The Relevance Between EEG Hypsarrhythmia And Prognosis In Children With Infantile Spasms And The Changes Of Immunization Levels

Objective: Infantile spasms (IS) is an age-dependent intractable epilepticencephalopathy. It is characterized by a triad composed of clusters of spasms、a interictal electroencephalogram(EEG) pattern,called hypsarrhythmia and theretardation or regression of psychomotor development. The hypsarrhythmiaincludes typical and variant forms,while the later has various types. This studyaims at studying the characteristic of EEG with hypsarrhythmia and itsrelevance to prognosis in children with IS, thus discussing the clinicalsignificance of hypsarrhythmia. In addition, the pathogenesis of IS has notbeen definite so far，but a large number of scholars at home and abroad havefound that children with IS exist immune dysfunction,through the detection ofCD3、CD4、CD8、intercellular adhesion molecule-1(ICAM-1)，IgA、IgG、IgM, interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α),we can analyzethe changes of the immunization levels, thus discuss the probable pathogenesisof IS, and then supply new train of thought and approach for its treatment.Methods: This study belongs to an open case-control study.33newly diagnosed and untreated children with IS, who wanted to betreated at neurology clinics and wards of Hebei Children’s Hospital fromSeptember2011to September2012,were chosen as case group,while another20healthy check-up infant from Children Health Care Department of HebeiChildren’s Hospital were chosen as normal control group.The case group children were divided into group A(typical hypsarrh-ythmia) and group B(variant hypsarrhythmia),according to the performancetype of EEG hypsarrhythmia,and video-EEG and blood samples wererespectively collected before treatment,3months and6months aftertreatment,while normal control group children collected blood samples only once.1ml anticoagulant venous blood with EDTA-K2and3-4ml coagulantvenous blood with seperation gel were collected from all the children withempty stomach on early morning. Applying flow cytometry(USA BECKMANCOULTER company,model Epics XL)to detect levels of CD3,CD4,CD8andICAM-1, and automatic biochemical immunity analyzer(Switzerland Rochecompany,model cobas8000) to detect levels of serum immunoglobulins,including lgA、IgG and IgM through immune turbidimetry.Levels of IL-6、TNF-α were measured by double antibody sandwich enzyme-linkedimmunosorbent assay(ELISA),and human IL-6、TNF-α ELISA Kit werepurchased from Beijing Bio-Swamp Life Science Lab.All datas were collated and collected, and then statistics softwareSPSS16.0was used to carry on statistics processing,P <0.05(double-side)hadstatistical significance.Result:1Among children with IS,compared with the variant hypsarrhythm-ia(group B),the typical hypsarrhythmia(group A) had higher control rates ofspasms seizure and hypsarrhythmia discharge,and there was significantlystatistical difference between them.2There had positive correlation between the cessation of spasms seizureand the disappearance of hypsarrhythmia discharge,but the extent of thecorrelation was ordinary.3Compared with the normal control group,in the blood of children withIS before treatment,the levels of CD3、CD4and IgA decreased, CD8、ICAM-1、IgG、IL-6and TNF-αlevels increased.There was significantlystatistical difference(P＜0.05)between them，whereas the increased level ofIgM had no statistical difference with that of normal control group.4After3months treatment, CD4level increased, there was significantlystatistical difference with normal control group, while no significant differencewith before treatment group. IgA level increased, and levels of CD8、ICAM-1and IgG decreased,there had significantly statistical difference withthe normal control group and before treatment group.While the decreased levels of IgM、IL-6and TNF-α, compared with the normal control group andbefore treatment group, had no significantly statistical difference.5After6months treatment, CD4level increased, there was significantlystatistical difference with both the normal control group and before treatmentgroup; CD3、IgA levels increased, CD8、ICAM-1、IgG、IgM、IL-6andTNF-α levels decreased,there had no significant difference with the normalcontrol group,while had significantly statistical difference with beforetreatment group.6Compared with3months treatment,IgA level increased, levels ofICAM-1、 IgG and IgM decreased after6months treatment, there hadsignificantly statistical difference between them.While levels of CD3、CD4increased and CD8、 IL-6、 TNF-α decreased， there had no significantdifference.Conclusion：In children with IS,EEG with typical hypsarrhythmia hadbetter prognosis than EEG with variant hypsarrhythmia.In addition,thecorrelation between the cessation of spasms seizure and the disappearance ofhypsarrhythmia discharge was positive,but the extent was ordinary.Thecessation of spasms seizure can’t absolutely reprensent the disappearance ofthe hypsarrhythmia discharge,so the situation of the EEG hypsarrhythmiaafter treatment should be considered as one of the most important indicators inthe course of the evaluation of IS curative effect.Cell-mediated immunity and humoral immunity functions weredisordered in children with IS, which was mainly manifested that levels ofCD3、CD4、IgA decreased and CD8、IgG levels increased.In addition, Theincreased levels of ICAM-1、IL-6and TNF-α suggested that inflammatorycytokines may possibably involve the pathogenesis of IS. After treatment,allindexes mentioned above were improved.Therefore, in the course of clinicaltreatment, we should pay attention to both the regulation of immune functionand the control of spasms seizure, which could help enhancing the treatmenteffect and then improving the prognosis.