Abstracts

Rationale: The EEG is said to be “One of the most abused investigations in clinical medicine.” NICE published evidence based guidelines on the care of adults and children with epilepsy in 2004 and this included criteria for use of the EEG. The EEG is used to confirm clinical suspicion of epileptic seizures and where possible identify epilepsy syndromes. In order to aid in the interpretation of the EEG, neurophysiology need relevant background information on the patient including current medication and particularly a detailed description of the attacks with a clinical theory on possible seizure type and syndrome. Methods: This was a prospective analysis of all paediatric EEG's performed in a 6 month period from August 2006 to January 2007. EEG result was matched with original EEG request from clinician and assessed using a proforma by the author. The proforma looked at the following areas: 1. Source of referral. 2. Who made the request: Consultant in epilepsy; other consultant; or other grade Doctor? 3. Waiting time. 4. Proportions of Standard v sleep recordings. 5. Assess quality of information on the request including information on underlying conditions and if there was mention of drug hx. 6. Particularly relevant was whether the clincial events were described in enough detail including use of the ILAE Axes 1,2 +/- 3. 7. Was the EEG justified based on info provided? 8. Did the quality of information provided translate into different results? 9. Was use of video, hyperventilation or photic stimulation recorded in report? Results: There were 109 EEG's performed in the study period on a wide range of children from neonates to teenagers. Most were outpatient recordings from across all 3 hospitals. The waiting time for standard EEG's varied from same day to 11 weeks with 30% performed within the 4 week target suggested by NICE. Information provided on request form in general could have been better. 28% were difficult to justify from request form. The consultants with responsibility for epilepsy had more "justifiable" requests, Consultants with responsibility for epilepsy gave more info: they decribed the attacks in more detail as well as attempting to suggest a form of seizure type. They were the only ones to suggest specific syndromes. Consultants with responsibility for epilepsy got more useful results i.e. less normal (70% compared to 81%) and more abnormal (29% compared to 14%). Most EEG reports made no mention of hyperventilation, photic stimulation or concurrent video of episodes unless abnormal. Conclusions: This provides further evidence that children with suspected epilepsy should be referred to and followed up in an epilepsy clinic. There is a plan ro redo the EEG request form with (subtle) prompts. There will be some education in the department re the clinician filling in the form being clear about history of attacks, what they think is going on and what they hope the EEG will tell them. A repeat audit is planned in the next 1-2 years