Inaccuracies in Parental Reporting of Treated Epileptic Spasms: Both Under- and Over-Reporting.

BACKGROUND: The purpose of this study was to evaluate the accuracy of parental reporting of epileptic spasms (ES) after 14 days of appropriate medical therapy for new-onset ES by comparison with extended video electroencephalography (vEEG) monitoring results. METHODS: Fifty-eight patients were identified from August 2019 to February 2021 with new-onset ES, confirmed on vEEG. Patients were initiated on appropriate treatment (high-dose steroids or vigabatrin). After two weeks of therapy, patients underwent overnight (18 to 24 hours) vEEG monitoring in the epilepsy monitoring unit. Parental reporting of presence or absence of ES on admission was compared with results of vEEG monitoring. RESULTS: The 58 patients ranged in age from three to 20 months (average 7.8 months). An underlying etiology was identified in 78%, whereas 22% patients had unknown etiology. The overall accuracy of parental reporting was 74% (43 of 58) when compared with results of vEEG within 14 to 18 days of starting therapy. Of these, 65% (28 of 43) reported ES resolution and 35% (15 of 43) reported continued ES. Of the 26% (15 of 58) families who were incorrect at two-week follow-up, 67% (10 of 15) reported resolution of ES. However, a minority of families, 33% (five of 15), who continued to report spasms clinically, were inaccurate. CONCLUSIONS: Although a majority of inaccurate parental reports at two weeks of treatment were due to unrecognized ES (a widely known phenomenon), a minority were conversely inaccurate due to persistent over-reporting of ES. This fact highlights the importance of correlating parental history with objective vEEG monitoring, to prevent inappropriate escalation of medication therapy.

Extent of EEG monitoring for detecting epileptic spasms.

INTRODUCTION: Epileptic spasms (ES) are the ictal manifestation of West syndrome. Due to poor interrater reliability in diagnosing hypsarrhythmia, identification of ES - ideally on video EEG monitoring - is important to start proper treatment. METHODS: We retrospectively analyzed inpatient video EEG recordings of 42 patients with new onset ES and calculated the time needed to capture the first ES, along with time to first sleep epoch, among other data. RESULTS: The average time to capture ES was 188.36 min with a 95 percent confidence interval from 116.95 to 259.76 min. The average onset of sleep occurred at 30.8 min with 95% Confidence interval between 19.9 and 41.9 min. There was no significant correlation between duration of symptoms and etiology and the time needed to detect first spasm on EEG. CONCLUSIONS: Routine or short duration EEGs are not sufficient to capture ES in most patients. 4-5-hour VEEG monitoring duration should be considered to capture ictal data in patients suspected of having ES.