PDF(Pubmed)
Abstract：
OBJECTIVE: Relapse of epileptic spasms after initial treatment of infantile epileptic spasms syndrome (IESS) is common. However, past studies of small cohorts have inconsistently linked relapse risk to etiology, treatment modality, and EEG features upon response. Using a large single-center IESS cohort, we set out to quantify the risk of epileptic spasms relapse and identify specific risk factors.
METHODS: We identified all children with epileptic spasms at our center using a clinical EEG database. Using the electronic medical record, we confirmed IESS syndrome classification and ascertained treatment, response, time to relapse, etiology, EEG features, and other demographic factors. Relapse-free survival analysis was carried out using Cox proportional hazards regression.
RESULTS: Among 599 children with IESS, 197 specifically responded to hormonal therapy and/or vigabatrin (as opposed to surgery or other second-line treatments). In this study, 41 (21%) subjects exhibited relapse of epileptic spasms within 12 months of response. Longer duration of IESS prior to response (>3 months) was strongly associated with shorter latency to relapse (hazard ratio = 3.11; 95% CI 1.59-6.10; p = 0.001). Relapse was not associated with etiology, developmental status, or any post-treatment EEG feature.
CONCLUSIONS: This study suggests that long duration of IESS before response is the single largest clinical predictor of relapse risk, and therefore underscores the importance of prompt and successful initial treatment. Further study is needed to evaluate candidate biomarkers of epileptic spasms relapse and identify treatments to mitigate this risk.
CONCLUSIONS: Relapse of infantile spasms is common after initially successful treatment. With study of a large group of children with infantile spasms, we determined that relapse is linked to long duration of infantile spasms. In contrast, relapse was not associated with the cause of infantile spasms, developmental measures, or EEG features at the time of initial response. Further study is needed to identify tools to predict impending relapse of infantile spasms.
METHODS: We identified all children with epileptic spasms at our center using a clinical EEG database. Using the electronic medical record, we confirmed IESS syndrome classification and ascertained treatment, response, time to relapse, etiology, EEG features, and other demographic factors. Relapse-free survival analysis was carried out using Cox proportional hazards regression.
RESULTS: Among 599 children with IESS, 197 specifically responded to hormonal therapy and/or vigabatrin (as opposed to surgery or other second-line treatments). In this study, 41 (21%) subjects exhibited relapse of epileptic spasms within 12 months of response. Longer duration of IESS prior to response (>3 months) was strongly associated with shorter latency to relapse (hazard ratio = 3.11; 95% CI 1.59-6.10; p = 0.001). Relapse was not associated with etiology, developmental status, or any post-treatment EEG feature.
CONCLUSIONS: This study suggests that long duration of IESS before response is the single largest clinical predictor of relapse risk, and therefore underscores the importance of prompt and successful initial treatment. Further study is needed to evaluate candidate biomarkers of epileptic spasms relapse and identify treatments to mitigate this risk.
CONCLUSIONS: Relapse of infantile spasms is common after initially successful treatment. With study of a large group of children with infantile spasms, we determined that relapse is linked to long duration of infantile spasms. In contrast, relapse was not associated with the cause of infantile spasms, developmental measures, or EEG features at the time of initial response. Further study is needed to identify tools to predict impending relapse of infantile spasms.
摘要：
目的：婴儿癫痫性痉挛综合征（IESS）初始治疗后癫痫性痉挛复发很常见。然而,过去对小型队列的研究将复发风险与病因联系不一致，治疗方式，和脑电图特征的反应。使用大型单中心IESS队列，我们着手量化癫痫性痉挛复发的风险,并确定具体的危险因素.
方法：我们使用临床脑电图数据库确定了我们中心所有患有癫痫性痉挛的儿童。使用电子病历，我们确认了IESS综合征分类并确定了治疗方法，回应,是时候复发了，病因学,脑电图特征，和其他人口因素。使用Cox比例风险回归进行无复发生存分析。
结果：在599名IESS儿童中，197对激素治疗和/或vigabatrin（与手术或其他二线治疗相反）有特异性反应。在这项研究中,41（21％）受试者在反应后12个月内表现出癫痫性痉挛复发。反应前IESS持续时间较长（>3个月）与复发潜伏期较短密切相关（风险比=3.11；95％CI1.59-6.10；p=0.001）。复发与病因无关，发展状况,或任何治疗后的脑电图特征。
结论：这项研究表明，缓解前长期IESS是复发风险的最大临床预测因子，因此强调了迅速和成功的初始治疗的重要性。需要进一步的研究来评估癫痫痉挛复发的候选生物标志物，并确定减轻这种风险的治疗方法。
结论：婴儿痉挛在最初成功治疗后复发是常见的。通过对一大群婴儿痉挛儿童的研究，我们确定复发与婴儿痉挛的持续时间长有关.相比之下,复发与婴儿痉挛的原因无关，发展措施，或初始反应时的脑电图特征。需要进一步的研究来确定预测婴儿痉挛即将复发的工具。
方法：我们使用临床脑电图数据库确定了我们中心所有患有癫痫性痉挛的儿童。使用电子病历，我们确认了IESS综合征分类并确定了治疗方法，回应,是时候复发了，病因学,脑电图特征，和其他人口因素。使用Cox比例风险回归进行无复发生存分析。
结果：在599名IESS儿童中，197对激素治疗和/或vigabatrin（与手术或其他二线治疗相反）有特异性反应。在这项研究中,41（21％）受试者在反应后12个月内表现出癫痫性痉挛复发。反应前IESS持续时间较长（>3个月）与复发潜伏期较短密切相关（风险比=3.11；95％CI1.59-6.10；p=0.001）。复发与病因无关，发展状况,或任何治疗后的脑电图特征。
结论：这项研究表明，缓解前长期IESS是复发风险的最大临床预测因子，因此强调了迅速和成功的初始治疗的重要性。需要进一步的研究来评估癫痫痉挛复发的候选生物标志物，并确定减轻这种风险的治疗方法。
结论：婴儿痉挛在最初成功治疗后复发是常见的。通过对一大群婴儿痉挛儿童的研究，我们确定复发与婴儿痉挛的持续时间长有关.相比之下,复发与婴儿痉挛的原因无关，发展措施，或初始反应时的脑电图特征。需要进一步的研究来确定预测婴儿痉挛即将复发的工具。
