Use of Early Childhood Epilepsy Severity Scale (E-Chess) in Classification and Prognostication of Children with West Syndrome: A Study from Tertiary Care Pediatric Neurology Centre

Background: West syndrome is a type of pediatric epilepsy syndrome often associated with a grave prognosis. The aim of this study was to evaluate clinicoradiologically cases of West syndrome, to use E-chess scoring, and classify and use it for prognostication.

Materials and Methods: Prospective observational clinical study for 1 year in the pediatric neurology out patients department of S.C.B. Medical College, Cuttack, Odisha. Patients were included as a case of West syndrome when they met all three criteria: (1) developmental plateau or regression, (2) epileptic spasm, (3) hypsarrhythmia on electroencephalography (EEG) who came to our center for first time (with/without previous treatments) after informed consent. They were classified into three groups by E-chess scoring according to severity of disease ([Table 1]).

Table 1 Classification of patients by E-chess scoring according to severity of disease

Types	E-chess score
I	6–9
II	10–12
III	13–15

Results: The total number of children included in the study was 13. Mean age of presentation was 9.4 months. Maximum patients were males. Mean duration of the disease was 3 months. Most of the patients were having hypoxic ischemic sequel in MRI. Twenty-three percent patients were categorized into type-III, 31% into type-II, 46% into type-I. Types II and III were drug-resistant epilepsy with poor response.

Conclusion: West syndrome is one of the infantile epilepsy syndromes with grave prognosis. E-chess scoring is a good and useful scoring system for classification and prognostication. This can be used in OPD basis for categorization of West syndrome. The types II and III are drug-resistant varieties with poor response to drugs. They should be planned for surgical therapy.