From Request To Result: The Clinical Significance of EEG in a Tertiary Hospital in Turkey
Year 2024,
Volume: 7 Issue: 3, 288 - 292, 27.10.2024
Dilek Ağırcan
,
Mehmet Bal
,
Murat Cekic
,
Tülin Gesoğlu Demir
,
Adalet Göçmen
,
Özlem Ethemoğlu
Abstract
Objective: This study aimed to assess the clinical and demographic profiles of patients undergoing electroencephalography (EEG) over one year, evaluate EEG's impact on patient management, and ascertain the appropriateness of EEG requests.
Methods: A retrospective analysis was conducted in the neurophysiology department at XXX University Faculty of Medicine over 12 months from October 2022 to October 2023. The study included the EEG request to the neurophysiology department; pediatrics and the cases that had artifacts or technical issues were excluded. Age, gender, imaging characteristics, EEG findings, and the reasons for EEG requests were recorded. The contribution of EEG to patient management was analyzed.
Results: The study included 1217 patients with a mean age of 34.4±16.5 years, ranging from 18 to 90 years. Of these, 656 were female and 561 male. A history of epilepsy was reported in 821 patients. Neurology outpatient clinics, inpatient wards, and intensive care units requested the majority of EEGs. Epilepsy, presyncope/syncope, and psychogenic non-epileptic seizures (PNES) were the top reasons for EEG requests. Among the newly diagnosed epilepsy patients, 13 showed abnormal EEG results. The study identified MRI abnormalities in 202 patients, with a 27% concordance between EEG and MRI findings. EEG significantly influenced patient management in 577 cases (46.5%), demonstrating its crucial role in clinical decision-making.
Conclusion: EEG's diagnostic value, particularly in epilepsy and complex neurological conditions, remains unique. Advocating suiting EEG requests and increasing physician knowledge of seizures can optimize patient care and resource use.
Ethical Statement
Ethical approval for this study was granted by the local ethics committee of Harran University Medical Faculty in 2024, with the assigned protocol number being HRÜ/24.02.01.
Supporting Institution
Null
References
- Tatum WO, Rubboli G, Kaplan PW, et al. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults [published correction appears in Clin Neurophysiol. 2022 Sep;141:160]. Clin Neurophysiol. 2018;129(5):1056-1082. doi:10.1016/j.clinph.2018.01.019
- Hasan TF, Tatum WO. When should we obtain a routine EEG while managing people with epilepsy? Epilepsy Behav Rep. 2021;16:100454. Published 2021 May 3. doi:10.1016/j.ebr.2021.100454
- Jefsen OH, Nielsen JRW, Christensen J, Hjerrild S. The clinical use of electroencephalography in a general psychiatric setting. Nord J Psychiatry. 2023;77(6):560-565. doi:10.1080/08039488.2023.2189300
- Scheepers B, Clough P, Pickles C. The misdiagnosis of epilepsy: findings of a population study. Seizure. 1998;7(5):403-406. doi:10.1016/s1059-1311(05)80010-x
- Smith D, Defalla BA, Chadwick DW. The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic. QJM. 1999;92(1):15-23. doi:10.1093/qjmed/92.1.15
- Pearce KM, Cock HR. An audit of electroencephalography requests: use and misuse. Seizure. 2006;15(3):184-189. doi:10.1016/j.seizure.2006.01.003
- Panayiotopoulos CP. The Epilepsies: Seizures, Syndromes and Management. Oxfordshire (UK): Bladon Medical Publishing; 2005.
- Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry. 2005;76 Suppl 2(Suppl 2):ii2-ii7. doi:10.1136/jnnp.2005.069245
- Wirrell EC. Prognostic significance of interictal epileptiform discharges in newly diagnosed seizure disorders. J Clin Neurophysiol. 2010;27(4):239-248. doi:10.1097/WNP.0b013e3181ea4288
- Perucca E, Tomson T. The pharmacological treatment of epilepsy in adults. Lancet Neurol. 2011;10(5):446-456. doi:10.1016/S1474-4422(11)70047-3
- Fowle AJ, Binnie CD. Uses and abuses of the EEG in epilepsy. Epilepsia. 2000;41 Suppl 3:S10-S18. doi:10.1111/j.1528-1157.2000.tb01529.x
- Azman-Iste F, Oge DD, Tezer-Filik FI, Saygı S. The EEG Profile of an Outpatient Adult EEG Laboratory of one of the Reference Epilepsy Center in Turkey. EPILEPSI. 2020;26(2):108-114. doi:10.14744/epilepsi.2020.09815
- Monif M, Seneviratne U. Clinical factors associated with the yield of routine outpatient scalp electroencephalograms: A retrospective analysis from a tertiary hospital. J Clin Neurosci. 2017;45:110-114. doi:10.1016/j.jocn.2017.08.014
- Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-Based Guideline: Management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsy Curr. 2015;15(3):144-152. doi:10.5698/1535-7597-15.3.144
- 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(9):1389-1398. doi:10.1111/epi.12720
- Parra J, Iriarte J, Kanner AM. Are we overusing the diagnosis of psychogenic non-epileptic events? Seizure. 1999;8(4):223-227. doi:10.1053/seiz.1999.0285
- Smith D, Bartolo R, Pickles RM, Tedman BM. Requests for electroencephalography in a district general hospital: retrospective and prospective audit. BMJ. 2001;322(7292):954-957. doi:10.1136/bmj.322.7292.95
İstemden Sonuca: Türkiye'de Üçüncü Basamak Bir Hastanede EEG'nin Klinik Önemi
Year 2024,
Volume: 7 Issue: 3, 288 - 292, 27.10.2024
Dilek Ağırcan
,
Mehmet Bal
,
Murat Cekic
,
Tülin Gesoğlu Demir
,
Adalet Göçmen
,
Özlem Ethemoğlu
Abstract
Amaç: Bu çalışmanın amacı, bir yıl boyunca elektroensefalografi (EEG) çekilen hastaların klinik ve demografik verilerini incelemek, EEG'nin hasta yönetimi üzerindeki etkisini ve EEG taleplerinin uygunluğunu değerlendirmektir.
