Automatic detection of interictal ripples on scalp EEG to evaluate the effect and prognosis of ACTH therapy in patients with infantile spasms

Objective We aimed to explore the feasibility of using scalp‐recorded high‐frequency oscillations (HFOs) to evaluate the efficacy and prognosis of adrenocorticotropic hormone (ACTH) treatment in patients with infantile spasms. Methods Thirty‐nine children with infantile spasms were enrolled and divided into seizure‐free and non–seizure‐free groups after ACTH treatment. Patients who were seizure‐free were further divided into relapse and non‐relapse subgroups based on the observations made during a 6‐month follow‐up period. Scalp ripples were detected and compared during the interictal periods before and after 2 weeks of treatment. Results After ACTH treatment, the number and channels of ripples were significantly lower, whereas the percentage decrease in the number, spectral power, and channels of ripples was significantly higher in the seizure‐free group than in the non–seizure‐free group. In addition, the relapse subgroup showed higher number and spectral power and wider distribution of ripples than did the non‐relapse subgroup. Changes in HFOs in terms of number, spectral power, and channel of ripples were closely related to the severity of epilepsy and can indicate disease susceptibility. Significance Scalp HFOs can be used as an effective biomarker to monitor the effect and evaluate the prognosis of ACTH therapy in patients with infantile spasms.