Electroencephalography as a tool for evidence-based diagnosis and improved outcomes in children with epilepsy in a
Ike Oluwa Abiola Lagunju1, Alexander Opebiyi Oyinlade1, Omolola Mojisola Atalabi2
1Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
Insights
Electroencephalography (EEG) significantly improves epilepsy diagnosis in Nigerian children, reducing misdiagnosis of generalized epilepsy and increasing identification of localization-related epilepsy. This impacts appropriate therapy and reduces healthcare burdens in resource-poor settings.
Area of Science:
- Pediatric Neurology
- Diagnostic Imaging in Epilepsy
Background:
- Electroencephalography (EEG) is crucial for epilepsy diagnosis.
- Children in developing nations often lack access to diagnostic tools, leading to misdiagnosis and improper treatment.
- This study examines EEG use in Nigerian children with epilepsy.
Purpose of the Study:
- To evaluate access to EEG services for pediatric epilepsy patients in Nigeria.
- To assess the impact of EEG on epilepsy diagnosis in children.
- To compare clinical diagnoses with post-EEG diagnoses.
Main Methods:
- Inter-ictal EEG was performed on pediatric epilepsy patients over 18 months.
- Clinical diagnoses were compared with final diagnoses after EEG evaluation.
- A cohort of 329 Nigerian children (3 months–16 years) was studied.
Main Results:
- Pre-EEG evaluation misclassified 69.3% of epilepsies as generalized.
- Post-EEG evaluation revealed a higher proportion of localization-related epilepsies (33.6%).
- EEG led to a 21% decrease in generalized epilepsy diagnoses and a 55% increase in localization-related epilepsy diagnoses (p<0.001).
Conclusions:
- Absence of EEG evaluation carries a high risk of misdiagnosis and inappropriate therapy for pediatric epilepsy.
- Findings are critical for resource-poor settings, aiming to reduce epilepsy care burdens.
- Improved diagnostic accuracy through EEG can optimize treatment and lower healthcare costs.
Introduction:
Electroencephalography (EEG) remains the most important investigative modality in the diagnostic evaluation of individuals with epilepsy. Children living with epilepsy in the developing world are faced with challenges of lack of access to appropriate diagnostic evaluation and a high risk of misdiagnosis and inappropriate therapy. We appraised EEG studies in a cohort of Nigerian children with epilepsy seen in a tertiary center in order to evaluate access to and the impact of EEG in the diagnostic evaluation of the cases.
Methods:
Inter-ictal EEG was requested in all cases of pediatric epilepsy seen at the pediatric neurology clinic of the University College Hospital, Ibadan, Nigeria over a period of 18 months. Clinical diagnosis without EEG evaluation was compared with the final diagnosis post- EEG evaluation.
Results:
A total of 329 EEGs were recorded in 329 children, aged 3 months to 16 years, median 61.0 months. Clinical evaluation pre-EEG classified 69.3% of the epilepsies as generalized. The a posteriori EEG evaluations showed a considerably higher proportion of localization-related epilepsies (33.6%). The final evaluation post EEG showed a 21% reduction in the proportion of cases labeled as generalized epilepsy and a 55% increase in cases of localization-related epilepsy(p<0.001).
Conclusion:
Here we show that there is a high risk of misdiagnosis and therefore the use of inappropriate therapies in children with epilepsy in the absence of EEG evaluation. The implications of our findings in the resource-poor country scenario are key for reducing the burden of care and cost of epilepsy treatment on both the caregivers and the already overloaded tertiary care services.
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