Scalp EEG interictal high frequency oscillations as an objective EEG biomarker of infantile spasms

ObjectiveTo investigate the diagnostic utility of high frequency oscillations (HFOs) via scalp electroencephalogram (EEG) in infantile spasms. MethodsWe retrospectively analyzed interictal slow-wave sleep EEGs sampled at 2,000 Hz recorded from 30 consecutive patients who were suspected of having infantile spasms. We measured the rate of HFOs (80-500 Hz) and the strength of the cross-frequency coupling between HFOs and slow-wave activity (SWA) at 3-4 Hz and 0.5-1 Hz as quantified with modulation indices (MIs). ResultsTwenty-three patients (77%) exhibited active spasms during the overnight EEG recording. Although the HFOs were detected in all children, increased HFO rate and MIs correlated with the presence of active spasms (p < 0.001 by HFO rate; p < 0.01 by MIs at 3-4 Hz; p = 0.02 by MIs at 0.5-1 Hz). The presence of active spasms was predicted by the logistic regression models incorporating HFO-related metrics (AUC: 0.80-0.98) better than that incorporating hypsarrhythmia (AUC: 0.61). The predictive performance of the best model remained favorable (87.5% accuracy) after a cross-validation procedure. ConclusionsIncreased rate of HFOs and coupling between HFOs and SWA are associated with active epileptic spasms. SignificanceScalp-recorded HFOs may serve as an objective EEG biomarker for active epileptic spasms. HighlightsO_LIObjective analyses of scalp high frequency oscillations and its coupling with slow-wave activity in infantile spasms were feasible. C_LIO_LIIncreased rate of high frequency oscillations and its coupling with slow-wave activity correlated with active epileptic spasms. C_LIO_LIThe scalp high frequency oscillations were also detected in neurologically normal children (although at the low rate). C_LI