Abstract
Background
Even though adrenocorticotropic hormone (ACTH) demonstrated powerful efficacy in the initially successful treatment of infantile spasms (IS), nearly half of patients have experienced a relapse. We sought to investigate whether features of electroencephalogram (EEG) predict relapse in those IS patients without structural brain abnormalities.
Methods
We retrospectively reviewed data from children with IS who achieved initial response after ACTH treatment, along with EEG recorded within the last two days of treatment. The recurrence of epileptic spasms following treatment was tracked for 12 months. Subjects were categorized as either non-relapse or relapse groups. General clinical and EEG recordings were collected, burden of amplitudes and epileptiform discharges (BASED) score and multiscale entropy (MSE) were carefully explored for cross-group comparisons.
Results
Forty-one patients were enrolled in the study, of which 26 (63.4%) experienced a relapse. The BASED score was significantly higher in the relapse group. MSE in the non-relapse group was significantly lower than the relapse group in the γ band but higher in the lower frequency range (δ, θ, α). Sensitivity and specificity were 85.71% and 92.31%, respectively, when combining MSE in the δ/γ frequency of the occipital region, plus BASED score were used to distinguish relapse from non-relapse groups.
Conclusions
BASED score and MSE of EEG after ACTH treatment could be used to predict relapse for IS patients without brain structural abnormalities. Patients with BASED score ≥ 3, MSE increased in higher frequency, and decreased in lower frequency had a high risk of relapse.
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Data availability
The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We would like to thank the medical staff at the pediatric department of Chinese PLA Hospital for their assistance with this study.
Funding
This research was partially supported by National Natural Science Foundation of China (Nos. 62171028, 62001026), the Natural Science Foundation of Beijing, China (No. 7222187), the Medical Big Data and Artificial Intelligence Research and Development Project of the Chinese PLA General Hospital (No. 2019MBD-004), the Epilepsy Research Fund of China Association Against Epilepsy (No. CU-B-2021-11), and the Nutrition and Care of Maternal & Child Research Fund Project of Guangzhou Biostime Institute of Nutrition & Care (No. 2021BINCMCF030).
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WL, ZCT and ZG contributed equally to the manuscript. WL contributed to the conception and design of the study, and wrote the first draft of the manuscript. ZCT wrote the first draft of the manuscript. ZG performed the data analyses, and wrote the first draft of the manuscript. SXY, WJ and ZLP performed the acquisition of data. ZB, CJ and SWB performed the data analyses. YCH and YG contributed to the conception and design of the study. All the authors helped to revise the manuscript regarding important intellectual content. All the authors approved the final version for publication.
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This was a retrospective cohort study, patient identity remained anonymous, and the requirement for informed consent was approved to waive by the Ethics Committee of First Medical Center of PLA General Hospital due to the observational nature of the study (S2020-337-01).
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Wan, L., Zhang, CT., Zhu, G. et al. Integration of multiscale entropy and BASED scale of electroencephalography after adrenocorticotropic hormone therapy predict relapse of infantile spasms. World J Pediatr 18, 761–770 (2022). https://doi.org/10.1007/s12519-022-00583-9
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DOI: https://doi.org/10.1007/s12519-022-00583-9