Abstracts

Rationale:
Epileptic spasms (ES) represent the most common form of infantile epilepsy, and is associated with significant morbidity in children, often with devastating consequences on developmental and intellectual function. Early initiation of treatment is more effective in controlling ES and improving outcomes.  Due to the subtle clinical nature of these epileptic events, parents often underestimate the number or presence of ES, however studies with objective data and EEG confirmation are lacking.  Routine EEGs often miss the diagnosis of ES and/or hypsarrythmia, which may only be present during sleep. For these reasons, extended EEG monitoring is recommended to evaluate response to treatment, especially at 2 week follow up. We present data on 28 patients with new onset ES, evaluating response to 14 days of appropriate medical therapy, and comparing parental report of ES with the extended overnight EEG monitoring study results. 
Method:
28 patients were identified from August 2019 to July 2020 with new onset ES, captured on video EEG monitoring. These patients were then prescribed appropriate hormonal treatment (high dose prednisone or ACTH) or vigabatrin. Patients were planned for re-admission for overnight ( >18 hours) video EEG monitoring in the EMU in 2 weeks. Parental reporting of presence or absence of ES on admission was compared to the final results of overnight EEG monitoring.  Results28 patients ranged in age from 3 to 13 months (average 7 months).  82% of patients had symptomatic ES, whereas 18% patients in this cohort were considered cryptogenic. ES were noted on all 28 initial diagnostic EEGs. The majority (71%) of patients were initiated on proper treatment within 24 hours of diagnosis. Exceptions (initiation ranging from 2-10 days) were attributed to insurance issues or prescription errors.  Prolonged video EEG within 14-18 days of starting appropriate therapy was performed. Overall accuracy of parental reporting was 64% (18/28). Out of these, 50% (9/18) reported resolution of ES and 50% (9/18) reported continued ES. Of the 36% (10/28) families who were incorrect at the 2 week follow up, 70% (7/10) reported resolution of ES. However, a significant minority of families, 30% (3/10), who continued to report spasms clinically, were inaccurate. 
Conclusion:
 Parental reporting of ES at the two week follow up mark was inaccurate in approximately 36% of patients in this cohort. While a majority of these patients were inaccurate due to unrecognized spasms (a widely known and documented phenomenon), a significant minority were conversely inaccurate due to persistent over-reporting of spasms. Many epilepsy centers may not perform follow up EEG study at this time if families continue to report spasms. However, in such cases, if formal monitoring is not performed, then inappropriate escalation of medication therapy may risk significant adverse effects and unnecessary healthcare cost. Therefore, follow up overnight vEEG at the two week mark should be done to assess response to treatment, even if families continue to report spasms.
Funding:
:Texas Neurological Society Research Grant