EEG Biomarkers of Repository Corticotropin Injection Treatment

Tanritanir, Ahmet; Vieluf, Solveig; Jafarpour, Saba; Wang, Xiaofan; Loddenkemper, Tobias

doi:10.1097/wnp.0000000000000886

Cited by 7 publications

(16 citation statements)

References 32 publications

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“…This suggests that a post-treatment decrease in FCN strength is a sensitive but not specific biomarker of favorable treatment response, while an increase in FCN strength is a specific but not sensitive biomarker of treatment non-response. Delta power and coherence showed similar trends, however, the degree of decrease following treatment in both metrics was found to be greater in responders as opposed to non-responders, group wise ( 43 ). Changes in DFA following first-line treatment closely mirrors whether the patient's post-treatment EEG met criteria for hypsarrhythmia or not ( 58 ).…”

Section: Discussionmentioning

confidence: 82%

“…Delta power and delta coherence measured in children with IS before and after ACTH treatment showed that decreases in these measurements following treatment were greater in responders who did not subsequently relapse compared to non-responders and responders who relapsed ( 43 ).…”

Section: Computational Analysismentioning

confidence: 99%

“…Delta band power and delta band coherence have both been shown to decrease to a greater degree following treatment in responders than in non-responders ( 43 ).…”

Section: Computational Analysismentioning

confidence: 99%

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EEG biomarkers for the diagnosis and treatment of infantile spasms

et al. 2022

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Early diagnosis and treatment are critical for young children with infantile spasms (IS), as this maximizes the possibility of the best possible child-specific outcome. However, there are major barriers to achieving this, including high rates of misdiagnosis or failure to recognize the seizures, medication failure, and relapse. There are currently no validated tools to aid clinicians in assessing objective diagnostic criteria, predicting or measuring medication response, or predicting the likelihood of relapse. However, the pivotal role of EEG in the clinical management of IS has prompted many recent studies of potential EEG biomarkers of the disease. These include both visual EEG biomarkers based on human visual interpretation of the EEG and computational EEG biomarkers in which computers calculate quantitative features of the EEG. Here, we review the literature on both types of biomarkers, organized based on the application (diagnosis, treatment response, prediction, etc.). Visual biomarkers include the assessment of hypsarrhythmia, epileptiform discharges, fast oscillations, and the Burden of AmplitudeS and Epileptiform Discharges (BASED) score. Computational markers include EEG amplitude and power spectrum, entropy, functional connectivity, high frequency oscillations (HFOs), long-range temporal correlations, and phase-amplitude coupling. We also introduce each of the computational measures and provide representative examples. Finally, we highlight remaining gaps in the literature, describe practical guidelines for future biomarker discovery and validation studies, and discuss remaining roadblocks to clinical implementation, with the goal of facilitating future work in this critical area.

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Section: Discussionmentioning

confidence: 82%

Section: Computational Analysismentioning

confidence: 99%

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EEG biomarkers for the diagnosis and treatment of infantile spasms

et al. 2022

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“…Only one automated detection study was low risk of bias and found spike rate in a 24-h recording correlated with seizure outcomes following ASM initiation. 78 One moderate-risk-of-bias study 104 detected spikes in only NREM sleep, using both visual detection and Persyst version 13, and found it correlated to seizure outcomes. Two moderate-risk-of-bias studies 53,54 and a high-riskof-bias case report 95 used 1-3 months of RNS system recordings to support IED rate as a biomarker of ASM efficacy.…”

Section: T a B L E 4 Studies That Investigated The Association Of Vis...mentioning

confidence: 99%

“…Eleven studies 44,62,[101][102][103][104][105][106][107][108][109] of both qualitative and quantitative biomarkers investigated short courses of adrenocorticotropic hormone or corticosteroids and compared results to freedom from epileptic spasm during the treatment course and relapse following course completion.…”

