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Assessment of the utility of paediatric electroencephalography
1Department of Neurosciences, Division of Paediatric Neurology, King Faisal Specialist Hospital & Research Centre, Jeddah, Kingdom of Saudi Arabia.
Insights
Electroencephalography (EEG) is crucial for diagnosing pediatric epilepsy. While normal EEG results are predictable in non-epileptic events, EEGs in children with epilepsy often yield unexpected, critical findings.
Area of Science:
- Pediatric Neurology
- Neurophysiology
Background:
- Electroencephalography (EEG) is a vital diagnostic tool for children with neurological disorders, especially epilepsy.
- Understanding the relationship between clinical indications and EEG outcomes is essential for effective patient management.
Purpose of the Study:
- To investigate the correlation between clinical indications and electroencephalography (EEG) results in pediatric patients.
- To evaluate the predictability of normal EEG findings in children.
- To assess the impact of EEG results on the management of pediatric neurological conditions.
Main Methods:
- Prospective analysis of 438 consecutive pediatric EEG studies.
- Independent review of EEG requisitions and results by a certified electroencephalographer.
- Correlation of clinical indications with EEG abnormalities, including prediction of normal results.
Main Results:
- Overall, 55% of EEGs were abnormal, with repeat EEGs showing higher abnormality rates (twice as likely).
- Established epilepsy, antiepileptic drug use, and sleep recordings strongly correlated with abnormal EEG results (P<0.0001).
- Normal EEG results were highly predictable in non-epileptic paroxysmal events (97% accuracy), but predictability was lower in children with seizures (54% accuracy).
Conclusions:
- Normal EEG results are highly predictable in pediatric non-epileptic paroxysmal events.
- EEG findings in children with epilepsy are less predictable and can lead to significant changes in patient management.
- The study highlights the continued importance of EEG in diagnosing and managing pediatric epilepsy, even when initial predictions suggest normal results.
Abstract:
Electroencephalography (EEG) is an important tool in investigating children with neurological disorders, particularly epilepsy. The objectives were to examine the relationship between clinical indications and EEG results, and assess the predictability of a normal result. 438 consecutive paediatric EEGs were included prospectively. One certified electroencephalographer (EEGer) reviewed EEG requisitions and recorded his prediction of a normal result. EEGs were reviewed separately and the relationship between the clinical indications and EEG abnormalities was recorded. The children's mean age was 5 years (SD 4.2). Paediatric neurologists ordered 32% of EEGs. The first EEG was studied in 65% of cases. Overall, 55% of the EEGs were abnormal. Repeat EEGs were twice as likely to be abnormal (95% CI 1.3-3, P= 0.001). Established epilepsy, using antiepileptic drugs, and sleep record, highly correlated with an abnormal result ( P< 0.0001). The EEGer predicted 26% of the EEGs to be normal. A normal EEG was correctly predicted in 97% of non-epileptic paroxysmal events, however, normalization of EEG was correctly predicted in only 54% of children with seizures. EEGs of 15 (3.4%) children with epilepsy revealed unexpected findings that completely changed their management. To conclude, a normal EEG is highly predictable in non-epileptic paroxysmal events. EEGs of children with epilepsy are not predictable and may yield unexpected results.