Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Pediatr Neurol. 2023 Aug;145:119-123. doi: 10.1016/j.pediatrneurol.2023.05.010. Epub 2023 May 19.
The purpose of this study was to evaluate the accuracy of parental reporting of epileptic spasms (ES) after 14 days of appropriate medical therapy for new-onset ES by comparison with extended video electroencephalography (vEEG) monitoring results.
Fifty-eight patients were identified from August 2019 to February 2021 with new-onset ES, confirmed on vEEG. Patients were initiated on appropriate treatment (high-dose steroids or vigabatrin). After two weeks of therapy, patients underwent overnight (18 to 24 hours) vEEG monitoring in the epilepsy monitoring unit. Parental reporting of presence or absence of ES on admission was compared with results of vEEG monitoring.
The 58 patients ranged in age from three to 20 months (average 7.8 months). An underlying etiology was identified in 78%, whereas 22% patients had unknown etiology. The overall accuracy of parental reporting was 74% (43 of 58) when compared with results of vEEG within 14 to 18 days of starting therapy. Of these, 65% (28 of 43) reported ES resolution and 35% (15 of 43) reported continued ES. Of the 26% (15 of 58) families who were incorrect at two-week follow-up, 67% (10 of 15) reported resolution of ES. However, a minority of families, 33% (five of 15), who continued to report spasms clinically, were inaccurate.
Although a majority of inaccurate parental reports at two weeks of treatment were due to unrecognized ES (a widely known phenomenon), a minority were conversely inaccurate due to persistent over-reporting of ES. This fact highlights the importance of correlating parental history with objective vEEG monitoring, to prevent inappropriate escalation of medication therapy.
本研究旨在通过与扩展视频脑电图 (vEEG) 监测结果比较，评估新诊断癫痫性痉挛（ES）患者在接受适当药物治疗 14 天后，父母对 ES 的报告准确性。
2019 年 8 月至 2021 年 2 月，我们从新诊断为 ES 并经 vEEG 确诊的患者中，共识别出 58 例患者。患者接受了适当的治疗（大剂量类固醇或氨己烯酸）。在治疗两周后，患者在癫痫监测单元进行了夜间（18 至 24 小时）vEEG 监测。入院时父母对 ES 存在或不存在的报告与 vEEG 监测结果进行比较。
58 例患者年龄为 3 至 20 个月（平均 7.8 个月）。78%的患者有明确病因，22%的患者病因不明。与开始治疗后 14 至 18 天的 vEEG 结果相比，父母报告的总体准确性为 74%（43/58）。其中，65%（28/43）报告 ES 缓解，35%（15/43）报告持续 ES。在 2 周随访时报告错误的 26%（15/58）家庭中，67%（10/15）报告 ES 缓解。然而，少数家庭（33%，5/15）继续报告痉挛，但临床不准确。
尽管大多数在治疗两周时不准确的父母报告是由于未识别的 ES（一种广为人知的现象）所致，但少数情况下，不准确的原因是持续过度报告 ES。这一事实突出了将父母的病史与客观 vEEG 监测相关联的重要性，以防止药物治疗的不当升级。
