Hyperventilation maneuver during EEG in children with epilepsy after the COVID-19 pandemic. Is a routine procedure
Loreto Ríos-Pohl1, Macarena Franco2, Magdalena Gonzalez1,2,3
1Clinica Integral de Epilepsia Infanto-juvenil, Santiago, Chile.
Insights
Hyperventilation (HV) is a common activation method in ambulatory electroencephalogram (EEG) for epilepsy diagnosis. This study found HV has low positivity and high specificity, suggesting it could be restricted during pandemics or for specific epilepsy types.
Area of Science:
- Neurology
- Epileptology
- Clinical Neurophysiology
Background:
- Hyperventilation (HV) is a standard activation technique in ambulatory electroencephalogram (EEG).
- COVID-19 pandemic necessitated reevaluation of routine procedures due to infection risks.
- Characterizing HV positivity is crucial for optimizing EEG protocols.
Purpose of the Study:
- To characterize patients with positive hyperventilation responses in an epilepsy center.
- To assess the utility of HV during the COVID-19 pandemic.
- To evaluate the role of HV in epilepsy diagnosis.
Main Methods:
- Retrospective analysis of ambulatory EEGs in a child and adolescent epilepsy center.
- Inclusion criteria: EEG performed within one year, epilepsy diagnosis criteria met, age 3 years and 11 months and above.
- Analysis of HV maneuver outcomes: physiological slowing, no change, or abnormal response.
Main Results:
- Out of 252 analyzed EEGs, 150 included a successful HV maneuver.
- Abnormal HV responses (positive) were observed in 9% (13/150) of EEGs.
- Positive HV results included increased epileptiform activity, abnormal slowing, or absence seizures triggered.
Conclusions:
- The low positivity and high specificity of HV suggest it could be excluded during pandemic situations.
- Recommends considering HV as a complementary maneuver, potentially restricted to suspected absence epilepsy cases.
- Further large-scale studies are needed to validate these findings and recommendations.
Objective:
Hyperventilation (HV) is one of the main and basic activation methods during ambulatory electroencephalogram (EEG), unless medical reasons contraindicate it. During the COVID-19 pandemic, with the high risk of human-to-human infection, local guidelines and recommendations have been developed that suggest not to perform the HV maneuver routinely. Our objective was to characterize patients who present positive HV in an epilepsy center.
Methods:
We analyzed retrospectively all the ambulatory EEGs performed during one year in our specialized ambulatory child and adolescent epilepsy center, and describe patients with positive maneuver.
Results:
A total of 305 EEGs were performed. Patients under 3 years and 11 months were excluded as well as all patients that did not fill up the criteria for epilepsy diagnosis. From the 252 EEGs that were included in the study, 194 EEGs (77%) were classified as abnormal and 58 (23%) as normal. From these same 252 EEGs, 150 EEG finished correctly the HV maneuver. Physiological slowing response was found in 54 EEGs (36%), no changes (negative) in 83 (55%), and abnormal response (positive) in 13 EEGs (9%). The 13 HV-positive EEGs showed 4 patients with an increase of epileptiform activity, 3 patients experienced an increase of basal preregistered abnormal slowing, and 6 EEGs showed trigger of bilaterally synchronous and symmetric 2-4 Hz spike-and-slow wave discharges and absences. None of these last 6 patients needed more than 3 minutes to elicit the paroxysmal discharge.
Significance:
Based on these findings and according with other studies, the low positivity and high specificity of the HV maneuver support the idea that HV could be excluded during the COVID-19 pandemic situation, and also reevaluate whether it could be changed to a complementary maneuver, restricted only for cases where absence epilepsy is suspected. Larger studies will be needed to reaffirm this proposal.
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