Despite all efforts for optimizing epilepsy management in children over the past decades, there is no clear consensus regarding whether to treat or not to treat epileptiform discharges after a first unprovoked seizure, or the optimal duration of therapy with anti-seizure medication (ASM). Defining what should be considered as a pathological EEG discharge that requires treatment on scalp EEG is therefore highly needed. Aim of the work: This retrospective study aimed to identify whether the coexistence of ripples/ high frequency oscillations (HFOs) with interictal epileptiform discharges in routinely acquired scalp EEG is associated with a higher risk of seizure recurrence and could be used as a prognostic marker. Methods: 100 children presenting with new onset seizures to Children Medical Center- Dallas during 2015-2016, who were not on ASM and had focal epileptiform discharges on an awake and sleep EEG recorded with sample frequency of 500 HZ, randomly were identified by database review. EEGs were analyzed blinded to patient’s data. HFOs were visually identified using review parameters including expanded time base and adjusted filter settings. Results: The average age of patients was 6.3 yrs (±4.35 SD). HFOs were visually identified in 19% of the studied patients with inter-rater reliability of 99% for HFO negative discharges and 78% agreement for identification of HFOs. HFOs were identified more often in the younger age group; however, they were identified in 11% of patients >5 yrs old. They were more frequently associated with spikes than with sharp waves, and more often with higher amplitude epileptiform discharges. Patients with HFOs were more likely to have recurrence of seizures in the year after first seizure (P< 0.05), and to continue to have seizures after two years (P<0.0001). There was no statistically significant difference between the two groups as regards continuing anti-seizure medications after 2 years. Conclusions: Including analysis for HFOs in routine EEG interpretation may increase the yield of the study and help guide the decision to start or discontinue ASM. In the future, this may also help identifying pathological discharges with deleterious effect on the growing brain and set a new target for management of epilepsy.

中文翻译：

---

常规获得头皮脑电图中发作间期癫痫样放电的高频振荡：它可以用作预后标志物吗？

尽管在过去几十年中为优化儿童癫痫管理做出了所有努力，但对于首次无端癫痫发作后是否治疗癫痫样放电或抗癫痫药物 (ASM) 治疗的最佳持续时间尚无明确共识。因此，非常需要定义需要对头皮 EEG 进行治疗的病理性 EEG 放电。工作目的：这项回顾性研究旨在确定常规获得性头皮 EEG 中波纹/高频振荡 (HFO) 与发作间期癫痫样放电的共存是否与较高的癫痫复发风险相关，并可用作预后标志物。方法：100 名儿童在 2015-2016 年期间向达拉斯儿童医疗中心就诊，新发癫痫发作，未使用 ASM 且在清醒和睡眠脑电图中有局灶性癫痫样放电（以 500 HZ 的采样频率记录），通过数据库审查随机确定。对患者数据不知情的情况下分析脑电图。使用审查参数（包括扩展的时基和调整的过滤器设置）直观地识别 HFO。结果：患者的平均年龄为 6.3 岁 (±4.35 SD)。19% 的研究患者在视觉上识别出 HFO，HFO 阴性放电的评估者间可靠性为 99%，识别 HFO 的一致性为 78%。HFOs 在较年轻的年龄组中更常见；然而，在 11% 的 > 5 岁的患者中发现了它们。与尖波相比，它们更频繁地与尖峰相关，并且更常见于更高幅度的癫痫样放电。HFOs 患者在首次癫痫发作后一年内更容易再次癫痫发作（P<0.05），并且在两年后继续癫痫发作（P<0.0001）。在 2 年后继续服用抗癫痫药物方面，两组之间没有统计学上的显着差异。结论：在常规脑电图解释中包括对 HFO 的分析可能会增加研究的产量，并有助于指导开始或停止 ASM 的决定。将来，这也可能有助于识别对发育中的大脑有有害影响的病理放电，并为癫痫的管理设定新的目标。在 2 年后继续服用抗癫痫药物方面，两组之间没有统计学上的显着差异。结论：在常规脑电图解释中包括对 HFO 的分析可能会增加研究的产量，并有助于指导开始或停止 ASM 的决定。将来，这也可能有助于识别对发育中的大脑有有害影响的病理放电，并为癫痫的管理设定新的目标。在 2 年后继续服用抗癫痫药物方面，两组之间没有统计学上的显着差异。结论：在常规脑电图解释中包括对 HFO 的分析可能会增加研究的产量，并有助于指导开始或停止 ASM 的决定。将来，这也可能有助于识别对发育中的大脑有有害影响的病理放电，并为癫痫的管理设定新的目标。