The role of clinical neurophysiology in the management of epilepsy

Utility of electroencephalography in the evaluation of common neurologic conditions in children

The objective of this study was to assess the utility of electroencephalography (EEG) in the evaluation of common neurologic conditions in children. The EEG recordings of 534 consecutive children (aged < 20 years) were prospectively read by a certified pediatric neurologist. Common diagnostic indications included the following: clinical seizures (33.8%), definite epilepsy (31.2%), attention-deficit hyperactivity disorder (ADHD) (9.1%), headache (8%), syncope (3.5%), learning disabilities (2%), tic disorders (1.4%), and sleep disorders (1.1%). Overall, 63.8% of EEG records were normal, slowing background activity was noted in 6.1%, ADHD was noted in 35.3% (definite epilepsy), and epileptiform activity was noted in 37.1% of the cases of definite epilepsy and 13.2% of the clinically suspected cases. Epileptiform activity was rarely found in the patients without epilepsy. All EEG records of children with syncope (n = 19) and headache (n = 43) were normal. These findings indicate that although EEG plays an important diagnostic role in epilepsy, interictal EEG is being overused during evaluation of various neurologic disorders in children, and a normal EEG is highly predictable in children with nonepileptic conditions.

Identifying and treating clinical subgroups of patients with epilepsy: a case review

This article uses case reviews to illustrate key clinical features of several important epilepsy subgroups: newly diagnosed patients with epilepsy, women of childbearing age with seizures, elderly patients who develop epilepsy, patients with developmental disabilities, and patients with medication-resistant epilepsy. Characteristic clinical features for these patients (seizure types, ages of seizure onset, and treatment responses) guide clinical evaluation, treatment selections, and monitoring for medication side effects and seizures.