Abstracts

Rationale: Children with neurodevelopmental disabilities are at increased risk for epilepsy.  Electroencephalogram (EEG) studies are often poorly tolerated due to the child’s inability to cooperate. Our hospital has utilized an outpatient protocol of sedation with dexmedetomidine to obtain EEGs in uncooperative children. This agent has been shown to have minimal effect on epileptiform abnormalities in subjects with known epilepsy.  The primary aim of our study was to determine the yield of clinically significant abnormalities in children sedated with dexmedetomidine compared to a non-sedated control population who achieved sleep during the EEG. Methods: Children who underwent EEGs between 2013 and 2015 were included in the study.  Those children who underwent sedated EEGs were compared to the children with autism spectrum disorder (ASD) or other developmental disabilities (DD) undergoing routine outpatient EEGs to determine if the rates of focal slowing and/or epileptiform transients were similar.  Children with previous EEGs or known epilepsy were excluded from the study.  Control subjects were required to have developmental disability at the time of their EEG and sleep captured on their EEG. Results: 79 children with sedated EEGs were compared to 140 children in the control group.  The rate of abnormalities in the sedated population was 41% in comparison to 19% in the control population (p = 0.0004).  There was a higher rate of ASD and more frequent events concerning for seizure in the sedated cohort. Children with ASD were then compared between the two cohorts (n=45 in the sedated population and n=50 in the control population).  There was no significant difference in age, sex, frequency of events, or indication for EEG between these two ASD cohorts.  The rate of abnormalities was 38% in the sedated population and 24% in the non-sedated cohort (p = 0.145). Conclusions: This study demonstrates that utilizing dexmedetomidine for sedated outpatient EEGs yields clinically significant abnormalities at similar rates to non-sedated controls.  Higher rates in the sedated cohort may be related to more severe impairment in these children. Dexmedetomidine sedated EEGs may be a useful tool in establishing the diagnosis of epilepsy and selection of appropriate antiseizure treatment in this population. Funding: None.