Yöntem: Bu çalışma Ekim 2022 ve Ekim 2023 tarihleri arasında XXX Üniversitesi Tıp Fakültesi'nde retrospektif olarak gerçekleştirildi. Çalışmada, nörofizyoloji laboratuvarına gelen EEG talepleri tarandı ve pediatrik vakalara ek olarak artefakt veya teknik sorunlar nedeniyle değerlendirilemeyen EEG'ler çalışmadan dışlandı. Hastaların yaşı, cinsiyeti, görüntüleme özellikleri, EEG bulguları ve EEG taleplerinin nedenleri kaydedildi. EEG'nin hasta yönetimine katkısı analiz edildi.
Bulgular: Çalışmaya yaş ortalaması 34,4±16,5 yıl olan ve yaşları 18 ile 90 arasında değişen 1217 hasta dahil edildi. Bunların 656'sı kadın ve 561'i erkekti. Hastaların 821'inde epilepsi öyküsü mevcuttu. EEG'lerin çoğu nöroloji poliklinikleri, nöroloji yatan hasta servisleri ve yoğun bakım ünitelerinden istenmişti. Epilepsi, presenkop/senkop ve psikojenik epileptik olmayan nöbetler (PNES) EEG taleplerinin en önemli nedenleriydi. Yeni tanı konulan 20 epilepsi hastasının 13'ünde anormal EEG bulguları saptandı. Çalışmada 202 hastada MRG anormallikleri tespit edildi ve EEG ile MRG bulguları arasında %27'lik bir uyum görüldü. EEG’nin 577 vakada (%46,5) hasta yönetimini etkilediği saptandı.
Sonuç: EEG'nin özellikle epilepsi ve diğer nörolojik hastalıklarda tanıya katkısı önemini korumaktadır. Uygun EEG taleplerinin teşvik edilmesi ve hekimlerin nöbetler hakkındaki bilgilerinin artırılması hasta bakımını ve kaynak kullanımını optimize edebilir.
References
- Tatum WO, Rubboli G, Kaplan PW, et al. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults [published correction appears in Clin Neurophysiol. 2022 Sep;141:160]. Clin Neurophysiol. 2018;129(5):1056-1082. doi:10.1016/j.clinph.2018.01.019
- Hasan TF, Tatum WO. When should we obtain a routine EEG while managing people with epilepsy? Epilepsy Behav Rep. 2021;16:100454. Published 2021 May 3. doi:10.1016/j.ebr.2021.100454
- Jefsen OH, Nielsen JRW, Christensen J, Hjerrild S. The clinical use of electroencephalography in a general psychiatric setting. Nord J Psychiatry. 2023;77(6):560-565. doi:10.1080/08039488.2023.2189300
- Scheepers B, Clough P, Pickles C. The misdiagnosis of epilepsy: findings of a population study. Seizure. 1998;7(5):403-406. doi:10.1016/s1059-1311(05)80010-x
- Smith D, Defalla BA, Chadwick DW. The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic. QJM. 1999;92(1):15-23. doi:10.1093/qjmed/92.1.15
- Pearce KM, Cock HR. An audit of electroencephalography requests: use and misuse. Seizure. 2006;15(3):184-189. doi:10.1016/j.seizure.2006.01.003
- Panayiotopoulos CP. The Epilepsies: Seizures, Syndromes and Management. Oxfordshire (UK): Bladon Medical Publishing; 2005.
- Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry. 2005;76 Suppl 2(Suppl 2):ii2-ii7. doi:10.1136/jnnp.2005.069245
- Wirrell EC. Prognostic significance of interictal epileptiform discharges in newly diagnosed seizure disorders. J Clin Neurophysiol. 2010;27(4):239-248. doi:10.1097/WNP.0b013e3181ea4288
- Perucca E, Tomson T. The pharmacological treatment of epilepsy in adults. Lancet Neurol. 2011;10(5):446-456. doi:10.1016/S1474-4422(11)70047-3
- Fowle AJ, Binnie CD. Uses and abuses of the EEG in epilepsy. Epilepsia. 2000;41 Suppl 3:S10-S18. doi:10.1111/j.1528-1157.2000.tb01529.x
- Azman-Iste F, Oge DD, Tezer-Filik FI, Saygı S. The EEG Profile of an Outpatient Adult EEG Laboratory of one of the Reference Epilepsy Center in Turkey. EPILEPSI. 2020;26(2):108-114. doi:10.14744/epilepsi.2020.09815
- Monif M, Seneviratne U. Clinical factors associated with the yield of routine outpatient scalp electroencephalograms: A retrospective analysis from a tertiary hospital. J Clin Neurosci. 2017;45:110-114. doi:10.1016/j.jocn.2017.08.014
- Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-Based Guideline: Management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsy Curr. 2015;15(3):144-152. doi:10.5698/1535-7597-15.3.144
- 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(9):1389-1398. doi:10.1111/epi.12720
- Parra J, Iriarte J, Kanner AM. Are we overusing the diagnosis of psychogenic non-epileptic events? Seizure. 1999;8(4):223-227. doi:10.1053/seiz.1999.0285
- Smith D, Bartolo R, Pickles RM, Tedman BM. Requests for electroencephalography in a district general hospital: retrospective and prospective audit. BMJ. 2001;322(7292):954-957. doi:10.1136/bmj.322.7292.95