Scalp EEG spikes predict impending epilepsy in TSC infants: A longitudinal observational study
Joyce Y Wu1, Monisha Goyal2, Jurriaan M Peters3
1Division of Pediatric Neurology, UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Insights
Interictal epileptiform discharges (IEDs) on electroencephalography (EEG) predict epilepsy in most infants with tuberous sclerosis complex (TSC). Ongoing seizures, not IEDs, correlate with neurocognitive decline in these children.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurodevelopmental Disorders
Background:
- Tuberous sclerosis complex (TSC) is a genetic disorder associated with a high risk of epilepsy and neurodevelopmental challenges.
- Early identification of epilepsy risk and neurocognitive outcomes in infants with TSC is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of routine electroencephalography (EEG) in seizure-naive infants with TSC for the development of epilepsy.
- To assess the relationship between EEG findings, epilepsy, and subsequent neurocognitive outcomes in infants with TSC.
Main Methods:
- Forty seizure-naive infants under 7 months with TSC underwent 1-hour awake and asleep video-EEG and developmental assessments (Mullen, Vineland-II) until 2 years of age.
- EEG data, including interictal epileptiform discharges (IEDs), were analyzed for predictive value of clinical seizures.
- Neurocognitive outcomes were assessed at 6, 12, and 24 months.
Main Results:
- Interictal epileptiform discharges (IEDs) on EEG had a 77.3% positive predictive value for developing epilepsy by age 2.
- IEDs preceded clinical seizures by a mean of 3.6 months.
- Significant neurocognitive decline was observed only in infants with persistent seizures, not those without seizures or with controlled seizures.
Conclusions:
- Routine EEG with IED detection is a valuable tool for predicting epilepsy in infants with TSC.
- Persistent seizures, rather than a history of IEDs or controlled seizures, are associated with poorer neurocognitive outcomes in TSC.
- EEG can serve as a biomarker for epileptogenesis in TSC infants, guiding early management strategies.
Objective:
To determine if routine electroencephalography (EEG) in seizure-naive infants with tuberous sclerosis complex (TSC) can predict epilepsy and subsequent neurocognitive outcomes.
Methods:
Forty infants 7 months of age or younger and meeting the genetic or clinical diagnostic criteria for tuberous sclerosis were enrolled. Exclusion criteria included prior history of seizures or treatment with antiseizure medications. At each visit, seizure history and 1-hour awake and asleep video-EEG, standardized across all sites, were obtained until 2 years of age. Developmental assessments (Mullen and Vineland-II) were completed at 6, 12, and 24 months of age.
Results:
Of 40 infants enrolled (mean age of 82.4 days), 32 completed the study. Two were lost to follow-up and six were treated with antiepileptic drugs (AEDs) due to electrographic seizures and/or interictal epileptiform discharges (IEDs) on their EEG studies prior to the onset of clinical seizures. Seventeen of the 32 remaining children developed epilepsy at a mean age of 7.5 months (standard deviation [SD] = 4.4). Generalized/focal slowing, hypsarrhythmia, and generalized/focal attenuation were not predictive for the development of clinical seizures. Presence of IEDs had a 77.3% positive predictive value and absence a 70% negative predictive value for developing seizures by 2 years of age. IEDs preceded clinical seizure onset by 3.6 months (mean). Developmental testing showed significant decline, only in infants with ongoing seizures, but not infants who never developed seizures or whose seizures came under control.
Significance:
IEDs identify impending epilepsy in the majority (77%) of seizure-naive infants with TSC. The use of a 1-hour awake and asleep EEG can be used as a biomarker for ongoing epileptogenesis in most, but not all, infants with TSC. Persistent seizures, but not history of interictal epileptiform activity or history of well-controlled seizures, correlated with low scores on the Vineland and Mullen tests at 2 years of age.
More Related Videos
08:23A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
09:57Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024