Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Ann Neurol. 2021 Jan;89(1):134-142. doi: 10.1002/ana.25939. Epub 2020 Oct 31.
Identification of children at risk of developing epilepsy after a first unprovoked seizure can be challenging. Interictal epileptiform discharges are associated with higher risk but have limited sensitivity and specificity. High frequency oscillations (HFOs) are newer biomarkers for epileptogenesis. We prospectively evaluated the predictive value of HFOs for developing epilepsy in scalp electroencephalogram (EEG) of children after a first unprovoked seizure.
After their first seizure, 56 children were followed prospectively over 12 months and then grouped in "epilepsy" or "no epilepsy." Initial EEGs were visually analyzed for spikes, spike ripples, and ripples. Inter-group comparisons of spike-rates and HFO-rates were done by Mann-Whitney U test. Predictive values and optimal thresholds were calculated by receiver operating characteristic (ROC) curves.
In the epilepsy group (n = 26, 46%), mean rates of ripples (0.3 vs 0.09 / minute, p < 0.0001) and spike ripples (0.6 vs 0.06 / minute, p < 0.05) were significantly higher, with no difference in spike rates (1.7 vs 3.0 / minute, p = 0.38). Of those 3 markers, ripples showed the best predictive value (area under the curve [AUC] = 0.88). The optimal threshold for ripples was calculated to be ≥ 0.125 / minute with a sensitivity of 87% and specificity of 85%. Ripple rates were negatively correlated to days passing before epilepsy-diagnosis (R = -0.59, p < 0.0001) and time to a second seizure (R = -0.64, 95% confidence interval [CI] = -0.77 to 0.43, p < 0.0001).
We could show that in a cohort of children with a first unprovoked seizure, ripples predict the development of epilepsy better than spikes or spike ripples and might be useful biomarkers in the estimation of prognosis and question of treatment. ANN NEUROL 2021;89:134-142.
识别首次无诱因发作后有癫痫风险的儿童具有挑战性。发作间期癫痫样放电与更高的风险相关，但敏感性和特异性有限。高频振荡（HFOs）是癫痫发生的新生物标志物。我们前瞻性评估了 HFOs 在儿童首次无诱因发作后头皮脑电图（EEG）中发展为癫痫的预测价值。
在首次发作后，56 名儿童进行了前瞻性随访 12 个月，然后分为“癫痫”或“非癫痫”组。对初始 EEG 的棘波、棘慢波和锐慢波进行视觉分析。采用 Mann-Whitney U 检验比较两组之间的棘波率和 HFO 率。通过受试者工作特征（ROC）曲线计算预测值和最佳阈值。
在癫痫组（n=26，46%）中，锐波（0.3 与 0.09/分钟，p<0.0001）和棘慢波锐波（0.6 与 0.06/分钟，p<0.05）的平均率明显更高，而棘波率无差异（1.7 与 3.0/分钟，p=0.38）。在这 3 个标志物中，锐波具有最佳的预测价值（曲线下面积[AUC]=0.88）。计算出锐波的最佳阈值为≥0.125/分钟，灵敏度为 87%，特异性为 85%。锐波率与癫痫诊断前的天数（R=-0.59，p<0.0001）和第二次发作的时间（R=-0.64，95%置信区间[CI]为-0.77 至 0.43，p<0.0001）呈负相关。
我们发现，在首次无诱因发作的儿童队列中，锐波比棘波或棘慢波锐波更能预测癫痫的发生，并且可能是评估预后和治疗问题的有用生物标志物。
