THE USE OF ACTIVATION PROCEDURES IN ROUTINE EEG RECORDING OF
IDIOPATHIC EPILEPSY TO ELICIT INTERICTAL EPILEPTIFORM DISCHARGES
Meidiary, A.A.Ayu , Anna Marita SG , Purwa Samatra DPG
Department of Neurology, Faculty of Medicine, University of Udayana, email: drmeidiary@yahoo.com
Purpose
The aim of this study is to find which activation procedure has the highest sensitivity to elicit interictal
epileptiform discharges (IEDs) in each epilepsy syndrome and epilepsy seizure
Methods
A cross sectional study was performing at Sanglah Hospital Denpasar Bali since July 2011 until June 2013. Subject are a consecutive series of patient who requested for EEG recording with diagnosis suspect epilepsy idiopathic. The age of subject range from 5 – 40 years old. All subject will give their written informed consent and undergo neurologist examination to evaluate the clinical semiology and epilepsy syndrome. We use digital EEG (BNeuro) for the routine EEG recording with three provocation procedures ( hyperventilation, Photic stimulation and sleep ).
Result :
There are 184 patients who requested for EEG recording with diagnosis idiopathic epilepsy during July 2011 until June 2013 period . Male are 105 patients and female are 79 patients. The number of patients who have the age range from 5 – 15 yo are 81 patients, 16-25 yo are 44 patients and 26 – 40 yo are 59 patients (Tablel 1). Temporal lobe epilepsy syndrome suspected in 18 ( 9,78%) patient, frontal lobe epilepsy syndrome in 14 ( 7,61%) patients, grandmal epilepsy syndrome in 116 (63,04%) patients, absence epilepsy syndrome in 11 ( 5,98%) patients, focal epilepsy seizure in 5 ( 2,72%)patients, focal secondary generalized seizure in 8 ( 4,35%), tonic seizure in 6 ( 3,26%) patients, atonic seizure in 6 ( 3,26%) patients ( Fig 1 ) . Subject whose suspected temporal lobe epilepsy showed normal EEG in 12 (66,67%), interictal epileptiform discharges (IEDs)elicited by sleep provocation in 5 (83,33%), by HV provocation in 1 (16,67%).Subject whose suspected frontal lobe epilepsy showed normal EEG in 7 (50%), IEDs elicited by sleep provocation in 3 (42,86%), IEDs by HV provocation in 1 ( 14,285%), IEDs elicited in awake recording without provocation in 2 (28,57%) patient, IEDs by sleep and HV provocation in 1 ( 14,285% ) patients. The patients whose suspected grandmal epilepsy syndrome showed normal EEG in 97 ( 83,62%) patients, IEDs elicited by sleep provocation in 6 ( 31.58%) patients, IEDS by HV provocation in 4 ( 21,05%) patients, IEDS elicited by HV and photic stimulation in 2 ( 10.53%) patients, IEDs which elicited in awake EEG recording without provocation in 7 ( 36.84%). Subject whose suspected absence epilepsy showed normal EEG in 5 ( 45,46%) patients, showed IEDs which elicited by HV provocation in 3 ( 50%) , elicited by sleep and HV in 1 (16.665% ) , elicited by HV and photic in 1 ( 16.665%) patient and elicited in awake EEG recording without provocation in 1 (16.67%). Subject whose present focal and focal secondary generalized epilepsy seizure showed normal EEG in 8 ( 61,54%) patients, showed IEDs which elicited by HV provocation in 3 (60%), elicited by sleep provocation in 1 (20%), elicited by sleep and HV provocation in 1 ( 20%). All of subject whose present tonic and atonic seizure showed Normal EEG. ( Fig 2 and Fig 3)
Conclusion : The study result showed that sleep activation procedure has the highest sensitivity to elicit IEDs in routine
EEG recording of subject whose suspected temporal lobe epilepsy (83,33%) , frontal lobe epilepsy syndrome (42,86%)and grandmal epilepsy (31,58%). Hyperventilation activation procedure has the highest sensitivity to elicit IEDs in routine EEG recording of subject whose suspected absence epilepsy syndrome (50%) and subject whose present focal and focal secondary generalized seizure (60%).Keyword : Activation procedures, hyperventilation, photic stimulation , sleep , epileptic syndrome
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