PDF(Pubmed)
Abstract：
OBJECTIVE: Infantile epileptic spasms syndrome (IESS) is a common and urgent diagnosis with seizure and nonseizure mimics. Evaluation with prolonged video-electroencephalography (EEG) can be time-consuming and costly. This study investigated the use of EEG review of a single sleep-wake cycle to exclude IESS.
METHODS: We retrospectively reviewed video-EEG studies to rule out IESS in children between the ages of 2 months and 2 years in the period from January 2019 through June 2020. EEG studies were reviewed from the start of the recording through the first sleep-wake cycle and scored as \"normal,\" \"consistent with IESS,\" or \"abnormal but not diagnostic of IESS.\" Scores were compared to the clinical report created by analysis of the entire video-EEG.
RESULTS: Inclusion criteria were met in 238 EEG studies. The mean patient age was 7.6 months. The median duration of the full study was 908 min, compared to 107.5 min for the first sleep-wake cycle only. The median difference in recording time was 801 min, p-value < .01. Scored outcomes were similar. Sixty-eight percent of EEG studies were scored as \"normal\" on first sleep-wake cycle review as compared to 63% on full study review, 13% scored as \"consistent with IESS\" compared to 16% and 19% scored as \"abnormal but not diagnostic of IESS\" compared to 21%. Sensitivity and specificity of the first sleep-wake cycle review for studies \"consistent with IESS\" was 84% and 100%, respectively. No cases of IESS were scored as normal on first sleep-wake cycle review.
CONCLUSIONS: A single sleep-wake cycle captured on EEG can triage studies when IESS is suspected. A normal first sleep-wake cycle did not miss cases of IESS and could result in reduced EEG recording time. Because most of these cases presented to an emergency department, a normal first sleep-wake cycle may help providers determine the acuity, or necessity, of further testing.
METHODS: We retrospectively reviewed video-EEG studies to rule out IESS in children between the ages of 2 months and 2 years in the period from January 2019 through June 2020. EEG studies were reviewed from the start of the recording through the first sleep-wake cycle and scored as \"normal,\" \"consistent with IESS,\" or \"abnormal but not diagnostic of IESS.\" Scores were compared to the clinical report created by analysis of the entire video-EEG.
RESULTS: Inclusion criteria were met in 238 EEG studies. The mean patient age was 7.6 months. The median duration of the full study was 908 min, compared to 107.5 min for the first sleep-wake cycle only. The median difference in recording time was 801 min, p-value < .01. Scored outcomes were similar. Sixty-eight percent of EEG studies were scored as \"normal\" on first sleep-wake cycle review as compared to 63% on full study review, 13% scored as \"consistent with IESS\" compared to 16% and 19% scored as \"abnormal but not diagnostic of IESS\" compared to 21%. Sensitivity and specificity of the first sleep-wake cycle review for studies \"consistent with IESS\" was 84% and 100%, respectively. No cases of IESS were scored as normal on first sleep-wake cycle review.
CONCLUSIONS: A single sleep-wake cycle captured on EEG can triage studies when IESS is suspected. A normal first sleep-wake cycle did not miss cases of IESS and could result in reduced EEG recording time. Because most of these cases presented to an emergency department, a normal first sleep-wake cycle may help providers determine the acuity, or necessity, of further testing.
摘要：
目的：婴儿癫痫性痉挛综合征（IESS）是癫痫发作和非癫痫模拟的常见和紧急诊断。使用长时间的视频脑电图（EEG）进行评估可能是耗时且昂贵的。这项研究调查了使用EEG回顾单个睡眠-觉醒周期来排除IESS。
方法：我们回顾性回顾了视频脑电图研究，以排除2019年1月至2020年6月期间2个月至2岁儿童的IESS。EEG研究从记录开始到第一个睡眠-觉醒周期进行回顾，并评分为“正常”，“\”与IESS一致，\"或\"异常，但不能诊断IESS。“将分数与通过分析整个视频脑电图创建的临床报告进行比较。
结果：238项脑电图研究符合纳入标准。患者平均年龄为7.6个月。完整研究的中位持续时间为908分钟，与仅第一个睡眠-觉醒周期的107.5分钟相比。记录时间的中位数差异为801分钟，p值<.01。评分结果相似。在第一次睡眠-觉醒周期审查中，68%的脑电图研究被评为“正常”，而在全面研究审查中，这一比例为63%。13%的人被评为“与IESS一致”，而16%和19%的人被评为“异常但不能诊断IESS”，而21%的人被评为“异常但不能诊断IESS”。“与IESS一致”的第一次睡眠-觉醒周期审查的敏感性和特异性分别为84%和100%，分别。在第一次睡眠-觉醒周期审查中，没有IESS病例被评为正常。
结论：脑电图记录的单个睡眠-觉醒周期可以在怀疑IESS时进行分类。正常的第一个睡眠-觉醒周期不会错过IESS的病例，并且可能导致EEG记录时间减少。因为大多数这些病例都提交给急诊科，正常的第一睡眠-觉醒周期可以帮助提供者确定敏锐度，或必要性，进一步的测试。
方法：我们回顾性回顾了视频脑电图研究，以排除2019年1月至2020年6月期间2个月至2岁儿童的IESS。EEG研究从记录开始到第一个睡眠-觉醒周期进行回顾，并评分为“正常”，“\”与IESS一致，\"或\"异常，但不能诊断IESS。“将分数与通过分析整个视频脑电图创建的临床报告进行比较。
结果：238项脑电图研究符合纳入标准。患者平均年龄为7.6个月。完整研究的中位持续时间为908分钟，与仅第一个睡眠-觉醒周期的107.5分钟相比。记录时间的中位数差异为801分钟，p值<.01。评分结果相似。在第一次睡眠-觉醒周期审查中，68%的脑电图研究被评为“正常”，而在全面研究审查中，这一比例为63%。13%的人被评为“与IESS一致”，而16%和19%的人被评为“异常但不能诊断IESS”，而21%的人被评为“异常但不能诊断IESS”。“与IESS一致”的第一次睡眠-觉醒周期审查的敏感性和特异性分别为84%和100%，分别。在第一次睡眠-觉醒周期审查中，没有IESS病例被评为正常。
结论：脑电图记录的单个睡眠-觉醒周期可以在怀疑IESS时进行分类。正常的第一个睡眠-觉醒周期不会错过IESS的病例，并且可能导致EEG记录时间减少。因为大多数这些病例都提交给急诊科，正常的第一睡眠-觉醒周期可以帮助提供者确定敏锐度，或必要性，进一步的测试。
