AUTHOR=Falsaperla Raffaele , Sciuto Sarah , Privitera Grete Francesca , Tardino Lucia Giovanna , Costanza Giuseppe , Di Nora Alessandra , Caraballo Roberto Horacio , Ruggieri Martino 

TITLE=Epileptic spasms in infants: can video-EEG reveal the disease’s etiology? A retrospective study and literature review

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1204844

DOI=10.3389/fneur.2023.1204844

ISSN=1664-2295

ABSTRACT=Objective 
Epileptic spasms are a type of seizure defined as a sudden flexion or extension predominantly of axial and/or truncal limb muscles, with a noticeable periodicity. Routine electroencephalogram supports the diagnosis of epileptic spasms, that can occur from different causes. The aim of the study was evaluating a possible association between the electro-clinical pattern and the underlying etiology. 
Material and methods 
We retrospectively reviewed the clinical and video-EEG data on 104 patients (from 1 to 22 months), admitted at our tertiary hospital in Catania and at the tertiary hospital in Buenos Aires, from January 2013 to December 2020, with a confirmed diagnosis of epileptic spasms. We divided the patient sample into structural, genetic, infectious, metabolic, immune, unknown, based on etiology. Fleiss' kappa (К) was used to assess agreement among raters in the electroencephalographic interpretation of hypsarrhythmia. A multivariate and bivariate analysis were conducted to understand the role of the different video-EEG variables on the etiology of epileptic spasms. Furthermore, decision trees were constructed for the classification of variables.
Results 
The results showed a statistically significant correlation between epileptic spasms semiology and etiology: flexor spasms were associated with spasms due to genetic cause (87.5%; OR < 1); instead mixed were associated with spasms from a structural cause (40%; OR < 1). The results showed a relationship between ictal and interictal EEG and epileptic spasms etiology: 73% patients with slow waves and sharp waves or slow waves on the ictal EEG, and asymmetric hypsarhythmia or hemihypsarhythmia on the interictal EEG, had spasms with structural etiology, instead, 69% of patients with genetic etiology presented typical interictalhypsarrhythmia with high-amplitude polymorphic delta with multifocal spike or modified hypsarrhythmia on interictal EEG and slow waves on the ictal EEG.
Conclusion
This study confirms that video-EEG is a key element for the diagnosis in epileptic spasms, also playing an important role in the clinical practice to determine the etiology.