TY - JOUR
T1 - Paroxysmal fast activity
T2 - An interictal scalp EEG marker of epileptogenesis in children
AU - Wu, Joyce Y.
AU - Koh, Susan
AU - Sankar, Raman
AU - Mathern, Gary W.
N1 - Funding Information:
This study was supported by NIH grants K23 NS051637 to JYW, R01 NS046516 to RS, and R01 NS038992 and P01 NS002808 to GWM.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2008/11
Y1 - 2008/11
N2 - Purpose: High-frequency oscillations (>100 Hz) have been proposed as localized markers of epileptic networks, but require intracranial electroencephalographic (EEG) recordings. This study explored if β- and γ-frequency paroxysmal fast activity (PFA), recorded interictally during non-REM sleep, could be used as a scalp EEG marker of epileptogenesis in children. Methods: The presence and scalp location of PFA was visually identified in 681 patients with overnight video-EEG (age 0-18 years), and compared with ictal onset sites. The clinical features of patients with PFA were compared with patients without PFA along with evidence of PFA evolution in 35 patients who had multiple video-EEG records. Results: PFA was present in 16% of all patients and in 28% of those with seizures. PFA was more frequently observed in EEGs from patients 3 years of age or younger (>40%), and children with infantile spasms (85%). When present, PFA predicted if the patient had epilepsy with 97% accuracy, and was not found in individuals with non-epileptic events. PFA localized with EEG-ictal onset sites with 91% sensitivity and 82% accuracy. Ictal scalp EEG events began with β- and γ-frequencies in 80% of patients with PFA, and they had increased seizure frequencies compared with non-PFA cases. In patients with multiple video-EEG studies, PFA showed progression over increased numbers of electrodes in 74%, improvement in 15%, and remained unchanged in 12% and correlated with seizure evolution. PFA was not associated with other seizure types, anatomic location, type of antiepileptic drug, etiology, or histopathology. Conclusions: While relatively infrequent, interictal PFA was specific in identifying younger children with epilepsy, co-localized with the ictal onset sites on scalp video-EEG, and progressed and correlated with seizure severity. We propose that PFA is a scalp EEG marker of epileptic networks with the advantage of being recorded non-invasively during interictal non-REM sleep.
AB - Purpose: High-frequency oscillations (>100 Hz) have been proposed as localized markers of epileptic networks, but require intracranial electroencephalographic (EEG) recordings. This study explored if β- and γ-frequency paroxysmal fast activity (PFA), recorded interictally during non-REM sleep, could be used as a scalp EEG marker of epileptogenesis in children. Methods: The presence and scalp location of PFA was visually identified in 681 patients with overnight video-EEG (age 0-18 years), and compared with ictal onset sites. The clinical features of patients with PFA were compared with patients without PFA along with evidence of PFA evolution in 35 patients who had multiple video-EEG records. Results: PFA was present in 16% of all patients and in 28% of those with seizures. PFA was more frequently observed in EEGs from patients 3 years of age or younger (>40%), and children with infantile spasms (85%). When present, PFA predicted if the patient had epilepsy with 97% accuracy, and was not found in individuals with non-epileptic events. PFA localized with EEG-ictal onset sites with 91% sensitivity and 82% accuracy. Ictal scalp EEG events began with β- and γ-frequencies in 80% of patients with PFA, and they had increased seizure frequencies compared with non-PFA cases. In patients with multiple video-EEG studies, PFA showed progression over increased numbers of electrodes in 74%, improvement in 15%, and remained unchanged in 12% and correlated with seizure evolution. PFA was not associated with other seizure types, anatomic location, type of antiepileptic drug, etiology, or histopathology. Conclusions: While relatively infrequent, interictal PFA was specific in identifying younger children with epilepsy, co-localized with the ictal onset sites on scalp video-EEG, and progressed and correlated with seizure severity. We propose that PFA is a scalp EEG marker of epileptic networks with the advantage of being recorded non-invasively during interictal non-REM sleep.
KW - Electroencephalography
KW - Epilepsy
KW - Fast ripples
KW - Hypsarrythmia
KW - Ictogenesis
KW - Lennox-Gastaut
KW - PFA
UR - http://www.scopus.com/inward/record.url?scp=64149112422&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=64149112422&partnerID=8YFLogxK
U2 - 10.1016/j.eplepsyres.2008.07.010
DO - 10.1016/j.eplepsyres.2008.07.010
M3 - Article
C2 - 18804956
AN - SCOPUS:64149112422
SN - 0920-1211
VL - 82
SP - 99
EP - 106
JO - Epilepsy Research
JF - Epilepsy Research
IS - 1
ER -