Current data on early diagnosis of West syndrome. Electroencephalographic evolution of hypsarrhythmia

Abstract

The review of current ideas about the early diagnosis of West syndrome is presented in terms of electroencephalography data based on a characterization of the period of prehypsarrhythmia preceding the appearance of the pattern of hypsarrhythmia. There are considered examples of our observations. Also, our data from a study of a group of children with hypsarrhythmia are described. A lot of studies of clinical manifestations and neurophysiological aspects of West syndrome have been conducted after the onset of clinical manifestations in the form of spasms, and variants of the transformation of West syndrome have been reported. On the other hand, very few studies of its clinical and electroencephalographic evolution have been conducted since the prehypsarrhythmic stage. The opportunity to reliably identify this precursor period would be the first step towards early diagnosis of West syndrome. Early prediction and subsequent intervention in West syndrome will have significant predictive value. A retrospective analysis of 68 electroencephalographic studies was conducted at the National Medical Research Center for childrens health. Based on the preliminary data of our study, we can distinguish a period of 1 to 3 months, during which in most children, the EEG pattern from prehypsarrhythmic in the form of multi-regional epileptiform activity with an average representation index or regional epileptiform activity in the parietal-occipital-posterior parts with a low representation index transforms to a pattern of hypsarrhythmia. It seems appropriate to recommend that newborns with structural brain disorders, premature infants, children with multi-regional epileptiform activity, with regional epileptiform activity in the parietal-occipital-posterior parts (even low index) to be observed with regular video EEG monitoring at least once every 1-2 months, to early detect the pattern of hypsarrhythmia and West syndrome.