Electroencephalographic evolution of hypsarrhythmia: Toward an early treatment option

Summary Purpose:  A retrospective study for a classification of prehypsarrhythmic elecroencephalographies (EEGs) was carried out to enable an early treatment option for West syndrome. Methods:  Out of 39 infants with symptomatic West syndrome, 18 infants (age 3–14 months) with 61 serial non‐REM slee...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2008-11, Vol.49 (11), p.1859-1864
Main Authors: Philippi, Heike, Wohlrab, Gabriele, Bettendorf, Uli, Borusiak, Peter, Kluger, Gerhard, Strobl, Karl, Bast, Thomas
Format: Article
Language:English
Subjects:
Anticonvulsants - therapeutic use
Biological and medical sciences
Children
EEG
Electroencephalography
Female
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
Hypsarrhythmia
Infant
Male
Medical sciences
Nervous system (semeiology, syndromes)
Neurology
Neuropharmacology
Neuroprotective agent
Pharmacology. Drug treatments
Prediction
Retrospective Studies
Sleep Stages - physiology
Spasms, Infantile - diagnosis
Spasms, Infantile - drug therapy
Spasms, Infantile - physiopathology
West syndrome
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Summary:Summary Purpose:  A retrospective study for a classification of prehypsarrhythmic elecroencephalographies (EEGs) was carried out to enable an early treatment option for West syndrome. Methods:  Out of 39 infants with symptomatic West syndrome, 18 infants (age 3–14 months) with 61 serial non‐REM sleep EEG records of the prehypsarrhythmic phase were identified. The prehypsarrhythmic phase encompassed 2 to 13 months (mean 4.5 months) after an initial insult. A classification system of three EEG types corresponding to the clinical states prior to West syndrome occurrence was developed. In addition, follow‐up of all patients presenting with type 2 EEGs (n = 22) was evaluated. Results:  Three clinical states and corresponding EEG types were classified. Clinical state 1 (weeks to months, silent phase) presented with (multi‐)focal epileptic discharges 50% of the non‐REM EEG recording time within abnormal background activity (imminent hypsarrhythmia). Clinical state 3 (mental deterioration) was characterized by hypsarryhthmia. Interrater reliability of seven blinded raters was good (median weighted κ 0.67). Out of 22 patients presenting with type 2 EEGs, two were lost for follow‐up, and 16 developed West syndrome, whereas four were treated early with anti‐epileptic drugs and remained stable. Conclusions:  Infants with West syndrome could be reliably identified several weeks before the occurrence of hypsarrhythmia by a typical EEG pattern (type 2), thereby opening the way for early intervention studies.
ISSN:0013-9580
1528-1167
DOI:10.1111/j.1528-1167.2008.01715.x