Optimising the protocols and enhancing the diagnostic value of sleep-deprived EEG

Sleep-deprived EEG (SD-EEG) is a diagnostic tool used to enhance the detection of epileptiform abnormalities, particularly in patients with suspected epilepsy. The diagnostic value of SD-EEG includes: • Increased Diagnostic Yield: SD-EEG has been shown to increase the detection rate of epileptiform discharges compared to standard EEG. For instance, in pediatric psychomotor epilepsy, SD-EEG was positive in 56.4% of cases where conventional EEG was negative, indicating a significant improvement in diagnostic yield [1]. Similarly, in children with previously normal awake EEGs, SD-EEG detected epileptic discharges in 27.2% of cases [2]. • Reliability and Agreement: The reliability of visual interpretation of SD-EEG is high, with substantial agreement among neurophysiologists for detecting epileptiform discharges (kappa 0.83) [3]. This suggests that SD-EEG is a reliable method for identifying epileptic abnormalities. • Effectiveness in Different Epilepsy Types: SD-EEG is particularly effective in diagnosing idiopathic generalized epilepsy, with a sensitivity of 64%, compared to 17% for focal epilepsies [4]. This indicates that SD-EEG may be more beneficial for certain types of epilepsy. Despite its benefits, some studies have shown conflicting results regarding the overall diagnostic value of SD-EEG. A meta-analysis revealed high heterogeneity among studies, suggesting the need for standardized protocols to optimize its use [5]. Additionally, one study found no significant difference in the yield of SD-EEG compared to routine EEG in diagnosing epilepsy [6]. The proposed study is aimed at analysing the yield of sleep-deprived EEG from a large database of adult and paediatric EEGs. It will also evaluate the optimum parameters for the test to maximise its yield without compromising the safety. References 1. Diagnostic value and its influence factors of sleep-deprived electroencephalogram on pediatric psychomotor epilepsy. Journal of Clinical Neurology (China), 2013 2. The complementary value of sleep-deprived EEG in childhood onset epilepsy. European Journal of Paediatric Neurology, 2010 3. Interobserver reliability of visual interpretation of electroencephalograms in children with newly diagnosed seizures. Developmental Medicine and Child Neurology, 2006 4. EEG after sleep deprivation is a sensitive tool in the first diagnosis of idiopathic generalized but not focal epilepsy. Clinical Neurophysiology, 2016 5. The diagnostic value of sleep-deprived EEG in epilepsy: A meta-analysis. Seizure, 2024 6. Yield of Sleep Deprivation EEG in Suspected Epilepsy. A Retrospective Study. Clinical EEG and Neuroscience, 2024