RESUMEN
Objective: Ambulatory electroencephalography (AEEG) monitoring allows for prolonged recordings in normal environments, such as patients' homes, and is recognized as a cost-effective alternative to inpatient long-term video-EEG primarily in resource-limited countries. We aim to describe the impact of AEEG on the assessment of patients with suspected or confirmed epilepsy in two independent Latin-American populations with limited resources. Methods: We included 63 patients who had undergone an AEEG due to confirmed/suspected epilepsy. Clinical (demographic, current antiseizure medication and indication) and electroencephalographic (duration of the study, result, and impact on clinical decision-making) were reviewed and compared. Results: The main indication for an AEEG was the differentiation of seizures from non-epileptic events with 57% of patients. It was categorized as positive in 36 patients and did have an impact on the clinical decision-making process in 57% of patients. AEEG captured clinical events in 35 patients (20 epileptic and 15 non-epileptic). Conclusions: AEEG proves to be a valuable tool in resource-limited settings for assessing suspected or confirmed epilepsy cases, with a significant impact on clinical decisions. Significance: Our study provides valuable insights into the use of AEEG in under-resourced regions, shedding light on the challenges and potential benefits of this tool in clinical practice.
RESUMEN
Background. Sleep is an activation procedure and is considered the most potent and best-documented modulator of seizures and interictal epileptiform discharges (IEDs) on electroencephalogram (EEG). The precise role of sleep deprivation in the diagnostic process of epilepsy has not been fully clarified after more than 50 years of use. Sleep deprivation is a procedure that is accompanied by discomfort for patients and their families. Therefore, an accurate indication according to each patient-specific characteristic is needed. This study aims to assess the effectiveness of sleep deprivation EEG in the diagnostic process of patients with suspected epilepsy in our center. Methods. We included patients with a first unprovoked seizure and patients with paroxysmal events suspecting seizures who underwent a sleep deprivation EEG (sdEEG) or routine EEG (rEEG). All patients were subsequently classified with confirmed epilepsy or not. Results. We included 460 patients. The group with sdEEG consisted of 115 patients, while the group with rEEG comprised 345 patients. In the sdEEG group, 19 patients (17%) were confirmed with epilepsy, of which 17 presented interictal epileptiform discharges (IEDs). For the rEEG group, 66 patients (19%) were confirmed with epilepsy, of which 63 presented IEDs. The difference was not statistically significant. Conclusion. Our study failed to find a difference in the yield of sleep deprivation versus routine EEG in patients with epilepsy, but there are many significant confounders/sample biases that limit the generalizability of the findings, particularly to the majority of adult practices.
