Rationale:
Ambulatory EEG (aEEG) is an excellent tool to monitor true seizure prevalence in epileptic patients in the outpatient setting. Moreover, it can detect subclinical seizures of which patients are not aware. The utilization of aEEG in underserved populations (such us the patient population at UI Health) can significantly enhance epilepsy monitoring, providing accessible and reliable diagnostic information to effectively manage their condition. The primary aim of this study was to determine the percentage of seizure detection in Ambulatory EEG in an underserved patient population and how it correlates with the patient’s self-reported seizure frequency. Secondary aim was the evaluation of possible risk factors associated with seizures on aEEG (education, race, type of epilepsy, medication compliance, presence of anxiety and depression).
Methods:
All patients with a diagnosis of epilepsy and underwent aEEG were included in the study. Patients who underwent aEEG but did not have a diagnosis of epilepsy (paroxysmal events of unclear etiology, syncope, provoked seizures) were excluded from the study. We retrospectively evaluated all medical records to obtain information about demographics, epilepsy and seizure types, self-reported seizure frequency, ASM (number of medications, type of medications), ASM compliance (by looking at ASM levels), presence of anxiety and depression (NIDDI and GAD scales when available), and EEG findings (epileptiform discharges, clinical and subclinical seizures, push button events).
Results:
One hundred ninety-nine patients were included in the study (115 female) with a median age of 38 years old: 47% of patients were African American, 42% Caucasian, 9% Hispanic, and 2% Asian. Forty-five percent of patients lived in an area with median income of < 50K and 55% of patients lived in an area with income >50K. Duration of epilepsy was >10 years in 58% of patients. In our population cohort, 39% of patients were unemployed, 16% were on disability, and 27% employed. Others were either retired or unknown status. Twenty eight percent of patients had high school level education, 14% finished college, 7% middle school only, and 5% with graduate school completion.
In our patient population (n=197, 2 patients didn’t not have this information), 55% patients had reported having seizures on monthly basis or several times a year. Thirty-five percent of patients reported having seizures at least once a year, whereas 17% patients had weekly seizures. Overall, only 30% of patients were seizure free. Of the 133 patients who reported having seizures, 20 (15%) patients had seizures recorded during ambEEG. Of the 60 patients who reported seizure freedom, 52 (87%) had no seizure recorded on ambEEG and 8 (13%) had seizures recorded on ambEEG. Seventy-two percent of patients with captured seizures on aEEG had educational level of high school or less.
Conclusions:
There appears to be a discrepancy between the perceived seizure control and actual seizure freedom. Thirteen percent of patients who reported seizure freedom at home, had seizures on their ambulatory EEG. Various social factors can be at play, including education level and extent of medical literacy.
Funding: No