Report-derived interictal epileptiform discharge burden is associated with 7-day antiseizure medication decisions after pediatric video electroencephalography
- 1Department of Pediatrics and Pediatric Neurology, The First People’s Hospital of Zhangjiagang City, Zhangjiagang Hospital Affiliated to Soochow University
Abstract
Objective: To determine whether a three-level interictal epileptiform discharge (IED) burden abstracted from qualitative wording in issued pediatric video electroencephalography (VEEG) reports, rather than directly measured spike frequency, was associated with antiseizure medication (ASM) decisions within 7 days.
Methods: This single-center retrospective cohort included 216 VEEG report episodes from 181 children. Two reviewers independently classified each report as showing no, low, or moderate-to-high IED burden while unaware of the standardized 7-day outcome; disagreements were adjudicated. We separately analyzed a diagnostic/initiation cohort for new ASM initiation and an established-epilepsy cohort for exploratory treatment intensification. Associations were assessed using exact and trend tests and logistic regression with patient-clustered robust standard errors.
Results: Agreement was 211/216 (97.7%); linear-weighted Cohen κ was 0.975 (patient-clustered bootstrap 95% CI 0.947–0.995). The diagnostic/initiation cohort comprised 113 reports from 112 children, with 36 new ASM initiations. Initiation rates were 13.0%, 42.9%, and 70.0% for no, low, and moderate-to-high burden, respectively (trend p < 0.001). The adjusted odds ratio per higher burden grade was 2.89 (95% CI 1.58–5.30; p < 0.001). The established-epilepsy cohort comprised 103 reports from 76 children, with 13 intensification events. Moderate-to-high burden versus none/low yielded an odds ratio of 4.73 (95% CI 1.31–17.08; p = 0.018), but complementary analyses were not statistically significant.
Conclusion: Report-derived IED burden showed a strong graded association with new ASM initiation within 7 days. The treatment-intensification finding was exploratory. These data describe prescribing context and do not establish causality, treatment benefit, or an IED-based treatment threshold.
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BibTeX
@article{zhu2026reportderived,
title = {{Report-derived interictal epileptiform discharge burden is associated with 7-day antiseizure medication decisions after pediatric video electroencephalography}},
author = {Fengming Zhu and Weidong Xu and Yun Gao and Shumin Kang and Zhenlong Zhang},
journal = {Frontiers in Neurology},
year = {2026},
month = nov,
doi = {10.3389/fneur.2026.1975177},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1975177/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Report-derived interictal epileptiform discharge burden is associated with 7-day antiseizure medication decisions after pediatric video electroencephalography
AU - Fengming Zhu
AU - Weidong Xu
AU - Yun Gao
AU - Shumin Kang
AU - Zhenlong Zhang
PY - 2026
DA - 2026/11/02
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1975177
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1975177/full
AB - Objective: To determine whether a three-level interictal epileptiform discharge (IED) burden abstracted from qualitative wording in issued pediatric video electroencephalography (VEEG) reports, rather than directly measured spike frequency, was associated with antiseizure medication (ASM) decisions within 7 days. Methods: This single-center retrospective cohort included 216 VEEG report episodes from 181 children. Two reviewers independently classified each report as showing no, low, or moderate-to-high IED burden while unaware of the standardized 7-day outcome; disagreements were adjudicated. We separately analyzed a diagnostic/initiation cohort for new ASM initiation and an established-epilepsy cohort for exploratory treatment intensification. Associations were assessed using exact and trend tests and logistic regression with patient-clustered robust standard errors. Results: Agreement was 211/216 (97.7%); linear-weighted Cohen κ was 0.975 (patient-clustered bootstrap 95% CI 0.947–0.995). The diagnostic/initiation cohort comprised 113 reports from 112 children, with 36 new ASM initiations. Initiation rates were 13.0%, 42.9%, and 70.0% for no, low, and moderate-to-high burden, respectively (trend p < 0.001). The adjusted odds ratio per higher burden grade was 2.89 (95% CI 1.58–5.30; p < 0.001). The established-epilepsy cohort comprised 103 reports from 76 children, with 13 intensification events. Moderate-to-high burden versus none/low yielded an odds ratio of 4.73 (95% CI 1.31–17.08; p = 0.018), but complementary analyses were not statistically significant. Conclusion: Report-derived IED burden showed a strong graded association with new ASM initiation within 7 days. The treatment-intensification finding was exploratory. These data describe prescribing context and do not establish causality, treatment benefit, or an IED-based treatment threshold.
SN - 1664-2295
ER -