Confirmation of infantile spasms resolution by prolonged outpatient EEGs

Yuskaitis, Christopher J.; Mysak, Kate; Godlewski, Brianna; Zhang, Bo; Harini, Chellamani

doi:10.1002/epi4.12540

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Preventability of these readmissions is doubtful when scant evidence exists to guide practices (eg, ideal duration of EEG monitoring necessary to assess risk for relapse prior to ASM wean). 8,37 In such situations, neurodiagnostic testing not only depends on physician/institutionspecific practices but may also be influenced by caregiver/ patient-related factors. Despite receiving sub-specialty ambulatory care (neurologists and epileptologists including IESS experts), 47% of the readmissions among patients with frequent readmissions were unplanned.…”

Section: Discussionmentioning

confidence: 99%

“…We have subsequently demonstrated that this modified approach along with clinical assessment was sufficient to detect treatment failure for IESS. 37 Our study was not designed to address preventability of readmissions. Nevertheless, our study findings could rationalize other approaches to contain hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…Scheduled readmissions related to EEG surveillance for characterization of events may be institution/provider (preferred practices) and systems (availability of outpatient full‐day EEG monitoring) specific. Preventability of these readmissions is doubtful when scant evidence exists to guide practices (eg, ideal duration of EEG monitoring necessary to assess risk for relapse prior to ASM wean) 8,37 . In such situations, neurodiagnostic testing not only depends on physician/institution‐specific practices but may also be influenced by caregiver/patient‐related factors.…”

Section: Discussionmentioning

confidence: 99%

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Hospital readmissions in children with new‐onset infantile epileptic spasms syndrome

et al. 2023

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Objective To describe inpatient resource use in the 2 years following infantile epileptic spasms syndrome (IESS) diagnosis, examine the association between clinical/demographic variables and incidence of readmission, and identify risk factors/reasons for frequent readmissions. Methods Retrospective cohort analysis of readmissions (scheduled/unscheduled) within the first 2 years following IESS diagnosis, details of readmissions (number/time between rehospitalizations, and length of stay), demographic/clinical variables, and reasons for readmissions were collected. Negative binomial regression analysis evaluated associations between incidence of readmissions (both scheduled/unscheduled and unscheduled alone) and demographic/clinical factors. Logistic regression assessed the risk of having recurrent readmissions (≥5 readmissions). Results Among 93 (60% males) new‐onset IESS patients, there were 394 readmissions (56% scheduled and 44% unscheduled) within 2‐years following IESS diagnosis. Mean length of stay was 3.5 days (SD: 5.9). Readmissions occurred in 82 patients (88%) and 37 (40%) experienced ≥5 readmissions. On multivariate regression analysis, readmissions were increased with use of multiple first‐line treatments for IESS (P = 0.006), technology assistance (P ≤ 0.001), and multispecialty care (P = 0.01); seizure freedom (P = 0.015) and known etiology (P = 0.011) lowered the incidence of readmissions. Examining unscheduled readmissions separately, increased readmissions occurred with public insurance (P = 0.013), technology use (P ≤ 0.0.001), and multispecialty care (P = 0.013); seizure freedom decreased unscheduled readmissions (P = 0.006). Technology assistance (G‐tube, NG tube, VP shunt, and tracheostomy use) increased the odds (P = 0.007) for recurrent readmissions. Reasons for readmissions included EEG monitoring (protocol driven for verification of IESS remission/characterization of events/EEG surveillance/presurgical monitoring) (51%), acute medical issues (21%), and seizure exacerbation (15%). Protocol‐driven readmissions declined an estimated 52% following protocol modification during the study. Significance In the 2 years following IESS diagnosis, there is substantial inpatient resource use with nearly 40% experiencing ≥5 readmissions (mostly epilepsy related). Since readmissions are increased by intrinsic patient characteristics such as medical complexity (technology use and multispecialty care) or epilepsy‐related issues, the preventability of readmissions is uncertain, except for protocol‐driven ones.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hospital readmissions in children with new‐onset infantile epileptic spasms syndrome

et al. 2023

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“…11 If the child appeared to have responded to treatment by day 7, we would continue to advocate for follow-up prolonged video EEG to confirm remission at day 14. 27…”

Section: Discussionmentioning

confidence: 99%

“…11 If the child appeared to have responded to treatment by day 7, we would continue to advocate for followup prolonged video EEG to confirm remission at day 14. 27 In conclusion, nearly 80% of children who respond to first-line infantile spasms therapy experience clinical remission by day 7 of treatment. This finding is widely applicable to clinical practice because neither infantile spasms etiology nor other clinical characteristics appeared to influence the time to response to the first infantile spasms medication.…”

Section: Acknowledgmentmentioning

confidence: 93%

Association of Time to Clinical Remission With Sustained Resolution in Children With New-Onset Infantile Spasms

et al. 2022

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Background and Objective:Standard therapies (ACTH, oral steroids, or vigabatrin) fail to control infantile spasms in almost half of children. Early identification of non-responders could enable rapid initiation of sequential therapy. We aimed to determine the time to clinical remission after appropriate infantile spasms treatment initiation and identify predictors of the time to infantile spasms treatment response.Methods:The National Infantile Spasms Consortium prospectively followed children aged 2-24 months with new onset infantile spasms at 23 US centers (2012-2018). We included children treated with standard therapy (adrenocorticotropic hormone (ACTH), oral steroids, or vigabatrin). Sustained treatment response was defined as having the last clinically recognized infantile spasms on or before treatment day 14, absence of hypsarrhythmia on EEG 2-4 weeks post-treatment, and persistence of remission to day 30. We analyzed the time to treatment response and assessed clinical characteristics to predict sustained treatment response.Results:Among 395 infants, clinical infantile spasms remission occurred in 43% (n=171) within the first two weeks of treatment, of which 81% (138/171) responded within the first week of treatment. There was no difference in the median time to response across standard therapies (ACTH: median 4 days, interquartile range (IQR) 3-7; oral steroids: median 3 days, IQR 2-5; vigabatrin: median 3 days, IQR 1-6). Individuals without hypsarrhythmia on the pre-treatment EEG (i.e., abnormal but not hypsarrhythmia) were more likely to have early treatment response than infants with hypsarrhythmia at infantile spasms onset (hazard ratio 2.23, 95% confidence interval 1.39-3.57). No other clinical factors predicted early responders to therapy.Conclusions:Remission after first infantile spasms treatment can be identified by treatment day 7 in most children. Given the importance of early and effective treatment, these data suggest that children who do not respond to standard infantile spasms therapy within 1 week should be reassessed immediately for additional standard treatment. This approach could optimize outcomes by facilitating early sequential therapy for children with infantile spasms.

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