title: Predictive value of EEG findings at control of epileptic spasms for seizure relapse in patients with West syndrome.
abstract: OBJECTIVE
  To evaluate the prognostic importance of electroencephalography (EEG) findings at cessation of epileptic spasms for seizure outcome.
  
  
  METHODS
  We reviewed 71 children with West syndrome (cryptogenic 14) who had obtained control of epileptic spasms with initial treatment (adrenocorticotropic hormone (ACTH) 37, high-dose vitamin B6 2, and antiepileptic drugs 32). According to the EEG findings at control of epileptic spasms, the subjects were divided into three groups: normal group (no epileptic activity, n=12), abnormal group (residual epileptic activity without hypsarrhythmia, n=53), and hypsarrhythmic group (persisting hypsarrhythmia, n=6).
  
  
  RESULTS
  Overall, 47 (66%) of the 71 patients (cryptogenic 4) had experienced relapses of seizures (epileptic spasms 23 and focal seizure 24) after initial control of epileptic spasms. Within symptomatic cases, seizure relapse rate varied widely from 0% (Down syndrome) to 100% (tuberous sclerosis), depending on underlying causes. Seizure relapse depended on the EEG findings at control of epileptic spasms. The normal group had a significantly lower seizure relapse rate (17%) in comparison with the abnormal group (75%), the hypsarrhythmic group (83%), and the epileptiform (abnormal plus hypsarrhythmic, 76%) group. No significant difference in seizure relapse rate was observed between non-hypsarrhythmic (normal plus abnormal, 65%) and hypsarrhythmic groups. At the last follow-up, normal group children also showed a favorable seizure prognosis (seizure control 100%).
  
  
  CONCLUSIONS
  A favorable seizure prognosis is associated with the disappearance of epileptic activity, but not the resolution of hypsarrhythmic pattern on EEG at control of epileptic spasms. We suggest that effective treatment for West syndrome should produce both cessation of epileptic spasms and disappearance of epileptic activity on EEG.
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan. Electronic address: keitaro_ymd1976@yahoo.co.jp.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Toribe
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kimizu
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Sadami
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mogami
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Yanagihara
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mano
authors.affiliation: Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D058256:Brain Waves / Q000187:drug effects / Q000502:physiology*; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D053284:Polyunsaturated Alkamides / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011422:Propionates / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013036:Spasms, Infantile / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D025101:Vitamin B 6 / Q000627:therapeutic use
chemical_list: D053284:Polyunsaturated Alkamides; D011422:Propionates; D025101:Vitamin B 6; C037512:3,4-dichlorophenyl propenylisobutylamide; D000324:Adrenocorticotropic Hormone
keywords: EEG; Epileptic spasms; Prognosis; Seizure relapse; West syndrome