Pediatric electroencephalography: a tertiary care university hospital experience

Background Routine electroencephalography (EEG) is a widely used test in children for the evaluation of many neurological conditions. It is specifically important in the diagnosis of epilepsy and the differentiation of epilepsy from nonepileptic events. Aim This study aimed to evaluate the current situation of EEG recording at Alexandria University Children’s Hospital. Patients and methods All patients who had a routine EEG recording during a period of 6 months were included in the study. Review of the records was done including personal data, place and indication of referral, and initial diagnosis. EEG data included condition during recording, activation procedures, EEG interpretation regarding background activity, presence or absence of epileptiform activity, type and origin of epileptiform discharges, and the final yield of EEG. Results The study included 570 children, comprising 336 males and 234 females, with a mean age of 5.5±4.1 years. The main indication for referral was epilepsy in 69.8%. Most of the cases (83.3%) had an awake recording. Photic stimulation and hyperventilation were done in 93.3 and 31.9%, respectively, and abnormal response to hyperventilation was observed in 9.9% of them. Ictal recording was done in 22 (3.8%) cases. Abnormal epileptiform discharges were detected in 173 (30.4%) of the studied children; of them, 162 cases were initially referred for established epilepsy and 11 cases for other reasons. The abnormality was generalized in 53.8% and focal in 46.2% of the cases. The commonest types of epileptiform discharges were spikes (65.9%) followed by spike-and-wave complexes (56.1%). Hypsarrhythmia, 3-Hz spike-and-wave complexes, and nonconvulsive status epilepticus were detected in 12.7, 10.4, and 2.9%, respectively. Phase reversal, sharp waves, and polyspikes were detected in 15.6, 5.2, and 2.3%, respectively. Conclusion Routine EEG is a valuable test for evaluation of seizures and epilepsy. Specific abnormal epileptiform discharges are diagnostic for certain epileptic syndromes. EEG finding may be normal in children with epilepsy and should be interpreted in the context of the clinical settings.