Mark A Kramer Lauren
M Ostrowski Daniel Y Song Emily L Thorn
Sally M Stoyell McKenna Parnes
Dhinakaran Chinappen Grace
Xiao Uri T Eden Kevin J Staley Steven M Stufflebeam Catherine J Chu. Scalp recorded spike ripples predict seizure
risk in childhood epilepsy better than spikes.
Brain, awz059, https://doi.org/10.1093/brain/awz059. Published: 25 March 2019
Abstract
In the past decade, brief bursts of fast oscillations in the
ripple range have been identified in the scalp EEG as a promising non-invasive
biomarker for epilepsy. However, investigation and clinical application of this
biomarker have been limited because standard approaches to identify these
brief, low amplitude events are difficult, time consuming, and subjective.
Recent studies have demonstrated that ripples co-occurring with epileptiform
discharges (‘spike ripple events’) are easier to detect than ripples alone and
have greater pathological significance. Here, we used objective techniques to
quantify spike ripples and test whether this biomarker predicts seizure risk in
childhood epilepsy. We evaluated spike ripples in scalp EEG recordings from a
prospective cohort of children with a self-limited epilepsy syndrome, benign
epilepsy with centrotemporal spikes, and healthy control children. We compared
the rate of spike ripples between children with epilepsy and healthy controls,
and between children with epilepsy during periods of active disease (active,
within 1 year of seizure) and after a period of sustained seizure-freedom
(seizure-free, >1 year without seizure), using semi-automated and automated
detection techniques. Spike ripple rate was higher in subjects with active
epilepsy compared to healthy controls (P = 0.0018) or subjects with epilepsy
who were seizure-free ON or OFF medication (P = 0.0018). Among epilepsy
subjects with spike ripples, each month seizure-free decreased the odds of a
spike ripple by a factor of 0.66 [95% confidence interval (0.47, 0.91), P =
0.021]. Comparing the diagnostic accuracy of the presence of at least one spike
ripple versus a classic spike event to identify group, we found comparable
sensitivity and negative predictive value, but greater specificity and positive
predictive value of spike ripples compared to spikes (P = 0.016 and P = 0.006,
respectively). We found qualitatively consistent results using a fully
automated spike ripple detector, including comparison with an automated spike
detector. We conclude that scalp spike ripple events identify disease and track
with seizure risk in this epilepsy population, using both semi-automated and
fully automated detection methods, and that this biomarker outperforms analysis
of spikes alone in categorizing seizure risk. These data provide evidence that
spike ripples are a specific non-invasive biomarker for seizure risk in benign
epilepsy with centrotemporal spikes and support future work to evaluate the
utility of this biomarker to guide medication trials and tapers in these
children and predict seizure risk in other at-risk populations.
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"This biomarker outperforms analysis of spikes alone in
categorizing seizure risk," Dr. Catherine J. Chu of Massachusetts General
Hospital and Harvard University in Boston and colleagues conclude. "These
data provide evidence that spike ripples are a specific non-invasive biomarker
for seizure risk in benign epilepsy with centrotemporal spikes (BECTS)."
The team prospectively evaluated spike ripples in scalp
electroencephalography (EEG) recordings from 21 children between 5 and 17 years
of age with BECTS and 13 healthy controls between 9 and 14 years of age, at one
medical center. Children without both a history of focal motor or generalized
seizures and an EEG showing sleep-activated centrotemporal spikes were excluded
from the study…
Dr. Ahmed T. Abdelmoity, director of the division of child
neurology at Children's Mercy Kansas City in Missouri, told Reuters Health by
email, "BECTS sometimes poses a challenge in the neurology clinic as most
patients have a benign course and will not require treatment; however about 10%
to 15% will require treatment and sometimes might develop a drug-resistant form
of epilepsy."
Dr. Abdelmoity, who was not involved in the study, noted
that "accuracy in predicting patients who might require treatment through
EEG and initiating treatment earlier are important, to help prevent seizures
and reduce family anxiety."
"These findings bring clarity, with the knowledge that
patients with BECTS can have different outcomes," he added. "They
also explain some of the neurophysiology of those outcomes."
The researchers recommend further related studies to
investigate using this biomarker to guide medication and predict seizure risk.
https://www.medscape.com/viewarticle/911979
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