Abstracts

West Syndrome is an early and severe type of childhood epilepsy, frequently presenting a catastrophic course. Early diagnosis and treatment are of paramount importance, as well as the recognition of predictors of outcome. In this study we assess the predictive value of clinical, etiological and EEG data on the electroclinical evolution of West Syndrome. From October 2002 to October 2004, 24 children with West Syndrome (18 boys and 6 girls) with ages ranging from 4 to 28 months were included. All had high resolution 1.5T MRI, etiological investigation and standardized treatment. Clinical variables include age of spasms onset, duration of epilepsy, previous antiepileptic treatments, and etiology. Laboratorial variables included EEG and MRI. EEGs were assessed and scored according to predefined scales applied to background activity and hypsarritmia analysis. According to electroclinical response patients were divided in two groups. Favorable outcome (group 1) was defined as disappearance of spasms and hypsarritmia for at least 28 consecutive days, without any recurrence until the end of the study (minimal follow-up of 6 months), and unfavorable outcome (group 2). Age of onset of the spasms ranged from 1 to 12 months in the group 1, and from 2 to 12 months in the group 2. Duration of epilepsy before admission to our center ranged from 0.5 to 19 months and 1 to 12 months, respectively. Both groups had previous antiepileptic treatment before admission to our service. The following etiologies were encountered in groups 1 and 2: a) metabolic: 2/2; b) perinatal: 5/1; c) congenital: 3/2; d) neurological: 1/2; d) unspecific MRI abnormalities: 1/1; e) cryptogenic: 3/1. MRI was normal in 6 and 5 children of groups 1 and 2, and abnormal in 9 and 4, respectively. Classical hypsarritmia was observed in 9 and 6 cases of groups 1 and 2, and modified hypsarritmia in 6 and 3, respectively. EEG scores were 11.73 (sd = 2.52) and 13.67 (sd = 3.08), respectively. Background and hypsarritmia scores were 5.13 (sd=2.07) and 6.0 (sd=1.31) in group 1, and 7.44(sd=3.17) and 5.89(sd=0.93). Statistical analysis ([italic]t student test) [/italic]revealed significant association of electroclinical outcome only to background score (p=0.04). Background activity scores appear to have significant correlation to electroclinical outcome, independently of other clinical and etiological variables (Supported by FAPESP.)