Katyayan Akshat, Lee Steven T, Martinez Luis, Takacs Danielle S
Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Duncan Neurological Research Institute, Baylor College of Medicine, Houston, Texas, USA.
Epilepsia. 2024 Dec;65(12):3583-3594. doi: 10.1111/epi.18143. Epub 2024 Oct 15.
To determine the optimal duration of electroencephalography (EEG) recording to detect epileptic spasms (ES) based on inpatient overnight video-EEG monitoring in patients with infantile epileptic spasms syndrome (IESS) at the 2-week follow-up.
Patients with IESS and overnight EEG monitoring between January 2020 and June 2022 were retrospectively reviewed. Time-to-ES, time-to-sleep and time-to-epileptic encephalopathy (EE) per the Burden of Amplitudes and Epileptiform Discharges (BASED 2021) score. BASED 2021 score were reported. ES and sleep detection sensitivity were calculated with respect to monitoring time. Etiology, treatment, and EEG features were assessed for strength of association with continued ES. Time-to-event analysis was performed with the first ES as the event of interest.
Of 90 patients, 39 (43%) continued to have ES; 78.6% with EE continued to have ES, whereas only 27.4% without EE had ES (odds ratio [OR] 12.05). Structural etiologies were also associated with continued ES (OR 5.24). ES detection was 35.9%, 76.9%, and 84.6% at 1, 4, and 6 h, respectively, with corresponding negative likelihood ratios (NLRs) of .64, .23, and .15. ES detection reached >90% and >95% at 14 and 19 h, respectively. Sleep detection was 52.2%, 84.4%, and 95.6% at 1, 4, and 6 h, respectively, and captured in all patients by 11 h. EE was observed by 6 h for all associated patients.
Typical routine EEG durations (<1 h) were not sufficient to detect ES, EE, or sleep in patients with IESS at the 2-week follow-up. Four hour outpatient EEG will capture ES in 77% and sleep in 84% of the patients. EE, if present, was shortly after sleep onset. Additional monitoring of up to 19 h was needed to capture >95% of patients with ES. Although EE was strongly associated with continued ES, 27.4% of patients without EE demonstrated ES. This study will help guide adequate duration of EEG monitoring at the 2-week follow-up for patients with IESS.
基于对婴儿痉挛症综合征（IESS）患者进行的为期2周随访的住院夜间视频脑电图监测，确定检测癫痫痉挛（ES）的最佳脑电图（EEG）记录时长。
回顾性分析2020年1月至2022年6月期间接受IESS治疗并进行夜间EEG监测的患者。根据振幅和癫痫样放电负担（BASED 2021）评分计算出现ES的时间、入睡时间和出现癫痫性脑病（EE）的时间，并报告BASED 2021评分。计算ES和睡眠检测灵敏度与监测时间的关系。评估病因、治疗和EEG特征与持续性ES的关联强度。以首次出现ES为感兴趣事件进行事件发生时间分析。
90例患者中，39例（43%）持续出现ES；患有EE的患者中有78.6%持续出现ES，而未患EE的患者中只有27.4%出现ES（优势比[OR]为12.05）。结构性病因也与持续性ES相关（OR为5.24）。ES检测在1、4和6小时时分别为35.9%、76.9%和84.6%，相应的阴性似然比（NLR）分别为0.64、0.23和0.15。ES检测在14和19小时时分别达到>90%和>95%。睡眠检测在1、4和6小时时分别为52.2%、84.4%和95.6%，到11小时时所有患者均检测到睡眠。所有相关患者在6小时时观察到EE。
典型的常规EEG时长（<1小时）不足以在2周随访时检测IESS患者的ES、EE或睡眠。4小时的门诊EEG可在77%的患者中检测到ES，在84%的患者中检测到睡眠。如果存在EE，则在入睡后不久出现。需要额外监测长达19小时才能检测到>95%的ES患者。虽然EE与持续性ES密切相关，但27.4%未患EE的患者出现了ES。本研究将有助于指导IESS患者在2周随访时进行EEG监测的适当时长。
