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Epileptic spasms in older pediatric patients: MEG and ictal high-frequency oscillations suggest focal-onset seizures in a subset of epileptic spasms.
Epilepsy Res. 2008 Feb; 78(2-3):216-24.ER

Abstract

OBJECTIVES

To elucidate the pathophysiology of intractable epileptic spasms in older children by describing the interictal magnetoencephalography spike sources (MEGSSs), intracranial EEG ictal-onset zones (IOZs) and their ictal high-frequency oscillations (HFOs) and surgical outcomes.

METHODS

We studied five patients (4.5-14 years) who underwent surgery following intracranial video-EEG (VEEG) monitoring. We analyzed clinical profiles, MRIs, scalp and intracranial VEEGs, and MEGSSs. We localized ictal HFOs using a sampling rate of 1000 Hz and multiple band frequency analysis (MBFA).

RESULTS

Seizure onset ranged from 0.4 to 8 years. Three patients presented with asymmetrical spasms. Interictal scalp VEEG recorded predominantly unilateral epileptiform discharges in four; generalized and multifocal in one. Ictal scalp VEEG showed generalized high-amplitude slow waves with superimposed fast waves in four patients; hemispheric electrodecremental episodes in one. MRI findings were normal in three, hemispheric polymicrogyria and periventricular heterotopia in one each. All patients had unilateral MEGSS clusters. Ictal HFOs, ranging from 150 to 250 Hz, localized over Rolandic and frontal regions in four, with one also having extensive temporo-occipital HFOs. After cortical resection, three patients were seizure free; one had >90% reduction in seizure frequency. One patient experienced residual seizures after resection of the hemispheric ictal HFO region.

CONCLUSION

Unilateral clusters of MEGSSs overlapped regional IOZs in older patients with epileptic spasms. High spatio-temporal MBFA before and during spasms revealed the regional ictal HFOs. Seizure-free outcomes following resection of zone with MEGSS clusters and ictal HFOs suggested that a subset of epileptic spasms was focal-onset seizures.

Authors+Show Affiliations

Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada M5G1X8. rnair@mcmaster.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18215506

Citation

Ramachandrannair, Rajesh, et al. "Epileptic Spasms in Older Pediatric Patients: MEG and Ictal High-frequency Oscillations Suggest Focal-onset Seizures in a Subset of Epileptic Spasms." Epilepsy Research, vol. 78, no. 2-3, 2008, pp. 216-24.
Ramachandrannair R, Ochi A, Imai K, et al. Epileptic spasms in older pediatric patients: MEG and ictal high-frequency oscillations suggest focal-onset seizures in a subset of epileptic spasms. Epilepsy Res. 2008;78(2-3):216-24.
Ramachandrannair, R., Ochi, A., Imai, K., Benifla, M., Akiyama, T., Holowka, S., Rutka, J. T., Snead, O. C., & Otsubo, H. (2008). Epileptic spasms in older pediatric patients: MEG and ictal high-frequency oscillations suggest focal-onset seizures in a subset of epileptic spasms. Epilepsy Research, 78(2-3), 216-24. https://doi.org/10.1016/j.eplepsyres.2007.12.007
Ramachandrannair R, et al. Epileptic Spasms in Older Pediatric Patients: MEG and Ictal High-frequency Oscillations Suggest Focal-onset Seizures in a Subset of Epileptic Spasms. Epilepsy Res. 2008;78(2-3):216-24. PubMed PMID: 18215506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epileptic spasms in older pediatric patients: MEG and ictal high-frequency oscillations suggest focal-onset seizures in a subset of epileptic spasms. AU - Ramachandrannair,Rajesh, AU - Ochi,Ayako, AU - Imai,Katsumi, AU - Benifla,Mony, AU - Akiyama,Tomoyuki, AU - Holowka,Stephanie, AU - Rutka,James T, AU - Snead,O Carter,3rd AU - Otsubo,Hiroshi, Y1 - 2008/01/22/ PY - 2007/09/12/received PY - 2007/11/14/revised PY - 2007/12/07/accepted PY - 2008/1/25/pubmed PY - 2008/4/24/medline PY - 2008/1/25/entrez SP - 216 EP - 24 JF - Epilepsy research JO - Epilepsy Res VL - 78 IS - 2-3 N2 - OBJECTIVES: To elucidate the pathophysiology of intractable epileptic spasms in older children by describing the interictal magnetoencephalography spike sources (MEGSSs), intracranial EEG ictal-onset zones (IOZs) and their ictal high-frequency oscillations (HFOs) and surgical outcomes. METHODS: We studied five patients (4.5-14 years) who underwent surgery following intracranial video-EEG (VEEG) monitoring. We analyzed clinical profiles, MRIs, scalp and intracranial VEEGs, and MEGSSs. We localized ictal HFOs using a sampling rate of 1000 Hz and multiple band frequency analysis (MBFA). RESULTS: Seizure onset ranged from 0.4 to 8 years. Three patients presented with asymmetrical spasms. Interictal scalp VEEG recorded predominantly unilateral epileptiform discharges in four; generalized and multifocal in one. Ictal scalp VEEG showed generalized high-amplitude slow waves with superimposed fast waves in four patients; hemispheric electrodecremental episodes in one. MRI findings were normal in three, hemispheric polymicrogyria and periventricular heterotopia in one each. All patients had unilateral MEGSS clusters. Ictal HFOs, ranging from 150 to 250 Hz, localized over Rolandic and frontal regions in four, with one also having extensive temporo-occipital HFOs. After cortical resection, three patients were seizure free; one had >90% reduction in seizure frequency. One patient experienced residual seizures after resection of the hemispheric ictal HFO region. CONCLUSION: Unilateral clusters of MEGSSs overlapped regional IOZs in older patients with epileptic spasms. High spatio-temporal MBFA before and during spasms revealed the regional ictal HFOs. Seizure-free outcomes following resection of zone with MEGSS clusters and ictal HFOs suggested that a subset of epileptic spasms was focal-onset seizures. SN - 0920-1211 UR - https://www.unboundmedicine.com/medline/citation/18215506/Epileptic_spasms_in_older_pediatric_patients:_MEG_and_ictal_high_frequency_oscillations_suggest_focal_onset_seizures_in_a_subset_of_epileptic_spasms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0920-1211(07)00370-1 DB - PRIME DP - Unbound Medicine ER -