Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges

doi:10.1212/WNL.0000000000002592

Observational Study

. 2016 Apr 19;86(16):1524-30.

doi: 10.1212/WNL.0000000000002592. Epub 2016 Mar 16.

Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges

Affiliations

¹ From the Departments of Neurology (D.B.B., J.W.B., V.R., R.R.F., K.M.K.-W., E.L.S., T.D.L., G.D.C., G.A.W.) and Child and Adolescent Neurology (P.J.C., K.C.N., L.C.W.-K., E.C.W.), Division of Epilepsy, Mayo Clinic, Rochester, MN; Department of Neurology (V.R.), Baylor Scott and White Health, Temple, TX; Department of Neurology (V.R.), West Virginia University Health Science Center, Morgantown; Spectrum Medical Group (R.R.F.), Rockford, MI; Division of Neurology (P.J.C.), McMaster University, Hamilton, Canada; and Minneapolis Clinic of Neurology (K.M.K.-W.), Edina. burkholder.davidb@gmail.com.
² From the Departments of Neurology (D.B.B., J.W.B., V.R., R.R.F., K.M.K.-W., E.L.S., T.D.L., G.D.C., G.A.W.) and Child and Adolescent Neurology (P.J.C., K.C.N., L.C.W.-K., E.C.W.), Division of Epilepsy, Mayo Clinic, Rochester, MN; Department of Neurology (V.R.), Baylor Scott and White Health, Temple, TX; Department of Neurology (V.R.), West Virginia University Health Science Center, Morgantown; Spectrum Medical Group (R.R.F.), Rockford, MI; Division of Neurology (P.J.C.), McMaster University, Hamilton, Canada; and Minneapolis Clinic of Neurology (K.M.K.-W.), Edina.

PMID: 26984946
PMCID: PMC4836883
DOI: 10.1212/WNL.0000000000002592

Observational Study

Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges

David B Burkholder et al. Neurology. 2016.

. 2016 Apr 19;86(16):1524-30.

doi: 10.1212/WNL.0000000000002592. Epub 2016 Mar 16.

Affiliations

¹ From the Departments of Neurology (D.B.B., J.W.B., V.R., R.R.F., K.M.K.-W., E.L.S., T.D.L., G.D.C., G.A.W.) and Child and Adolescent Neurology (P.J.C., K.C.N., L.C.W.-K., E.C.W.), Division of Epilepsy, Mayo Clinic, Rochester, MN; Department of Neurology (V.R.), Baylor Scott and White Health, Temple, TX; Department of Neurology (V.R.), West Virginia University Health Science Center, Morgantown; Spectrum Medical Group (R.R.F.), Rockford, MI; Division of Neurology (P.J.C.), McMaster University, Hamilton, Canada; and Minneapolis Clinic of Neurology (K.M.K.-W.), Edina. burkholder.davidb@gmail.com.
² From the Departments of Neurology (D.B.B., J.W.B., V.R., R.R.F., K.M.K.-W., E.L.S., T.D.L., G.D.C., G.A.W.) and Child and Adolescent Neurology (P.J.C., K.C.N., L.C.W.-K., E.C.W.), Division of Epilepsy, Mayo Clinic, Rochester, MN; Department of Neurology (V.R.), Baylor Scott and White Health, Temple, TX; Department of Neurology (V.R.), West Virginia University Health Science Center, Morgantown; Spectrum Medical Group (R.R.F.), Rockford, MI; Division of Neurology (P.J.C.), McMaster University, Hamilton, Canada; and Minneapolis Clinic of Neurology (K.M.K.-W.), Edina.

PMID: 26984946
PMCID: PMC4836883
DOI: 10.1212/WNL.0000000000002592

Abstract

Objective: To compare the yield of epileptiform abnormalities on 30-minute recordings with those greater than 45 minutes.

Methods: We performed a prospective observational cross-sectional study of all outpatient routine EEGs comparing the rate of interictal epileptiform discharges (IEDs) and clinical events during the initial 30 minutes (routine) with those occurring in the remaining 30-60 minutes (extended). A relative increase of 10% was considered clinically significant.

