Pediatric Neurology (EEG Lab), Hospital Dona Estefânia, Lisbon, Portugal; Escola Superior de Tecnologias e Saúde de Lisboa (ESTeSL), Lisbon, Portugal.
Department Clinical Neurophysiology, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal.
Epilepsy Behav. 2020 Mar;104(Pt A):106902. doi: 10.1016/j.yebeh.2020.106902. Epub 2020 Jan 25.
Continuous spike-wave of sleep (CSWS) syndrome is one of the most common epileptic encephalopathies of childhood. Because the associated cognitive/behavioral disturbances relate more to the amount of spike activity than of seizures, methods of spike quantification gained relevance in diagnosis and monitoring treatment. The conventional methodology for quantification of spike index (SI) relies on repeated full 10-20 long-term ambulatory electroencephalography (aEEG), which is both expensive and poorly tolerated.
The objectives of this study were to demonstrate the clinical value of repeated SI assessments in CSWS and to build and validate a wearable device allowing inexpensive and well-tolerated, repeated quantifications.
A group of N = 38 patients with CSWS were submitted to repeated SI quantifications based on aEEG, as seen fit by the medical clinical assistant. Responses to therapy with corticosteroids (N = 10), sulthiame (N = 7), and the ketogenic diet (N = 3) were monitored. We used a conventional method based on a semiautomatic template match spike search. The individual variability in time spans of days (N = 4) or months (N = 10) was assessed and used to determine the meaningful neurophysiological responses to the diverse therapies. A wearable device capable of recording 2 bipolar EEG channels for 24 h was used to simplify SI quantification.
Corticosteroids produced the most powerful SI reduction, but a large individual variability in both amount and time of onset of clinical response with some patients exhibiting recurrence shortly after therapy. A more frequent sampling of SI would provide a more accurate follow-up, with clinical benefit. The comparison of the SI obtained from standard 10-20 electrodes and 2 bipolar EEG channel subsets in aEEG or between the 10-20 and simultaneous wearable recordings, demonstrated that the new method provides an accurate SI quantification.
A wearable EEG device with 2 bipolar channels simplifies the process of obtaining repeated SI quantification allowing a more accurate follow-up of spike activity in the clinical setting.
睡眠中持续棘慢波（CSWS）综合征是儿童中最常见的癫痫性脑病之一。由于相关的认知/行为障碍与棘波活动的数量而非发作的数量有关，因此棘波量化方法在诊断和监测治疗方面变得具有相关性。量化棘波指数（SI）的传统方法依赖于重复的 10-20 长程动态脑电图（aEEG），这种方法既昂贵又难以耐受。
本研究的目的是证明 CSWS 中重复 SI 评估的临床价值，并构建和验证一种允许廉价且耐受良好、重复量化的可穿戴设备。
一组 N=38 例 CSWS 患者根据医疗临床助理的要求进行了重复的 SI 量化。监测了皮质类固醇（N=10）、硫必利（N=7）和生酮饮食（N=3）治疗的反应。我们使用了一种基于半自动模板匹配棘波搜索的传统方法。评估了日间（N=4）或月间（N=10）时间跨度的个体可变性，并将其用于确定对各种治疗的有意义的神经生理反应。使用能够记录 2 个双极 EEG 通道 24 小时的可穿戴设备来简化 SI 量化。
皮质类固醇产生了最强大的 SI 降低，但临床反应的数量和时间存在很大的个体差异，一些患者在治疗后不久就出现复发。更频繁地采样 SI 将提供更准确的随访，带来临床益处。标准 10-20 电极和 aEEG 中 2 个双极 EEG 通道子集或 10-20 与同时可穿戴记录之间获得的 SI 的比较表明，新方法提供了准确的 SI 量化。
具有 2 个双极通道的可穿戴 EEG 设备简化了重复 SI 量化的过程，允许在临床环境中更准确地跟踪棘波活动。
