Scalp Fast Ripples Are Detectable in a Large Pediatric Cohort with an Age-dependent Distribution (P8-10.004)

Objective To investigate the role of age in the presence of high frequency oscillations (HFOs) on scalp electroencephalograms (EEGs) in a large pediatric cohort suspected or diagnosed with epilepsy. Background HFOs have been widely reported in invasive recordings as epileptogenic biomarkers. Whether they can be reliably detected on non-invasive scalp EEGs has been the focus of recent interest. Whereas spontaneously-occurring ripples (100–250 Hz) can be associated with either physiological or pathological activity, spontaneously-occurring fast ripples (FRs; 250–500 Hz) are pathological and can therefore serve as an important non-invasive epileptogenic biomarker. Whether the faster FR can be visually and reliably detected, and whether FR can be equally detected across age groups is not clear. Design/Methods For patients admitted to our institution for whom a video-EEG was obtained for clinical diagnosis and management, all video-EEGs recorded at 2048 Hz sampling rate with a 500 Hz high frequency filter were visually reviewed for FR during 10-minute artifact-free sleep epochs. All artifacts were excluded, and the presence or absence of scalp FRs was tallied. Data were assessed with R studio: 1) continuously by years of age, and 2) by age bins: Infants (0–2 years), Children (2–13 years) and Teens (13+ years). Results After a total of 1597 video-EEGs were assessed for FR, with the continuous age data analysis, FR presence was noted across the age spectrum and varied significantly across age (p=0.002 ), peaking during mid-childhood years, and less frequently detected in infants and teens. When categorized into age bins, FR prevalence was also highest in children (37.9%) compared to infants (27.1%) and adolescents (26.4%; p<0.001). Conclusions This study shows 1) that scalp FR can be visually and reliably detected in sleep in a large pediatric cohort; and 2) that scalp FR appears age-based within the pediatric population, most prevalent in children, followed by infants, and least prevalent in teens. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Ms. Panyam has nothing to disclose. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biocodex. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Marinus. The institution of Dr. Wu has received research support from National Institutes of Health. Dr. Wu has received personal compensation in the range of $500-$4,999 for serving as a Study section member with National Institutes of Health.