Scalp EEG interictal high frequency oscillations as an objective biomarker of infantile spasms

Hiroki Nariai*, Shaun A. Hussain, Danilo Bernardo, Hirotaka Motoi, Masaki Sonoda, Naoto Kuroda, Eishi Asano, Jimmy C. Nguyen, David Elashoff, Raman Sankar, Anatol Bragin, Richard J. Staba, Joyce Y. Wu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To investigate the diagnostic utility of high frequency oscillations (HFOs) via scalp electroencephalogram (EEG) in infantile spasms. Methods: We retrospectively analyzed interictal slow-wave sleep EEGs sampled at 2,000 Hz recorded from 30 consecutive patients who were suspected of having infantile spasms. We measured the rate of HFOs (80–500 Hz) and the strength of the cross-frequency coupling between HFOs and slow-wave activity (SWA) at 3–4 Hz and 0.5–1 Hz as quantified with modulation indices (MIs). Results: Twenty-three patients (77%) exhibited active spasms during the overnight EEG recording. Although the HFOs were detected in all children, increased HFO rate and MIs correlated with the presence of active spasms (p < 0.001 by HFO rate; p < 0.01 by MIs at 3–4 Hz; p = 0.02 by MIs at 0.5–1 Hz). The presence of active spasms was predicted by the logistic regression models incorporating HFO-related metrics (AUC: 0.80–0.98) better than that incorporating hypsarrhythmia (AUC: 0.61). The predictive performance of the best model remained favorable (87.5% accuracy) after a cross-validation procedure. Conclusions: Increased rate of HFOs and coupling between HFOs and SWA are associated with active epileptic spasms. Significance: Scalp-recorded HFOs may serve as an objective EEG biomarker for active epileptic spasms.

Original languageEnglish (US)
Pages (from-to)2527-2536
Number of pages10
JournalClinical Neurophysiology
Issue number11
StatePublished - Nov 2020
Externally publishedYes


  • FR
  • HFO
  • Modulation index
  • Physiological HFO
  • Ripple

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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