Abstracts

Rationale: EEG is an important tool in the evaluation and management of patients with Epilepsy. ACNS recommends a baseline record should contain at least 20 min of technically satisfactory recording. The time needed to complete a routine 20 min EEG per ACNS guidelines usually runs 60 min and the yield of an epileptiform abnormality from a single standard EEG is 32- 59% in children and 12 – 44% in adults. In a resource limited settings such as free health camps where large number of patients are seen within a limited time period, it is challenging to offer EEG testing to patients presenting with a diagnostic dilemma. With the limited resources and time constraints, performing a routine EEG with ACNS guidelines for 20 minutes limited the utilization of EEG in this clinical setting hence a modified protocol was developed to increase the number of patients being tested with EEG. Methods: In rural Maharashtra in India regular Epilepsy treatment camps are held by the Epilepsy Foundation of India, in association with government agencies, in the various camp sites. Between 2012 to 2017 over 12,000 patients were seen for evaluation and treatment of Epilepsy in these camps. Often this is the only time many of these patients have been seen by a specialist, some are treatment naïve and the vast majority have never had an EEG done presenting a diagnostic dilemma for some of these patients. At each camp site there were 3 portable EEG machines.A limited 7 minute EEG protocol was developed while still using the standard 10-20 electrode placement. After the initial setup baseline EEG was recorded for 3 minutes followed by 3 minutes of hyperventilation (HV) and 1 minute post HV. The EEG’s were reviewed by a trained Neurologist on site. This protocol decreased the total time needed to complete an EEG per patient to 15-20 min and made it possible to complete more EEGs each day.Epileptiform abnormalities included generalized spike and wave, focal sharp waves, multifocal sharp waves, spikes and Ictal patterns. Nonspecific changes included nonspecific slowing & asymmetry.  Results: Data was obtained from 970 patients, which was included for this analysis. There were 538 pediatric patients (Age 1-17) and 432 adults (Age 18 and above).Of the 538 pediatric EEG’s 294 showed epileptic abnormalities (yield of 54%). In adult EEGs 203 out of the 432 had epileptic abnormalities (yield of 46%). 29% (160 of 538) pediatric EEG’s were normal and 37% (162 of 432) adult EEG’s were normal and so these did not even have any nonspecific changes. Conclusions: This study shows that in resource limited settings, in selected patients presenting with diagnostic dilemma where a large number of patients need EEGs to be performed a shorter limited (7 min) EEG with hyperventilation yielded results similar to those undergoing routine EEGs in a regular clinical setting. Most of the patients included in this study had never had an EEG before and had long standing epilepsy and some were treatment naïve likely making it possible to capture the abnormalities in a shorter duration. This data will help expand the reach of EEG to a larger number of patients without straining the resources in such specific clinical settings. Funding: None