Abstract Details

Title Increased Diagnostic Yield of 4-Hour Outpatient EEG Compared to Routine EEG

Topic Clinical Neurophysiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 235

Objective

Background BACKGROUND: Yield of the initial REEG in patients with epilepsy (PWES) is approximately 30-55%. Inpatient video-EEG or outpatient ambulatory EEG increases diagnosis with increased cost and resource utilization. Outpatient XEEG recording may have benefit and small incremental resource utilization.

Design/Methods DESIGN/METHODS: From 2010-2012, 77 consecutive patients evaluated for possible seizures or known epilepsy and having a 2-4 hour XEEG at a single university medical center neurophysiology lab underwent retrospective chart review. For most of these XEEGs, 1 of 2 electroencephalographers interpreted the first 40-minutes of the EEG (REEG) and filed separate interpretation of the entire XEEG. 26% of patients had their XEEG report compared against an REEG performed weeks-months earlier.

Results RESULTS: Mean age was 47 yr (range 19-90 yr). 50% were suspected of having epilepsy prior to the XEEG (29 LRE, 10 Generalized epilepsy). 69% of the total cohort was on AEDs. Median number of AEDs used during the XEEG was 1 (range 1 to 4). Mean XEEG duration was 3.6 hrs (range 2-4 hr, >75% were 4h). 38% of REEGs vs. 48% of XEEGs contained significant focal or epileptiform abnormalities. This 10% difference is statistically significant (95%CI 3-18%, p=0.01). Epileptiform abnormalities were noted in 18% of the REEGs and 27% of the XEEGs. 1 nonepiletic event was recorded on the rEEG, and 3 XEEGs had events (1 epileptic, 2 nonepiletpic).

Conclusions CONCLUSIONS: This rigorous case-control study shows 4-hour EEG provides significantly more diagnostic information in this group of adults evaluated for 1 or multiple possible seizures. Most of this benefit came from detection of epileptiform discharges.

Authors/Disclosures
PRESENTER	No disclosure on file
Rainald Schmidt-Kastner	No disclosure on file
Stephen Wong, MD (Atlantic Health System)	No disclosure on file
Ram Mani, MD (Rutgers - Robert Wood Johnson Medical School)	No disclosure on file
Rohit Bakshi, MD, FAAN	Dr. Bakshi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Bakshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. The institution of Dr. Bakshi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neuroimaging. The institution of Dr. Bakshi has received research support from Bristol Myers Squibb. The institution of Dr. Bakshi has received research support from EMD Serono. The institution of Dr. Bakshi has received research support from Novartis.

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