Concordance between the interictal focal EEG pattern and MRI lesions as a predictor of a favorable surgical outcome in patients with epileptic spasms: a Chinese study

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OBJECTIVE

The aim of this study was to evaluate the electro-clinical features, etiology, treatment, and postsurgical seizure outcomes in patients with intractable epileptic spasms (ESs).

METHODS

The authors retrospectively studied the medical records of all patients who had presented with medically intractable ESs and had undergone surgery in the period between October 2009 and August 2015. The interictal electroencephalography (EEG) pattern, MRI studies, magnetoencephalography findings, and postsurgical seizure outcomes were compared.

RESULTS

Twenty-six patients, 12 boys and 14 girls (age range 3–22 years), were eligible for study inclusion. Of these 26 patients, 84.6% (22) presented with multiple seizure types including partial seizures (PSs) independent of the ESs (30.8%); ESs followed by tonic seizures (30.8%); myoclonic seizures (19.2%); tonic seizures (19.2%); ESs followed by PSs (19.2%); focal seizures with secondary generalization (15.4%); atypical absence (11.5%); PSs followed by ESs (7.7%); and myoclonic followed by tonic seizures (7.7%). Seventeen patients underwent multilobar resection and 9 underwent unilobar resection. At the last follow-up (mean 36.6 months), 42.3% of patients were seizure free (outcome classification [OC] 1), 23.1% had > 50% reduction in seizure frequency (OC2–OC4), and 34.6% had < 50% reduction in seizure frequency or no improvement (OC5 and OC6). Predictors of favorable outcomes included an interictal focal EEG pattern and concordance between interictal EEG and MRI-demonstrated lesions (p = 0.001 and 0.004, respectively).

CONCLUSIONS

A favorable surgical outcome is achievable in a highly select group of patients with ESs secondary to structural lesions. Interictal EEG can help in identifying patients with the potential for favorable resective outcomes.

ABBREVIATIONS EEG = electroencephalography; ES = epileptic spasm; ES-PS = epileptic spasms followed by partial seizures; GPFA = generalized paroxysmal fast activities; GSW = generalized spikes and slow waves; IEEG = intracranial EEG; MEG = magnetoencephalography; OC = outcome classification; PS = partial seizure; PS-ES = partial seizures followed by epileptic spasms; SPECT = single-photon emission computed tomography; TSC = tuberous sclerosis complex; VEEG = video-EEG; WS = West syndrome.

Article Information

Correspondence Guojun Zhang: Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China. zgj62051@163.com.

INCLUDE WHEN CITING Published online February 1, 2019; DOI: 10.3171/2018.10.PEDS18380.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Interictal EEG showing generalized spikes and slow waves. B: Ictal EEG showing high-amplitude slow waves followed by voltage attenuation and fast activity. C: Coronal MR image showing encephalomalacia in the right temporal lobe.

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    A: Interictal EEG showing multifocal spikes and waves, predominately at the right P4 and T6. B: Ictal EEG showing diffused slow waves and a focal leading spike at T6. C: Axial MR image showing tumor in the right temporal lobe.

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    A: Interictal EEG showing generalized spikes and slow waves. B: Ictal EEG showing diffused spikes. C: Axial MR image showing a malformation of cortical development in the left parietooccipital cortex.

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    A: Interictal IEEG showing generalized spikes and slow waves. B: Ictal IEEG showing multifocal spike rhythmicity and a focal fast activity.

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    Kaplan-Meier survival curve illustrating the chances of seizure freedom following surgery.

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    Kaplan-Meier survival curve illustrating the chances of seizure freedom following surgery, according to the identified prognostic indicators.

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