The sleep-deprived electroencephalogram: evidence and practice

Area of Science:

• Neurology
• Clinical Neurophysiology

Background:

• Sleep deprivation for initial electroencephalogram (EEG) in suspected seizures is a common yet inconsistent practice.
• Non-neurologists often lack understanding regarding the indications and value of sleep EEGs versus sleep-deprived EEGs.
• There is a need for clear guidance on best practices for utilizing sleep and sleep deprivation in seizure diagnosis.

Purpose of the Study:

• To assess the variability in neurologists' practices regarding sleep deprivation for EEG.
• To evaluate the level of understanding among non-neurologists concerning EEG protocols.
• To review the existing evidence and stimulate the development of consensus advisories for EEG in seizure diagnosis.

Main Methods:

• Surveyed knowledge and practices of non-neurologists, neurologists, and epileptologists.
• Examined electroencephalogram laboratory protocols, textbook recommendations, and journal literature.
• Contacted national professional organizations for existing advisories or guidelines.

Main Results:

• Most non-neurologists misunderstood sleep versus sleep-deprived EEGs and their protocols.
• Neurologists exhibit inconsistent practices, with experts acknowledging sleep deprivation enhances epileptiform discharge activation.
• Despite evidence, sleep deprivation is often not recommended for initial EEGs due to patient inconvenience, with minimal evidence-based guidance available.

Conclusions:

• Widespread confusion regarding sleep deprivation for EEG, coupled with discrepancies between evidence and practice, highlights the need for expert consensus.
• Inconsistent practices and lack of clear advisories necessitate further research into alternative methods for improving diagnostic yield in seizure evaluation.
• Development of consensus guidelines is crucial to standardize the use of sleep and sleep deprivation in EEG for suspected seizures.