EEG biomarkers for the diagnosis and treatment of infantile spasms
Blanca Romero Milà1,2, Kavyakantha Remakanthakurup Sindhu1, John R Mytinger3
1Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States.
Insights
Early diagnosis of infantile spasms (IS) is crucial for better outcomes. This review explores visual and computational EEG biomarkers to improve IS diagnosis, treatment response prediction, and relapse assessment.
Area of Science:
- Neuroscience
- Clinical Neurology
- Biomedical Engineering
Background:
- Infantile spasms (IS) require early diagnosis and treatment for optimal outcomes.
- Current diagnostic and prognostic tools for IS are limited, leading to misdiagnosis, treatment failure, and relapse.
- Electroencephalography (EEG) plays a vital role in IS management, prompting research into EEG biomarkers.
Purpose of the Study:
- To review existing visual and computational EEG biomarkers for infantile spasms (IS).
- To organize biomarkers by clinical application: diagnosis, treatment response, and relapse prediction.
- To identify gaps in current research and provide guidelines for future biomarker development and clinical implementation.
Main Methods:
- Literature review of visual and computational EEG biomarkers for IS.
- Categorization of biomarkers based on their clinical utility (diagnosis, treatment, prediction).
- Introduction of computational EEG measures with examples.
Main Results:
- Visual biomarkers include hypsarrhythmia, epileptiform discharges, fast oscillations, and the BASED score.
- Computational biomarkers encompass amplitude, power spectrum, entropy, connectivity, HFOs, temporal correlations, and phase-amplitude coupling.
- The review highlights the potential of various EEG markers but also points to the need for further validation.
Conclusions:
- EEG biomarkers show promise for improving the diagnosis, treatment response assessment, and relapse prediction in infantile spasms (IS).
- Further research and validation are needed to bridge the gap between biomarker discovery and clinical application.
- Standardized guidelines are essential for the development and implementation of reliable EEG biomarkers for IS.
Abstract:
Early diagnosis and treatment are critical for young children with infantile spasms (IS), as this maximizes the possibility of the best possible child-specific outcome. However, there are major barriers to achieving this, including high rates of misdiagnosis or failure to recognize the seizures, medication failure, and relapse. There are currently no validated tools to aid clinicians in assessing objective diagnostic criteria, predicting or measuring medication response, or predicting the likelihood of relapse. However, the pivotal role of EEG in the clinical management of IS has prompted many recent studies of potential EEG biomarkers of the disease. These include both visual EEG biomarkers based on human visual interpretation of the EEG and computational EEG biomarkers in which computers calculate quantitative features of the EEG. Here, we review the literature on both types of biomarkers, organized based on the application (diagnosis, treatment response, prediction, etc.). Visual biomarkers include the assessment of hypsarrhythmia, epileptiform discharges, fast oscillations, and the Burden of AmplitudeS and Epileptiform Discharges (BASED) score. Computational markers include EEG amplitude and power spectrum, entropy, functional connectivity, high frequency oscillations (HFOs), long-range temporal correlations, and phase-amplitude coupling. We also introduce each of the computational measures and provide representative examples. Finally, we highlight remaining gaps in the literature, describe practical guidelines for future biomarker discovery and validation studies, and discuss remaining roadblocks to clinical implementation, with the goal of facilitating future work in this critical area.
