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Electroencephalography in pediatric moyamoya disease: reappraisal of clinical value

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Abstract

Purpose

The clinical value of electroencephalography (EEG) in pediatric moyamoya disease has been underestimated, though the characteristic patterns are well known. We undertook this study to evaluate the clinical value of EEG as a diagnostic and postoperative follow-up modality in pediatric moyamoya disease.

Methods

We retrospectively reviewed the pre and postoperative EEG with effective hyperventilation in 127 pediatric moyamoya patients and compared their patterns with hemodynamic images.

Results

One hundred and two patients (80.3 %) among 127 showed abnormal EEG findings before revascularization surgery. The typical rebuild-up phenomenon was observed in 82 (64.6 %) and localized build-up in 32 (25.2 %) without any significant clinical ischemic events during and after hyperventilation. The rebuild-up was observed more frequently in younger age groups (less than 13 years) and Suzuki stages III. The location of the rebuild-up distribution and asymmetric build-up was consistent with the area showing hemodynamic abnormalities on single photon emission computed tomography and/or perfusion magnetic resonance imaging. Postoperative follow-up EEGs were performed in 41 patients. Six patients with remaining rebuild-up in postoperative follow-up EEG showed poorer postoperative clinical outcomes.

Conclusions

This study may reappraise EEG as an easy, safe, and adjunctive diagnostic and postoperative follow-up modality for evaluation of hemodynamic status and clinical outcome, especially in children with moyamoya disease.

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References

  1. Baba T, Houkin K, Kuroda S (2008) Novel epidemiological features of moyamoya disease. J Neurol Neurosurg Psychiatry 79(8):900–904

    Article  CAS  PubMed  Google Scholar 

  2. Caldarelli M, Di Rocco C, Gaglini P (2001) Surgical treatment of moyamoya disease in pediatric age. J Neurosurg Sci 45(2):83

    CAS  PubMed  Google Scholar 

  3. Fisch BJ (1999) Fisch and Spehlmann's EEG primer: basic principles of digital and analog EEG. Elsevier, New York

    Google Scholar 

  4. Goda M, Isono M, Ishii K, Kamida T, Abe T, Kobayashi H (2004) Long-term effects of indirect bypass surgery on collateral vessel formation in pediatric moyamoya disease. Journal of Neurosurgery: Pediatrics 100(2):156–162

    Google Scholar 

  5. Houkin K, Aoki T, Takahashi A, Abe H (1994) Diagnosis of moyamoya disease with magnetic resonance angiography. Stroke 25(11):2159–2164

    Article  CAS  PubMed  Google Scholar 

  6. Houkin K, Kuroda S, Nakayama N (2001) Cerebral revascularization for moyamoya disease in children. Neurosurgery Clinics of North America 12(3):575

    CAS  PubMed  Google Scholar 

  7. Ishikawa T, Houkin K, Kamiyama H, Abe H (1997) Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease. Stroke 28(6):1170–1173

    Article  CAS  PubMed  Google Scholar 

  8. Kameyama M, Shirane R, Tsurumi Y, Takahashi A, Fujiwara S, Suzuki J, Ito M, Ido T (1986) Evaluation of cerebral blood flow and metabolism in childhood moyamoya disease: an investigation into “re-build-up” on EEG by positron CT. Child's Nervous System 2(3):130–133

    Article  CAS  PubMed  Google Scholar 

  9. Kim CY, Wang KC, Kim SK, Chung YN, Kim HS, Cho BK (2003) Encephaloduroarteriosynangiosis with bifrontal encephalogaleo (periosteal) synangiosis in the pediatric moyamoya disease: the surgical technique and its outcomes. Child's Nervous System 19(5):316–324

    Article  PubMed  Google Scholar 

  10. Kim DS, Ko TS, Ra YS, Choi CG (2006) Postoperative electroencephalogram for follow up of pediatric moyamoya disease. J Korean Med Sci 21(3):495–499

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kim SK, Seol HJ, Cho BK, Hwang YS, Lee DS, Wang KC (2004) Moyamoya disease among young patients: its aggressive clinical course and the role of active surgical treatment. Neurosurgery 54(4):840

    Article  PubMed  Google Scholar 

  12. Kim SK, Wang KC, Kim DG, Paek SH, Chung HT, Hee M, Ahn Y, Cho BK (2000) Clinical feature and outcome of pediatric cerebrovascular disease: a neurosurgical series. Childs Nerv Syst 16(7):421–428

    Article  CAS  PubMed  Google Scholar 

  13. Kim SK, Wang KC, Kim IO, Lee DS, Cho BK (2002) Combined encephaloduroarteriosynangiosis and bifrontal encephalogaleo (periosteal) synangiosis in pediatric moyamoya disease. Neurosurgery 50(1):88–96

    PubMed  Google Scholar 

  14. Kim SK, Wang KC, Oh CW, Kim IO, Lee DS, Song IC, Cho BK (2003) Evaluation of cerebral hemodynamics with perfusion MRI in childhood moyamoya disease. Pediatr Neurosurg 38(2):68–75

    Article  PubMed  Google Scholar 

  15. Kodama N, Aoki Y, Hiraga H, Wada T, Suzuki J (1979) Electroencephalographic findings in children with moyamoya disease. Arch Neurol 36(1):16

    Article  CAS  PubMed  Google Scholar 

  16. Kurlemann G, Fahrendorf G, Krings W, Sciuk J, Palm D (1992) Characteristic EEG findings in childhood moyamoya syndrome. Neurosurg Rev 15(1):57–60

