PMC7365978_01
PMC7365978_02
Sleep EEG (day 30): Burst-suppression pattern with 3-4 s of suppression between bursts of high amplitude slow wave with multi-focal spikes.
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EEG was performed on days 30 and 73 revealing a burst-suppression pattern during awake and sleep (Fig. 1a). TPM, the boy began to exhibit infantile spasms and EEG began to transition into hypsarrhythmia (Fig. 1b shows EEG correlate of spasm only). The spasms showed signs of abatement after starting ACTH therapy (0.025 mg/kg/alternate-days x 9 courses), but not the tonic seizures.
EEG during an attack (day 30): brief generalized spikes were recorded. Epileptic spasms were recorded on video synchronous with the high amplitude slow waves with overriding fast activity.
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However, each antiseizure drug was discontinued after failing to control seizures (Fig. 2a). The boy was discharged home the same day (Fig. 2b).
Seizure chart (Day 0-30).. Vertical axis: number of generalized seizures per day. Horizontal axis: Age (day).. PB: phenobarbital, MDZ: midazolam, DZP: diazepam, ZNS: zonisamide, VitB6: vitamin B6, CLB: clobazam, LEV: levetiracetam, PHT: phenytoin.
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Thereafter, his tonic seizures reduced in frequency, and were completely eliminated by day 234 (Fig. 3).
Seizure chart (Day 30-120).. Vertical axis: number of generalized seizures per day. Horizontal axis: Age (day).. PB: phenobarbital, ZNS: zonisamide, PHT: phenytoin, VPA: sodium valproate, TPM: topiramate, ACTH: adrenocorticotropic hormone, LTG: lamotrigine, Br: potassium bromide.
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The boy's parents have observed no clear recurrence of tonic seizures to date, nearly 11 months after he began taking CBD (Fig. 4).
Seizure event diary around CBD initiation.. The patient started taking CBD paste (50 mg/day) noted at first white line and increased to CBD tincture (150 mg/day) noted at second white line. Hash marks are individual tonic seizures observed by parents. Daily count summarized in the column to the far right of the day number.
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Background EEG patterns in a recording made on day 326 showed clear improvements over the previous time (Fig. 5).