Confirmation of infantile spasms resolution by prolonged outpatient EEGs

Abstract Objective There is no consensus on the type or duration of the posttreatment EEG needed for assessing treatment response for infantile spasms (IS). We assessed whether outpatient electroencephalograms (EEGs) are sufficient to confirm infantile spasms (IS) treatment response. Methods Three‐y...

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Autores principales:	Christopher J. Yuskaitis, Kate Mysak, Brianna Godlewski, Bo Zhang, Chellamani Harini
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	2‐week treatment response electroencephalogram outpatient prolonged EEG predictive value West syndrome Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/4c71c07f8f6e4300beeed08c5d541743
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spelling	oai:doaj.org-article:4c71c07f8f6e4300beeed08c5d5417432021-12-01T06:09:19ZConfirmation of infantile spasms resolution by prolonged outpatient EEGs2470-923910.1002/epi4.12540https://doaj.org/article/4c71c07f8f6e4300beeed08c5d5417432021-12-01T00:00:00Zhttps://doi.org/10.1002/epi4.12540https://doaj.org/toc/2470-9239Abstract Objective There is no consensus on the type or duration of the posttreatment EEG needed for assessing treatment response for infantile spasms (IS). We assessed whether outpatient electroencephalograms (EEGs) are sufficient to confirm infantile spasms (IS) treatment response. Methods Three‐year retrospective review identified new‐onset IS patients. Only presumed responder to IS treatment at 2 weeks with a prolonged (>90 minutes) outpatient EEG to assess treatment response and at least 3‐month follow‐up were included. Hypsarrhythmia, electroclinical spasms, and sleep were evaluated for the first hour and for the duration of the EEG. Results We included 37 consecutive patients with new‐onset IS and presumed clinical response at 2 weeks posttreatment. Follow‐up outpatient prolonged EEGs (median: 150 minutes, range: 90‐240 minutes) were obtained 14 days (IQR: 13‐17) after treatment initiation. EEGs detected ongoing IS in 11 of 37 (30%) presumed early responders. Prolonged outpatient EEG had a sensitivity of 85% (confidence interval [CI] 55%‐98%) for detecting treatment failure. When hypsarrhythmia and/or electroclinical spasms were not seen, EEG had a negative predictive value 92% (CI: 75%‐99%) for confirming continued IS resolution. Outpatient EEG combined with clinical assessment, however, identified all treatment failures at 2 weeks. Compared with the entire prolonged EEG, the first‐hour recording missed IS in 45% (5/11). While sleep was captured in 95% (35/37) of the full EEG recording, the first hour of recording captured sleep in only 54% (20/37). Significance Infantile spasms treatment response can be confirmed with a clinical history of spasm freedom and an outpatient prolonged EEG without evidence for ongoing spasms (hypsarrhythmia/electroclinical spams on EEG). Outpatient prolonged EEG, but not routine EEGs, represents an alternative to inpatient long‐term monitoring for IS posttreatment EEG follow‐up.Christopher J. YuskaitisKate MysakBrianna GodlewskiBo ZhangChellamani HariniWileyarticle2‐week treatment responseelectroencephalogramoutpatient prolonged EEGpredictive valueWest syndromeNeurology. Diseases of the nervous systemRC346-429ENEpilepsia Open, Vol 6, Iss 4, Pp 714-719 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	2‐week treatment response electroencephalogram outpatient prolonged EEG predictive value West syndrome Neurology. Diseases of the nervous system RC346-429
spellingShingle	2‐week treatment response electroencephalogram outpatient prolonged EEG predictive value West syndrome Neurology. Diseases of the nervous system RC346-429 Christopher J. Yuskaitis Kate Mysak Brianna Godlewski Bo Zhang Chellamani Harini Confirmation of infantile spasms resolution by prolonged outpatient EEGs
description	Abstract Objective There is no consensus on the type or duration of the posttreatment EEG needed for assessing treatment response for infantile spasms (IS). We assessed whether outpatient electroencephalograms (EEGs) are sufficient to confirm infantile spasms (IS) treatment response. Methods Three‐year retrospective review identified new‐onset IS patients. Only presumed responder to IS treatment at 2 weeks with a prolonged (>90 minutes) outpatient EEG to assess treatment response and at least 3‐month follow‐up were included. Hypsarrhythmia, electroclinical spasms, and sleep were evaluated for the first hour and for the duration of the EEG. Results We included 37 consecutive patients with new‐onset IS and presumed clinical response at 2 weeks posttreatment. Follow‐up outpatient prolonged EEGs (median: 150 minutes, range: 90‐240 minutes) were obtained 14 days (IQR: 13‐17) after treatment initiation. EEGs detected ongoing IS in 11 of 37 (30%) presumed early responders. Prolonged outpatient EEG had a sensitivity of 85% (confidence interval [CI] 55%‐98%) for detecting treatment failure. When hypsarrhythmia and/or electroclinical spasms were not seen, EEG had a negative predictive value 92% (CI: 75%‐99%) for confirming continued IS resolution. Outpatient EEG combined with clinical assessment, however, identified all treatment failures at 2 weeks. Compared with the entire prolonged EEG, the first‐hour recording missed IS in 45% (5/11). While sleep was captured in 95% (35/37) of the full EEG recording, the first hour of recording captured sleep in only 54% (20/37). Significance Infantile spasms treatment response can be confirmed with a clinical history of spasm freedom and an outpatient prolonged EEG without evidence for ongoing spasms (hypsarrhythmia/electroclinical spams on EEG). Outpatient prolonged EEG, but not routine EEGs, represents an alternative to inpatient long‐term monitoring for IS posttreatment EEG follow‐up.
format	article
author	Christopher J. Yuskaitis Kate Mysak Brianna Godlewski Bo Zhang Chellamani Harini
author_facet	Christopher J. Yuskaitis Kate Mysak Brianna Godlewski Bo Zhang Chellamani Harini
author_sort	Christopher J. Yuskaitis
title	Confirmation of infantile spasms resolution by prolonged outpatient EEGs
title_short	Confirmation of infantile spasms resolution by prolonged outpatient EEGs
title_full	Confirmation of infantile spasms resolution by prolonged outpatient EEGs
title_fullStr	Confirmation of infantile spasms resolution by prolonged outpatient EEGs
title_full_unstemmed	Confirmation of infantile spasms resolution by prolonged outpatient EEGs
title_sort	confirmation of infantile spasms resolution by prolonged outpatient eegs
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/4c71c07f8f6e4300beeed08c5d541743
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Confirmation of infantile spasms resolution by prolonged outpatient EEGs

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