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Risk of Developing Seizures in Children With Abnormal EEG Findings During Polysomnography
Elise L Mercier1, Swati Chanchani1, Karen S Carvalho1
1Section of Neurology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Insights
Abnormal electroencephalogram (EEG) findings during polysomnography (PSG) in children without a prior epilepsy diagnosis often indicate abnormalities on routine EEG (rEEG) and an increased risk for future seizures.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Polysomnography (PSG) uses abbreviated electroencephalogram (EEG) for sleep staging.
- The diagnostic utility of EEG abnormalities detected during PSG in non-epileptic children requires further investigation.
Purpose of the Study:
- To assess the correlation between epileptiform abnormalities on abbreviated EEG during PSG and routine EEG (rEEG) in children.
- To determine if these EEG abnormalities predict an increased risk of seizures in children without a prior epilepsy diagnosis.
Main Methods:
- Retrospective chart review of 67 children with EEG abnormalities during PSG, excluding those with a prior epilepsy diagnosis.
- Analysis included subsequent routine EEG (rEEG) results and epilepsy diagnosis as primary outcomes.
Main Results:
- Abnormal epileptiform discharges were identified in 65% of children on PSG-derived EEG.
- Children with abnormal PSG EEG findings were significantly more likely to have abnormal rEEG results.
- A notable proportion of these children (29%) subsequently developed seizures, with higher rates observed for generalized or mixed abnormalities.
Conclusions:
- Abnormal EEG findings during PSG in children without a history of seizures are predictive of abnormalities on routine EEG.
- These children face an elevated risk of developing epilepsy, underscoring the importance of follow-up evaluations.
Background:
Polysomnography (PSG) utilizes abbreviated electroencephalogram (EEG) to stage sleep. The aim of this study was to determine whether epileptiform abnormalities on this limited EEG coverage correlated with abnormalities on routine EEG (rEEG) and an increased risk for seizures in children without a prior diagnosis of epilepsy.
Methods:
A six-year retrospective chart review was performed assessing children with abnormalities on EEG during PSG. Children who underwent subsequent rEEG were included; children with a prior diagnosis of seizures were excluded. The main outcome measures were rEEG results and subsequent diagnosis of epilepsy.
Results:
A total of 67 children met inclusion criteria. Average age was six years, and 43 (64%) were male. rEEG was normal in 16 (24%). Epileptiform abnormalities were focal in 36 (54%), generalized in eight (12%), and mixed in five (8%). An additional two (3%) had slow background rhythm without epileptiform discharges. Thirty-one patients had neurology clinic follow-up with an average duration of 31 months (range 4 to 65 months). Of these, nine (29%) developed seizures, including all three with generalized epileptiform discharges, four of 19 (21%) with focal epileptiform discharges, and two of five (40%) with mixed epileptiform discharges or background slowing. None of the four patients with a normal rEEG had seizures. Eight of the nine patients with seizures were treated with antiepileptic drugs.
Conclusions:
Children with no history of seizures found to have abnormal EEG during PSG are likely to have an abnormal rEEG. Additionally, they have an increased risk for developing seizures.
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