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Observational Study
. 2016 Jan:54:29-34.
doi: 10.1016/j.pediatrneurol.2015.09.013. Epub 2015 Sep 25.

Clinical Electroencephalographic Biomarker for Impending Epilepsy in Asymptomatic Tuberous Sclerosis Complex Infants

Joyce Y Wu  1 , Jurriaan M Peters  2 , Monisha Goyal  3 , Darcy Krueger  4 , Mustafa Sahin  2 , Hope Northrup  5 , Kit Sing Au  5 , Gary Cutter  3 , E Martina Bebin  6
Affiliations
Observational Study

Clinical Electroencephalographic Biomarker for Impending Epilepsy in Asymptomatic Tuberous Sclerosis Complex Infants

Joyce Y Wu et al. Pediatr Neurol. 2016 Jan.

Abstract

Background: We assessed the clinical utility of routine electroencephalography (EEG) in the prediction of epilepsy onset in asymptomatic infants with tuberous sclerosis complex.

Methods: This multicenter prospective observational study recruited infants younger than 7 months, seizure-free and on no antiepileptic drugs at enrollment, who all underwent serial physical examinations and video EEGs throughout the study. Parental education on seizure recognition was completed at the time of initial enrollment. Once seizure onset occurred, standard of care was applied, and subjects were followed up until 24 months.

Results: Forty patients were enrolled, 28 older than 12 months with completed EEG evaluation at the time of this interim analysis. Of those, 19 (67.8%) developed seizures. Epileptic spasms occurred in 10 (52.6%), focal seizures in five (26.3%), generalized tonic-clonic seizure in one (5.3%), and a combination of epileptic spasms and focal seizures in three (15.7%). Fourteen infants (73.6%) had the first emergence of epileptiform abnormalities on EEG at an average age 4.2 months, preceding seizure onset by a median of 1.9 months. Hypsarrhythmia or modified hypsarrhythmia was not found in any infant before onset of epileptic spasms. All children with epileptiform discharges subsequently developed epilepsy (100% positive predictive value), and the negative predictive value for not developing epilepsy after a normal EEG was 64%.

Conclusions: Serial routine EEGs in infants with tuberous sclerosis complex is a feasible strategy to identify individuals at high risk for epilepsy. The most frequent clinical presentation was epileptic spasms followed by focal seizures, and then a combination of both seizure types.

Keywords: EEG; epileptic spasms; partial seizures; video EEG use in epilepsy.

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Figures

Figure 1
Figure 1
Cohort of TSC study participants
Figure 2
Figure 2
Summary of EEG in Relation to Clinical Seizure Onset
See this image and copyright information in PMC

Comment in

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