Benjamin Tolchin1, Jong Woo Lee2, Milena Pavlova3, Barbara A Dworetzky4, Rani A Sarkis5. 1. Department of Neurology, The Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: btolchin@partners.org. 2. Department of Neurology, The Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: jlee38@partners.org. 3. Department of Neurology, The Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: mpavlova@bwh.harvard.edu. 4. Department of Neurology, The Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: bdworetzky@partners.org. 5. Department of Neurology, The Edward B. Bromfield Epilepsy Program, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: rsarkis@partners.org.
Abstract
OBJECTIVE: The diagnostic yield of ambulatory EEG in the elderly is not known. We sought to determine diagnostic yield and identify factors predicting diagnostic findings in this elderly population. METHODS: We reviewed 156 consecutive 24-72h ambulatory EEGs performed on patients aged 60 or older. RESULTS: Of the 156 studies, 58 studies (37%) revealed potentially diagnostic findings: either epileptiform discharges, an epileptic seizure, or a typical nonepileptic event. Focal slowing on routine EEG predicted epileptiform abnormalities on ambulatory EEG with an odds ratio of 4.0 (95% CI 1.7-9.7, p=0.002). Age, the presence of a focal lesion on MRI, and duration of ambulatory EEG failed to predict epileptiform abnormalities on ambulatory EEG. Duration of ambulatory EEG predicted capture of a typical nonepileptic event with an odds ratio of 2.7 (95% CI 1.3-5.7, p=0.009) for every additional day of study duration. CONCLUSIONS: Focal slowing on routine EEGs may warrant an ambulatory EEG in the setting of diagnostic uncertainty. Longer ambulatory EEGs have a higher yield in capturing patients' typical non-epileptic events, and should be considered in patients where nonepileptic events are a likely diagnostic possibility. SIGNIFICANCE: These findings offer guidance in the use of ambulatory EEGs in the elderly.
OBJECTIVE: The diagnostic yield of ambulatory EEG in the elderly is not known. We sought to determine diagnostic yield and identify factors predicting diagnostic findings in this elderly population. METHODS: We reviewed 156 consecutive 24-72h ambulatory EEGs performed on patients aged 60 or older. RESULTS: Of the 156 studies, 58 studies (37%) revealed potentially diagnostic findings: either epileptiform discharges, an epilepticseizure, or a typical nonepileptic event. Focal slowing on routine EEG predicted epileptiform abnormalities on ambulatory EEG with an odds ratio of 4.0 (95% CI 1.7-9.7, p=0.002). Age, the presence of a focal lesion on MRI, and duration of ambulatory EEG failed to predict epileptiform abnormalities on ambulatory EEG. Duration of ambulatory EEG predicted capture of a typical nonepileptic event with an odds ratio of 2.7 (95% CI 1.3-5.7, p=0.009) for every additional day of study duration. CONCLUSIONS: Focal slowing on routine EEGs may warrant an ambulatory EEG in the setting of diagnostic uncertainty. Longer ambulatory EEGs have a higher yield in capturing patients' typical non-epileptic events, and should be considered in patients where nonepileptic events are a likely diagnostic possibility. SIGNIFICANCE: These findings offer guidance in the use of ambulatory EEGs in the elderly.
Authors: Maurice Abou Jaoude; Haoqi Sun; Kyle R Pellerin; Milena Pavlova; Rani A Sarkis; Sydney S Cash; M Brandon Westover; Alice D Lam Journal: Sleep Date: 2020-11-12 Impact factor: 5.849
Authors: Rani A Sarkis; Louis Beers; Emile Farah; Mohammad Al-Akaidi; Yuxiang Zhang; Joseph J Locascio; Michael J Properzi; Aaron P Schultz; Jasmeer P Chhatwal; Keith A Johnson; Reisa A Sperling; Page B Pennell; Gad A Marshall Journal: Clin Neurophysiol Date: 2020-09-19 Impact factor: 3.708