Usefulness of a simple sleep-deprived EEG protocol for epilepsy diagnosis in de novo subjects

• Published in: Clinical neurophysiology Vol. 124; no. 11; pp. 2101 - 2107
• Main Authors: Giorgi, Filippo S., Perini, Daria, Maestri, Michelangelo, Guida, Melania, Pizzanelli, Chiara, Caserta, Anna, Iudice, Alfonso, Bonanni, Enrica
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 01.11.2013
• Subjects: Adult; Circadian Rhythm; Electroencephalogram; Electroencephalography; Epilepsies, Partial - diagnosis; Epilepsies, Partial - etiology; Epilepsy; Epilepsy - diagnosis; Epilepsy - etiology; Epileptic interictal abnormalities; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurology; Retrospective Studies; Seizures - diagnosis; Seizures - etiology; Sensitivity and Specificity; Sleep deprivation; Sleep Deprivation - complications; Sleep Deprivation - physiopathology; Sleep/wake cycle; Electroencephalogram; Sleep/wake cycle; Epileptic interictal abnormalities; Epilepsy; Sleep deprivation
• ISSN: 1388-2457; 1872-8952; 1872-8952
• DOI: 10.1016/j.clinph.2013.04.342

•We assessed retrospectively the role of a simple method of EEG after sleep deprivation (SD-EEG) on a large population of de novo patients evaluated for suspected seizures, bearing a normal basal EEG.•In these patients SD-EEG often reveals interictal abnormalities and bears a high specificity in epilepsy diagnosis.•Interictal abnormalities are different in generalized versus focal epilepsies, and in the latter the interictal abnormalities yield in SD-EEG is higher than in a repeated routine EEG. In case series concerning the role of EEG after sleep deprivation (SD-EEG) in epilepsy, patients’ features and protocols vary dramatically from one report to another. In this study, we assessed the usefulness of a simple SD-EEG method in well characterized patients. Among the 963 adult subjects submitted to SD-EEG at our Center, in the period 2003–2010, we retrospectively selected for analysis only those: (1) evaluated for suspected epileptic seizures; (2) with a normal/non-specific baseline EEG; (3) still drug-free at the time of SD-EEG; (4) with an MRI analysis; (5) with at least 1year follow-up. SD-EEG consisted in SD from 2:00 AM and laboratory EEG from 8:00 AM to 10:30 AM. We analyzed epileptic interictal abnormalities (IIAs) and their correlations with patients’ features. Epilepsy was confirmed in 131 patients. SD-EEG showed IIAs in 41.2% of all patients with epilepsy, and a 91.1% specificity for epilepsy diagnosis; IIAs types observed during SD-EEG are different in generalized versus focal epilepsies; for focal epilepsies, the IIAs yield in SD-EEG is higher than in second routine EEG. This simple SD-EEG protocol is very useful in de novo patients with suspected seizures. This study sheds new light on the role of SD-EEG in specific epilepsy populations.