Abstract
Objective: Intracranial high frequency oscillation (HFO) occurrence rate (OR) and slow wave activity (SWA) coupling are potential markers of epileptogenicity in epileptic spasms (ES). Scalp ripple (R) detection and SWA coupling have been described in ES; however, the feasibility of scalp fast ripple (FR) detection and measurement of scalp FR coupling to SWA is not known. We evaluated interictal scalp R and FR OR and SWA coupling in pre-treatment EEG in children with short-term treatment-refractory ES compared to short-term treatment non-refractory ES. Methods: We retrospectively identified children with ES and identified HFOs using a semi-automated HFO detector on pre-treatment scalp EEG during sleep. We evaluated HFO OR and event-triggered modulation index (MI) to quantify R (100–250 Hz) and FR (250–600 Hz) coupling strength with different SWA passbands (0.5–1, 1–2, 2–3, 3–4, and 4–8 Hz). We used HFO phasor transform and circular statistics to evaluate phase coupling angle distributions. Results: We identified 15 children with ES with pre-treatment EEG recorded at 2000 Hz. Thirteen out of 15 patients had HFOs and were included for analysis. There were six treatment responders and seven nonresponders three months after treatment initiation. Responders and nonresponders were similar in age (6.1 vs 7.2 mo), ES diagnosis duration (0.7 vs 2.6 mo), and HFO OR (R: 1.07 vs 2.30/min, FR: 0.43 vs 1.96/min). No differences between responders and nonresponders were seen in HFO MI at different SWA. Coupling of R and FR to 2–3 Hz SWA demonstrated increased incidence rate ratio in nonresponders relative to responders at distinct phase coupling angle distributions. Conclusions: This study demonstrates the feasibility of interictal scalp R and FR detection and quantification of scalp R and FR coupling to SWA in ES. Significance: HFO phase coupling with SWA may be useful as a marker of potential treatment refractoriness in patients with ES.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1433-1443 |
| Number of pages | 11 |
| Journal | Clinical Neurophysiology |
| Volume | 131 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2020 |
Funding
HN is supported by Susan Spencer Clinical Research Training Fellowship in Epilepsy from the American Academy of Neurology, with funding from the American Epilepsy Society, the American Brain Foundation , and the Epilepsy Foundation . SAH has received research support from the Epilepsy Therapy Project, the Milken Family Foundation , the Hughes Family Foundation , and the Elsie and Isaac Fogelman Endowment . HN is supported by Susan Spencer Clinical Research Training Fellowship in Epilepsy from the American Academy of Neurology, with funding from the American Epilepsy Society, the American Brain Foundation, and the Epilepsy Foundation. SAH has received research support from the Epilepsy Therapy Project, the Milken Family Foundation, the Hughes Family Foundation, and the Elsie and Isaac Fogelman Endowment. RS receives royalties from the publication of ?Pediatric Neurology,? 3rd ed. (Demos Publishing, 2008) and ?Epilepsy: Mechanisms, Models, and Translational Perspectives? (CRC Press, 2011). JW has received research funding from Novartis, GW Pharmaceuticals, the National Institute of Neurological Disorders and Stroke/National Institutes of Health (NINDS/NIH; R01 NS082649, U01 NS082320, U54 NS092090, U01 NS092595), and the Today's and Tomorrow's Children Fund from UCLA Mattel Children's Hospital at the University of California Los Angeles. DB and HN do not have any conflicts of interest to disclose. SAH has received research support from Eisai, Lundbeck, Insys, GW Pharmaceuticals, UCB Biopharma, Zogenix, and the NIH (R34MH089299). He has received honoraria for service on the scientific advisory boards of Mallinckrodt, Upsher-Smith Laboratories, Insys, UCB Biopharma, Zogenix, and Amzell; as a consultant to UCB, Mallinckrodt, Insys, GW Pharma, West Therapeutic Development, Aquestive Therapeutics, and Amzell; and on the speaker's bureau for Mallinckrodt and GW Pharmaceuticals. RS serves on scientific advisory boards for and has received honoraria and funding for travel from Eisai, UCB Pharma, Sunovion, Supernus, Upsher?Smith, Acorda, and Lundbeck Pharma; serves on speakers? bureaus for and has received speaker honoraria from Eisai, UCB, GlaxoSmithKline, Cyberonics, Supernus, and Lundbeck. JW has served on the Advisory Boards and Speakers? Bureaus for Novartis Pharmaceuticals and Greenwich Biosciences. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. JW has received research funding from Novartis , GW Pharmaceuticals , the National Institute of Neurological Disorders and Stroke/National Institutes of Health (NINDS/NIH; R01 NS082649, U01 NS082320, U54 NS092090, U01 NS092595), and the Today's and Tomorrow's Children Fund from UCLA Mattel Children's Hospital at the University of California Los Angeles.
Keywords
- Cross-frequency coupling
- High frequency oscillations
- Infantile spasms
- Pediatric epilepsy
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
- Sensory Systems
- Physiology (medical)