    Article  CAS  PubMed  Google Scholar 

  17. Kuroda S, Houkin K (2008) Moyamoya disease: current concepts and future perspectives. Lancet Neurol 7(11):1056–1066

    Article  PubMed  Google Scholar 

  18. Kuroda S, Kamiyama H, Isobe M, Houkin K, Abe H, Mitsumori K (1995) Cerebral hemodynamics and “re-build-up” phenomenon on electroencephalogram in children with moyamoya disease. Child's Nervous System 11(4):214–219

    Article  CAS  PubMed  Google Scholar 

  19. Mesiwala AH, Sviri G, Fatemi N, Britz GW, Newell DW (2008) Long-term outcome of superficial temporal artery–middle cerebral artery bypass for patients with moyamoya disease in the US. Neurosurg Focus 24(2):E15

    Article  PubMed  Google Scholar 

  20. Scott RM, Smith ER (2009) Moyamoya disease and moyamoya syndrome. N Engl J Med 360(12):1226–1237

    Article  CAS  PubMed  Google Scholar 

  21. So Y, Lee HY, Kim SK, Lee JS, Wang KC, Cho BK, Kang E, Lee DS (2005) Prediction of the clinical outcome of pediatric moyamoya disease with postoperative basal/acetazolamide stress brain perfusion SPECT after revascularization surgery. Stroke 36(7):1485–1489

    Article  PubMed  Google Scholar 

  22. Sunder T, Erwin C, Dubois P (1980) Hyperventilation induced abnormalities in the electroencephalogram of children with moyamoya disease. Electroencephalogr Clin Neurophysiol 49(3):414–420

    Article  CAS  PubMed  Google Scholar 

  23. Suzuki J, Takaku A (1969) Cerebrovascular "moyamoya" disease: disease showing abnormal net-like vessels in base of brain. Arch Neurol 20(3):288

    Article  CAS  PubMed  Google Scholar 

  24. Togao O, Mihara F, Yoshiura T, Tanaka A, Noguchi T, Kuwabara Y, Kaneko K, Matsushima T, Honda H (2006) Cerebral hemodynamics in moyamoya disease: correlation between perfusion-weighted MR imaging and cerebral angiography. Am J Neuroradiol 27(2):391–397

    CAS  PubMed  Google Scholar 

  25. Touho H, Karasawa J, Ohnishi H (1996) Preoperative and postoperative evaluation of cerebral perfusion and vasodilatory capacity with 99mTc-HMPAO SPECT and acetazolamide in childhood moyamoya disease. Stroke 27(2):282–289

    Article  CAS  PubMed  Google Scholar 

  26. Touho H, Karasawa J, Shishido H, Morisako T, Yamada K, Nagai S, Shibamoto K (1990) Mechanism of the re-buildup phenomenon in moyamoya disease—analysis of local cerebral hemodynamics with intra-arterial digital subtraction angiography. Neurol Med Chir 30(10):721

    Article  CAS  Google Scholar 

  27. Vendrame M, Kalelyias J, Loddenkemper T, Smith E, Rockoff M, Manganaro S, McKenzie B, Gao L, Scott M, Bourgeois B, Kothare S (2011) Encephalogram monitoring during intracranial surgery for moyamoya disease. Pediatr Neurol 44:427–432

    Article  PubMed  Google Scholar 

  28. Wakai K, Tamakoshi A, Ikezaki K, Fukui M, Kawamura T, Aoki R, Kojima M, Lin Y, Ohno Y (1997) Epidemiological features of moyamoya disease in Japan: findings from a nationwide survey. Clin Neurol Neurosurg 99:S1–S5

    Article  PubMed  Google Scholar 

  29. Yamada I, Suzuki S, Matsushima Y (1995) Moyamoya disease: diagnostic accuracy of MRI. Neuroradiology 37(5):356–361

    Article  CAS  PubMed  Google Scholar 

  30. Yamatani M, Konishi T, Murakami M, Okuda T (1994) Hyperventilation activation on EEG recording in childhood. Epilepsia 35(6):1199–1203

    Article  CAS  PubMed  Google Scholar 

  31. Yun TJ, Cheon JE, Na DG, Kim WS, Kim IO, Chang KH, Yeon KM, Song IC, Wang KC (2009) Childhood moyamoya disease: quantitative evaluation of perfusion MR imaging—correlation with clinical outcome after revascularization surgery1. Radiology 251(1):216–223

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A120099).

We would like to thank Jae So Cho for English revision of this article.

Conflict of interest

The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

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Authors and Affiliations

  1. Division of Pediatric Neurology, Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Anna Cho, Jong-Hee Chae, Hun Min Kim, Byung Chan Lim, Hee Hwang, Yong Seung Hwang & Ki Joong Kim

  2. Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea

    Ji Hoon Phi, Seung-Ki Kim, Kyu-Chang Wang & Byung-Kyu Cho

  3. Pediatric Clinical Neuroscience Center, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Anna Cho, Jong-Hee Chae, Hun Min Kim, Byung Chan Lim, Hee Hwang, Yong Seung Hwang, Ji Hoon Phi, Seung-Ki Kim, Kyu-Chang Wang, Byung-Kyu Cho & Ki Joong Kim

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  1. Anna Cho
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  2. Jong-Hee Chae
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  3. Hun Min Kim
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  10. Byung-Kyu Cho
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Corresponding author

Correspondence to Ki Joong Kim.

Additional information

Jong-Hee Chae: Equally contributed and first author of the study.

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Cho, A., Chae, JH., Kim, H.M. et al. Electroencephalography in pediatric moyamoya disease: reappraisal of clinical value. Childs Nerv Syst 30, 449–459 (2014). https://doi.org/10.1007/s00381-013-2215-4

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  • DOI: https://doi.org/10.1007/s00381-013-2215-4

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