Section: Dose Adjustmentmentioning

confidence: 99%

Prognostic interictal electroencephalographic biomarkers and models to assess antiseizure medication efficacy for clinical practice: A scoping review

et al. 2023

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Antiseizure medication (ASM) is the primary treatment for epilepsy. In clinical practice, methods to assess ASM efficacy (predict seizure freedom or seizure reduction), during any phase of the drug treatment lifecycle, are limited. This scoping review identifies and appraises prognostic electroencephalographic (EEG) biomarkers and prognostic models that use EEG features, which are associated with seizure outcomes following ASM initiation, dose adjustment, or withdrawal. We also aim to summarize the population and context in which these biomarkers and models were identified and described, to understand how they could be used in clinical practice. Between January 2021 and October 2022, four databases, references, and citations were systematically searched for ASM studies investigating changes to interictal EEG or prognostic models using EEG features and seizure outcomes. Study bias was appraised using modified Quality in Prognosis Studies criteria. Results were synthesized into a qualitative review. Of 875 studies identified, 93 were included. Biomarkers identified were classed as qualitative (visually identified by wave morphology) or quantitative. Qualitative biomarkers include identifying hypsarrhythmia, centrotemporal spikes, interictal epileptiform discharges (IED), classifying the EEG as normal/abnormal/epileptiform, and photoparoxysmal response. Quantitative biomarkers were statistics applied to IED, high‐frequency activity, frequency band power, current source density estimates, pairwise statistical interdependence between EEG channels, and measures of complexity. Prognostic models using EEG features were Cox proportional hazards models and machine learning models. There is promise that some quantitative EEG biomarkers could be used to assess ASM efficacy, but further research is required. There is insufficient evidence to conclude any specific biomarker can be used for a particular population or context to prognosticate ASM efficacy. We identified a potential battery of prognostic EEG biomarkers, which could be combined with prognostic models to assess ASM efficacy. However, many confounders need to be addressed for translation into clinical practice.

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Epileptic spasms relapse is associated with response latency but not conventional attributes of post‐treatment EEG

Deckard,

Sathe,

Tabibzadeh

et al. 2024

Epilepsia Open

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ObjectiveRelapse of epileptic spasms after initial treatment of infantile epileptic spasms syndrome (IESS) is common. However, past studies of small cohorts have inconsistently linked relapse risk to etiology, treatment modality, and EEG features upon response. Using a large single‐center IESS cohort, we set out to quantify the risk of epileptic spasms relapse and identify specific risk factors.MethodsWe identified all children with epileptic spasms at our center using a clinical EEG database. Using the electronic medical record, we confirmed IESS syndrome classification and ascertained treatment, response, time to relapse, etiology, EEG features, and other demographic factors. Relapse‐free survival analysis was carried out using Cox proportional hazards regression.ResultsAmong 599 children with IESS, 197 specifically responded to hormonal therapy and/or vigabatrin (as opposed to surgery or other second‐line treatments). In this study, 41 (21%) subjects exhibited relapse of epileptic spasms within 12 months of response. Longer duration of IESS prior to response (>3 months) was strongly associated with shorter latency to relapse (hazard ratio = 3.11; 95% CI 1.59–6.10; p = 0.001). Relapse was not associated with etiology, developmental status, or any post‐treatment EEG feature.SignificanceThis study suggests that long duration of IESS before response is the single largest clinical predictor of relapse risk, and therefore underscores the importance of prompt and successful initial treatment. Further study is needed to evaluate candidate biomarkers of epileptic spasms relapse and identify treatments to mitigate this risk.Plain Language SummaryRelapse of infantile spasms is common after initially successful treatment. With study of a large group of children with infantile spasms, we determined that relapse is linked to long duration of infantile spasms. In contrast, relapse was not associated with the cause of infantile spasms, developmental measures, or EEG features at the time of initial response. Further study is needed to identify tools to predict impending relapse of infantile spasms.

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EEG Biomarkers of Repository Corticotropin Injection Treatment

Cited by 7 publications

References 32 publications

EEG biomarkers for the diagnosis and treatment of infantile spasms

EEG biomarkers for the diagnosis and treatment of infantile spasms

Prognostic interictal electroencephalographic biomarkers and models to assess antiseizure medication efficacy for clinical practice: A scoping review

Epileptic spasms relapse is associated with response latency but not conventional attributes of post‐treatment EEG

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