms

et al. 2022

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Early diagnosis and treatment are critical for young children with infantile spasms (IS), as this maximizes the possibility of the best possible child-specific outcome. However, there are major barriers to achieving this, including high rates of misdiagnosis or failure to recognize the seizures, medication failure, and relapse. There are currently no validated tools to aid clinicians in assessing objective diagnostic criteria, predicting or measuring medication response, or predicting the likelihood of relapse. However, the pivotal role of EEG in the clinical management of IS has prompted many recent studies of potential EEG biomarkers of the disease. These include both visual EEG biomarkers based on human visual interpretation of the EEG and computational EEG biomarkers in which computers calculate quantitative features of the EEG. Here, we review the literature on both types of biomarkers, organized based on the application (diagnosis, treatment response, prediction, etc.). Visual biomarkers include the assessment of hypsarrhythmia, epileptiform discharges, fast oscillations, and the Burden of AmplitudeS and Epileptiform Discharges (BASED) score. Computational markers include EEG amplitude and power spectrum, entropy, functional connectivity, high frequency oscillations (HFOs), long-range temporal correlations, and phase-amplitude coupling. We also introduce each of the computational measures and provide representative examples. Finally, we highlight remaining gaps in the literature, describe practical guidelines for future biomarker discovery and validation studies, and discuss remaining roadblocks to clinical implementation, with the goal of facilitating future work in this critical area.

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“…It is the largest single epilepsy subgroup affecting 13–45.5% of infants ( 2 ) with an annual incidence of 32.7/100 000 live births ( 3 ). In recent years, more and more studies have been conducted to discover that on scalp EEG, γ oscillations can better detect susceptibility to epilepsy than ripple and fast ripple oscillations in IS children ( 4 ). High-frequency oscillations (HFOs) and coupling between HFOs and slow-wave activity can trigger spasms ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Different Frequency Bands in Various Regions of the Brain Play Different Roles in the Onset and Wake-Sleep Stages of Infantile Spasms

Dong

Zhang

et al. 2022

Front. Pediatr.

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Objective:The study aimed to identify the signatures of brain networks using electroencephalogram (EEG) in patients with infantile spasms (IS).MethodsScalp EEGs of subjects with IS were prospectively collected in the first year of life (n = 8; age range 4–8 months; 3 males, 5 females). Ten minutes of ictal and interictal EEGs were clipped and filtered into different EEG frequency bands. The values of each pair of EEG channels were directly compared between ictal with interictal onsets and the sleep-wake phase to calculate IS brain network attributes: characteristic path length (CPL), node degree (ND), clustering coefficient (CC), and betweenness centrality (BC).ResultsCPL, ND, and CC of the fast waves decreased while BC increased. CPL and BC of the slow waves decreased, while ND and CC increased during the IS ictal onset (P < 0.05). CPL of the alpha decreased, and BC increased during the waking time (P < 0.05).ConclusionThe transmission capability of the fast waves, the local connectivity, and the defense capability of the slow waves during the IS ictal onset were enhanced. The alpha band played the most important role in both the global and local networks during the waking time. These may represent the brain network signatures of IS.

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Application of High-Frequency Oscillations on Scalp EEG in Infant Spasm: A Prospective Controlled Study

Cited by 16 publications

References 34 publications

Assessing Risk for Relapse among Children with Infantile Spasms Using the Based Score after ACTH Treatment: A Retrospective Study

Assessing Risk for Relapse among Children with Infantile Spasms Using the Based Score after ACTH Treatment: A Retrospective Study

EEG biomarkers for the diagnosis and treatment of infantile spasms

Different Frequency Bands in Various Regions of the Brain Play Different Roles in the Onset and Wake-Sleep Stages of Infantile Spasms

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