Second Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, China; Neurology Department, Shenzhen Children's Hospital, Guangdong, China; Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou, China.
Neurology Department, Shenzhen Children's Hospital, Guangdong, China.
Seizure. 2019 Oct;71:151-157. doi: 10.1016/j.seizure.2019.05.023. Epub 2019 May 30.
We investigated whether the presence of interictal scalp EEG high frequency oscillations (HFOs) in children with epileptic encephalopathy with continuous spike-and-wave during sleep (CSWS) can predict seizure and cognitive outcome after steroid therapy.
Twenty-two children with CSWS were prospectively enrolled and received methylprednisolone therapy. Interictal scalp HFOs, spike wave index (SWI) and intelligence quotient (IQ) were assessed before and after the treatment. The children were divided into two groups based on the early seizure reduction ratio at 2 weeks (≥50%, "response group"; otherwise "non-response group"). The "response group" was further divided into two subgroups ("relapse" and "non-relapse" subgroups) according to the late seizure outcome (after 3 months).
Interictal HFOs and electrical status epilepticus in sleep (ESES) (defined as SWI ≥ 85%) were detected in all children at the baseline. In the response with relapse group (n = 11), the detection ratio of HFOs was significantly higher than that of ESES at 2 weeks (81.2 vs. 27.3%), 3 months (90.9 vs. 36.4%), and 6 months (100 vs. 54.5%) post-therapy. In the non-response group (n = 4), both HFOs and ESES persisted in all children. The average IQ improved significantly only in the response with non-relapse group. The persistence of HFOs negatively correlated with both the average IQ, yet the persistence of ESES did not.
Interictal scalp HFOs may be a favorable non-invasive biomarker of predicting seizure and cognitive outcome in CSWS.
我们研究了癫痫性脑病伴睡眠中持续棘慢波（CSWS）患儿的发作间期头皮 EEG 高频振荡（HFOs）是否可以预测类固醇治疗后的发作和认知结局。
前瞻性纳入 22 例 CSWS 患儿，接受甲基泼尼松龙治疗。在治疗前后评估发作间期头皮 HFOs、棘波指数（SWI）和智商（IQ）。根据 2 周内早期癫痫发作减少率（≥50%，“反应组”；否则为“非反应组”）将患儿分为两组。根据晚期癫痫发作结果（3 个月后），“反应组”进一步分为“复发”和“非复发”亚组。
所有患儿在基线时均检测到发作间期 HFOs 和睡眠电持续状态（ESES）（定义为 SWI≥85%）。在有复发的反应组（n=11）中，HFOs 的检出率在治疗后 2 周（81.2%比 27.3%）、3 个月（90.9%比 36.4%）和 6 个月（100%比 54.5%）时显著高于 ESES。在无反应组（n=4）中，所有患儿的 HFOs 和 ESES 均持续存在。只有在无复发的反应组中，平均 IQ 显著提高。HFOs 的持续存在与平均 IQ 呈负相关，而 ESES 的持续存在则没有。
发作间期头皮 HFOs 可能是 CSWS 预测癫痫发作和认知结局的有利的非侵入性生物标志物。
