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Published on: September 6, 2017
An audit of ambulatory cassette EEG monitoring in children
K Saravanan1, B Acomb, M Beirne
1The Roald Dahl EEG Unit, Department of Neurology, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK.
Insights
Ambulatory cassette electroencephalogram (EEG) recordings without video monitoring are not very useful for diagnosing childhood epilepsy. Most children did not have episodes during the test, limiting the diagnostic yield of this epilepsy diagnostic tool.
Area of Science:
- Neurology
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Paroxysmal episodes in children, including epilepsy, often require electroencephalogram (EEG) for diagnosis.
- Ambulatory cassette EEG without simultaneous video monitoring is a common diagnostic tool.
- The diagnostic utility of this method in pediatric populations needs further evaluation.
Purpose of the Study:
- To evaluate the role and usefulness of ambulatory cassette EEG recordings without video monitoring in children presenting with paroxysmal episodes.
- To determine the contribution of ambulatory EEG to the clinical management of pediatric epilepsy and related disorders.
Main Methods:
- A 12-month audit of 54 children undergoing 48-hour ambulatory cassette EEG recordings.
- Analysis of EEG results correlated with clinical episodes experienced during the recording period.
- Categorization of patients into epilepsy and non-epilepsy groups based on clinical assessment and EEG findings.
Main Results:
- Only 31 of 54 children (57%) experienced typical clinical episodes during their ambulatory EEG.
- Epilepsy was diagnosed in 15 of these 31 children; only 3 had EEG abnormalities during an episode.
- Ambulatory EEG results were helpful in the management of only 17 of 54 patients (31%).
Conclusions:
- Ambulatory cassette EEG without video monitoring has limited diagnostic yield for childhood paroxysmal episodes, including epilepsy.
- Stricter clinical criteria for selecting patients and advancements in EEG technology may enhance the usefulness of this diagnostic procedure.
- Further research into improved diagnostic tools for pediatric epilepsy is warranted.
Abstract:
This audit evaluated the role and usefulness of ambulatory cassette EEG recordings without simultaneous video monitoring in children with paroxysmal episodes including epilepsy. Fifty-four children underwent ambulatory EEG recordings for 48 hours over a 12 month period. Only 31 of the 54 children experienced one of their typical clinical episodes during their recordings. Fifteen of these 31 patients were considered to have epilepsy, only three of whom had a clinical episode at the time of their recording and in all three the EEG demonstrated abnormal (generalized spike and slow wave or focal, rhythmic slow wave) activity. All 10 patients who were considered to have non-epileptic episodes showed no electrical change during their EEG recordings. The results of the ambulatory cassette EEG recordings were considered to have been helpful and to have contributed to the management of only 17 (31%) of the 54 patients in this audit. Stricter clinical criteria for undertaking ambulatory recordings and improved technology are likely to increase the role and usefulness of this procedure.
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