Abstracts

Rationale: Children with neurobehavioral disorders are at increased risk for seizures and non-epileptic behaviors that often require an EEG to guide management. Sedated studies are often considered in order to ensure the safety of the child and EEG technologist, and to improve study quality. The goal of this study is to assess the impact of newer anesthetic agents on the ability to identify diagnostically significant EEG abnormalities. Methods: The records of all children who underwent sedated outpatient EEGs over a 3 year period were reviewed. Patients who had known epilepsy or previous EEGs at our facility were excluded (n=65). 79 children were included in the study with reason for sedation, indication for EEG, frequency of events concerning for seizure, induction anesthesia, and maintenance anesthesia documented. The EEGs of these children were then reviewed to identify epileptiform transients or focal slowing. The time from EEG initiation to the first abnormalities was also documented. Results: Indications for sedation included: autism (n=45), behavioral issues (n=9), developmental/cognitive impairment (n=23), or pervasive developmental disorder (n=4). Mean age of sedated EEG was 7.82 years (SD 3.99). 87% of children received induction anesthesia with sevoflurane, nitrous oxide, or both. Other agents used included opioids, propofol, and ketamine. Sedation was maintained in 72/79 children with intravenous infusion of dexmedetomidine alone. The other children received boluses of opioids or propofol in addition to an infusion of dexmedetomidine. Epileptiform transients were identified on 29 recordings (37%) with isolated focal slowing seen on 3 recordings. Mean time from initiation of recording to first epileptiform transient was 3 minutes (SD 3.17 minutes). There was not a significant effect of age, indication for sedation, indication for EEG, or frequency of events on the identification of an abnormality. Conclusions: This study demonstrates that clinically relevant information can be obtained from sedated EEG studies using newer anesthetic agents. In previous studies using secobarbital for sedation only 14% of recordings revealed diagnostically significant abnormalities, suggesting the current protocol may be of greater benefit. Further investigation is necessary to determine diagnostic yield and clinical utility. Funding: None