目的:我们研究了癫痫性脑病患儿在睡眠过程中持续尖峰波(CSWS)的发作间头皮脑电图高频振荡(HFO)的存在是否可以预测类固醇治疗后的癫痫发作和认知结局。
方法:前瞻性纳入22例CSWS患儿,并接受甲基强的松龙治疗。发作间头皮HFOs,分别于治疗前后进行秒波指数(SWI)和智商(IQ)评估。根据2周时的早期癫痫发作减少率(≥50%,\"响应组\";否则\"非响应组\")。根据晚期癫痫发作结果(3个月后),将“反应组”进一步分为两个亚组(“复发”和“非复发”亚组)。
结果:在基线时,所有儿童均检测到发作间HFO和睡眠中的电癫痫持续状态(ESES)(定义为SWI≥85%)。在有复发反应组(n=11)中,2周时HFOs检出率明显高于ESES(81.2vs.27.3%),3个月(90.9与36.4%),和6个月(100vs.54.5%)治疗后。在无反应组(n=4)中,HFOs和ESES都适用于所有儿童。平均智商仅在无复发组的反应中显着提高。HFOs的持久性与平均智商呈负相关,然而,ESES的持久性没有。
结论:间期头皮HFOs可能是预测CSWS癫痫发作和认知结果的有利的非侵入性生物标志物。
OBJECTIVE: We investigated whether the presence of interictal scalp EEG high frequency oscillations (HFOs) in children with epileptic encephalopathy with continuous spike-and-wave during sleep (
CSWS) can predict seizure and cognitive outcome after steroid therapy.
METHODS: Twenty-two children with
CSWS were prospectively enrolled and received methylprednisolone therapy. Interictal scalp HFOs, spike wave index (SWI) and intelligence quotient (IQ) were assessed before and after the treatment. The children were divided into two groups based on the early seizure reduction ratio at 2 weeks (≥50%, \"response group\"; otherwise \"non-response group\"). The \"response group\" was further divided into two subgroups (\"relapse\" and \"non-relapse\" subgroups) according to the late seizure outcome (after 3 months).
RESULTS: Interictal HFOs and electrical status epilepticus in sleep (ESES) (defined as SWI ≥ 85%) were detected in all children at the baseline. In the response with relapse group (n = 11), the detection ratio of HFOs was significantly higher than that of ESES at 2 weeks (81.2 vs. 27.3%), 3 months (90.9 vs. 36.4%), and 6 months (100 vs. 54.5%) post-therapy. In the non-response group (n = 4), both HFOs and ESES persisted in all children. The average IQ improved significantly only in the response with non-relapse group. The persistence of HFOs negatively correlated with both the average IQ, yet the persistence of ESES did not.
CONCLUSIONS: Interictal scalp HFOs may be a favorable non-invasive biomarker of predicting seizure and cognitive outcome in
CSWS.