Related Experiment Video
Updated: Nov 9, 2025
Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017
A reliable interictal EEG grading scale for children with infantile spasms - The 2021 BASED score
John R Mytinger1, Jorge Vidaurre1, Melissa Moore-Clingenpeel2
1Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43205, USA.
Insights
A new electroencephalogram (EEG) grading scale, the 2021 BASED score, was developed for infantile spasms. It demonstrates high inter-rater reliability and effectively correlates with infantile spasms, aiding clinical assessment.
Area of Science:
- Pediatric Neurology
- Clinical Electrophysiology
Background:
- Infantile spasms (IS) diagnosis relies on electroencephalogram (EEG) interpretation.
- Existing grading scales may lack sufficient inter-rater reliability (IRR).
Purpose of the Study:
- To develop an improved interictal EEG grading scale for infantile spasms.
- Establish a scale with adequate IRR for clinical and research use.
Main Methods:
- Three blinded reviewers assessed 93 EEGs from 62 children (controls and IS patients).
- Evaluated IRR of specific EEG elements: background amplitude, epileptiform discharges, spike foci, grouped multifocal spikes (GMFS), voltage attenuations, and spindle symmetry.
- Finalized the 2021 BASED (Burden of AmplitudeS and Epileptiform Discharges) score.
Main Results:
- All elements in the 2021 BASED score showed moderate to near-perfect IRR.
- Abnormal high amplitude background waves were defined (>200 μv, >300 μv in specific regions).
- Paroxysmal voltage attenuations, GMFS, and >50% >3 spike foci distinguished pre- and post-treatment IS studies.
Conclusions:
- The 2021 BASED score incorporates elements with high IRR.
- The score correlates well with the presence or absence of infantile spasms.
- This scale supports improved clinical and research evaluation of infantile spasms.
Objective:
To develop an improved interictal electroencephalogram (EEG) grading scale for children with infantile spasms founded on elements with adequate inter-rater reliability (IRR) to justify its further study for clinical and research purposes.
Methods:
Three blinded reviewers assessed five-minute sleep epochs in 93 EEGs from 62 children (31 consecutive controls, 31 consecutive infantile spasms [pretreatment and posttreatment studies]) using a longitudinal bipolar montage. We determined the IRR of background amplitude, epileptiform discharges, >3 spike foci (including <50 % or >50 %), grouped multifocal spikes, paroxysmal voltage attenuations, and symmetry of sleep spindles. Data were used to finalize the 2021 BASED (Burden of AmplitudeS and Epileptiform Discharges) score.
Results:
All elements included in the 2021 BASED score had moderate to near perfect IRR. Among controls, >200 μv background waves occurred commonly in the bilateral posterior temporal (T3-T5, T4-T6) and midline (Fz-Cz, Cz-Pz) regions. Excluding midline and occipital channels (which have normal high amplitude background waves), we designated abnormal high amplitude background waves as >200 μv for most channels, but >300 μv for T3-T5 and T4-T6. The IRR was moderate to near perfect for <50 % >3 spike foci, >50 % >3 spike foci, paroxysmal voltage attenuations, grouped multifocal spikes (GMFS), and symmetric sleep spindles. Paroxysmal voltage attenuations, GMFS, and >50 % >3 spike foci all significantly distinguished pretreatment from posttreatment studies whereas symmetric sleep spindles did not (as planned, the latter was not included in the 2021 BASED score). When the 2021 BASED score was applied to the 22 children with infantile spasms achieving clinical remission with treatment, 19 met criteria for electroclinical remission and three did not.
Significance:
The 2021 BASED score includes elements with high levels of IRR and correlates well with the presence or absence of infantile spasms.
More Related Videos
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
09:57Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
