Diagnostic Yield of Five Minutes Compared to Three Minutes Hyperventilation During Electroencephalography in Children
Nivetha Vasudevan1, Ranjith Kumar Manokaran1, Saji James1
1Sri Ramachandra Institute of Higher Education and Research, Chennai, TN, India.
Insights
Prolonging hyperventilation (HV) during electroencephalography (EEG) to 5 minutes increases seizure detection and diagnostic yield in children. Extended HV is safe and feasible for pediatric epilepsy evaluations.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
- Epilepsy Diagnostics
Background:
- Electroencephalography (EEG) is crucial for diagnosing epilepsy in children.
- Hyperventilation (HV) is a standard EEG activation technique.
- The optimal duration of HV for maximizing diagnostic yield in pediatric populations is debated.
Purpose of the Study:
- To assess if 5-minute HV increases EEG diagnostic yield compared to 3-minute HV in children.
- To determine the feasibility and safety of performing 5-minute HV in pediatric patients.
Main Methods:
- Retrospective analysis of EEG data from 579 children (<18 years) undergoing epilepsy evaluation.
- Comparison of seizure and interictal epileptiform discharge (IED) precipitation during the first 3 minutes versus the last 2 minutes of HV.
- Monitoring for adverse events during the extended HV period.
Main Results:
- 68.7% of children completed the full 5-minute HV.
- 33.33% of HV-triggered seizures and 11.5% of HV-triggered IEDs occurred in the final 2 minutes.
- No adverse events were reported during the extended 5-minute HV period.
Conclusions:
- Extending HV to 5 minutes significantly enhances the diagnostic yield of pediatric EEG.
- A 5-minute HV protocol is safe and feasible for children undergoing epilepsy evaluation.
- This prolonged HV duration is recommended for improved diagnostic accuracy in pediatric epilepsy.
Abstract:
To investigate whether hyperventilation (HV) for 5 minutes increases the diagnostic yield of electroencephalography (EEG) compared to 3 minutes HV and to determine whether performing HV for 5 minutes is feasible and safe in children. Data were evaluated from 579 children aged less than 18 years, referred to EEG for epilepsy evaluation. Occurrence of seizures, HV induced interictal epileptiform discharges precipitation and potentiation and adverse events if any were noted during the first 3 minutes and last 2 minutes of HV separately. 398 children (68.7%) completed 5 minutes HV. Seizures were precipitated during the first 3 minutes of HV in 2 children, and during the last 2 minutes in one more child. Inter-ictal EEG abnormalities were precipitated in the first 3 minutes of HV in 31 children, and during the last 2 min in 4 more children. All 398 children completed HV during the last 2 minutes successfully and no adverse events occurred during the last 2 minutes of HV. 33.33% of seizures and 11.5% of inter-ictal EEG abnormalities triggered by HV occurred during the last 2 min of HV. This finding supports the utility of prolonged hyperventilation for 5 minutes. Prolonged HV for 5 minutes increases the diagnostic yield of EEG in paediatric population and it is safe and feasible.