Results: EEGs from 1,803 patients were included; overall EEG duration was 59.4 minutes (SD ±6.5). Of 426 patients with IEDs at any time during the EEG, 81 (19.1%, 95% confidence interval 15.6-23) occurred only after the initial 30 minutes. The rate of late IEDs was not associated with age, indication, IED type, or sleep deprivation. Longer recording times also increased event capture rate by approximately 30%.

Conclusions: The yield of IED and event detection is increased in extended outpatient EEGs compared to 30-minute studies.

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Figures

**Figure. Early- and late-occurring interictal epileptiform discharges (IEDs) by sleep status**
Early and late IEDs by (A) sleep deprivation at time of EEG, (B) sleep during EEG, and (C) early or late sleep during EEG.

See this image and copyright information in PMC

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References

1. Marsan CA, Zivin LS. Factors related to the occurrence of typical paroxysmal abnormalities in the EEG records of epileptic patients. Epilepsia 1970;11:361–381. - PubMed
1. Salinsky M, Kanter R, Dasheiff RM. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 1987;28:331–334. - PubMed
1. Doppelbauer A, Zeitlhofer J, Zifko U, Baumgartner C, Mayr N, Deecke L. Occurrence of epileptiform activity in the routine EEG of epileptic patients. Acta Neurol Scand 1993;87:345–352. - PubMed
1. Baldin E, Hauser WA, Buchhalter JR, Hesdorffer DC, Ottman R. Yield of epileptiform electroencephalogram abnormalities in incident unprovoked seizures: a population-based study. Epilepsia 2014;55:1389–1398. - PMC - PubMed
1. Faulkner HJ, Arima H, Mohamed A. Latency to first interictal epileptiform discharge in epilepsy with outpatient ambulatory EEG. Clin Neurophysiol 2012;123:1732–1735. - PubMed

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[1] Marsan CA, Zivin LS. Factors related to the occurrence of typical paroxysmal abnormalities in the EEG records of epileptic patients. Epilepsia 1970;11:361–381. - PubMed

[2] Marsan CA, Zivin LS. Factors related to the occurrence of typical paroxysmal abnormalities in the EEG records of epileptic patients. Epilepsia 1970;11:361–381. - PubMed

[3] Salinsky M, Kanter R, Dasheiff RM. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 1987;28:331–334. - PubMed

[4] Salinsky M, Kanter R, Dasheiff RM. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 1987;28:331–334. - PubMed

[5] Doppelbauer A, Zeitlhofer J, Zifko U, Baumgartner C, Mayr N, Deecke L. Occurrence of epileptiform activity in the routine EEG of epileptic patients. Acta Neurol Scand 1993;87:345–352. - PubMed

[6] Doppelbauer A, Zeitlhofer J, Zifko U, Baumgartner C, Mayr N, Deecke L. Occurrence of epileptiform activity in the routine EEG of epileptic patients. Acta Neurol Scand 1993;87:345–352. - PubMed

[7] Baldin E, Hauser WA, Buchhalter JR, Hesdorffer DC, Ottman R. Yield of epileptiform electroencephalogram abnormalities in incident unprovoked seizures: a population-based study. Epilepsia 2014;55:1389–1398. - PMC - PubMed

[8] Baldin E, Hauser WA, Buchhalter JR, Hesdorffer DC, Ottman R. Yield of epileptiform electroencephalogram abnormalities in incident unprovoked seizures: a population-based study. Epilepsia 2014;55:1389–1398. - PMC - PubMed

[9] Faulkner HJ, Arima H, Mohamed A. Latency to first interictal epileptiform discharge in epilepsy with outpatient ambulatory EEG. Clin Neurophysiol 2012;123:1732–1735. - PubMed

[10] Faulkner HJ, Arima H, Mohamed A. Latency to first interictal epileptiform discharge in epilepsy with outpatient ambulatory EEG. Clin Neurophysiol 2012;123:1732–1735. - PubMed

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Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges

Affiliations

Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges

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