Wyładowania międzypadaczkowe a długoterminowe wyniki neurorozwojowe u dzieci z padaczką początkową: Przegląd systematyczny i synteza narracyjna
Interictal Epileptiform Discharges and Long-Term Neurodevelopmental Outcomes in Children with Early-Onset Epilepsy: A Systematic Review and Narrative Synthesis
W skrócie
[Preprint - wstępne wyniki] Badanie analizuje związek między wyładowaniami elektrycznymi w mózgu (widocznymi w EEG między napadami) a rozwojem poznawczym u małych dzieci z padaczką. Mimo że wykazano kierunkowy związek między ciężkością tych wyładowań a gorszymi wynikami neurorozwojowymi, autorzy podkreślają, że obecna baza badań jest zbyt ograniczona i niskiej jakości, aby wyciągać pewne wnioski. Potrzebne są lepiej znormalizowane metody badań i bardziej precyzyjne miary, aby ostatecznie potwierdzić wartość prognostyczną tych wyładowań w przewidywaniu rozwoju dziecka.
Oryginalny abstract (angielski)
Background: Children with early-onset epilepsy (seizure onset ≤ 5 years) are at elevated risk of adverse neurodevelopmental outcomes, including cognitive impairment, intellectual disability, and autism spectrum features. Seizure burden alone provides limited prognostic information. Interictal epileptiform discharges (IEDs), spike or sharp-wave complexes occurring between clinical seizures on electroencephalography (EEG), are common in paediatric epilepsy and may reflect brain network instability relevant to neurodevelopment. Whether interictal EEG features recorded in early childhood are associated with long-term neurodevelopmental outcomes remains unclear. Methods: A systematic review was conducted in accordance with a prospectively registered protocol (PROSPERO: CRD420251162420) and reported per PRISMA 2020 guidelines. MEDLINE, Embase, PubMed, PsycINFO, and Scopus were searched from 1966 to October 2025. Longitudinal studies examining interictal EEG features in children with epilepsy onset ≤ 5 years, with neurodevelopmental outcomes assessed ≥12 months after baseline EEG, were eligible. Risk of bias was assessed using QUIPS; certainty of evidence using GRADE. Results: Of 1,613 records identified, four longitudinal studies met inclusion criteria (epilepsy contexts: infant-onset focal epilepsy, Sturge–Weber syndrome, epileptic encephalopathies, cryptogenic generalised epilepsies). Across all four studies, greater severity or disruption of interictal EEG activity showed a directional association with poorer neurodevelopmental outcomes. All four studies were rated at moderate to high risk of bias. Certainty of evidence was low to very low across all outcome domains. Conclusions: Directional evidence links interictal EEG severity to neurodevelopmental outcomes in early-onset epilepsy. However, the evidence base is too sparse, insufficiently standardised, and of too low methodological quality to support definitive prognostic inference. Standardised, state-resolved IED metrics and harmonised outcome batteries are needed to clarify the prognostic role of interictal activity in early-onset epilepsy. Keywords: epilepsy; interictal epileptiform discharges; electroencephalography; prognosis; neurodevelopment; cognition; paediatric