The Yield of EEG Studies in a Lower Income Country Epilepsy Referral Center (I14.009)

Objective: To assess the occurrence and predictors of epileptiform EEG abnormalities in people with epilepsy at a national referral clinic in a lower income country without neurologists or routine neurological services. Background: Low income and low-middle income countries - such as Bhutan - carry a heavy burden of epilepsy, but the role of EEGs in these settings is not well characterized. Methods: Participants of any age who had seizures or suspected seizures were recruited on a “first come, first served” basis at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu, Bhutan through physician, health care worker or traditional healer referrals. Participants completed questionnaires in English or verbal translations to Dzongkha and underwent 25-minute EEG studies performed by a registered EEG technician. EEGs were interpreted by at least two members of a panel of 8 independent board-certified neurologists in the United States or Canada. Conflicts were adjudicated by additional members when required. Results: 267 participants (n=77 <18 years) were recruited over 9 months in 2014-2015. Of these participants, 167 (63[percnt]) had EEGs that were normal, 35 (13[percnt]) showed slowing but no epileptiform activity, and 65 (24[percnt]) showed epileptiform activity with or without background slowing (40 asymmetric epileptiform activity, 11 generalized spike-wave activity, 12 bilateral or other epileptiform activity, 2 acute seizures). Unintentional seizure-related injury (odds ratio 2.2, 95[percnt] confidence interval 1.2, 4.2; p=0.015) and history of head injury (OR 2.8, 95[percnt] CI 1.4, 5.6; p<0.001) were significantly associated with epileptiform EEGs, but loss of consciousness, age of epilepsy diagnosis and use of multiple AEDs were not. Conclusions: EEG abnormalities may be used to guide treatment decisions for people with epilepsy in this lower income country. Epileptiform EEGs were significantly associated with self-reported seizure-related injury. These results support the diagnostic value of EEG in resource-limited settings. Disclosure: Dr. Wong has nothing to disclose. Dr. Cash has nothing to disclose. Dr. Thibert has nothing to disclose. Dr. Bui has received personal compensation for activities with UCB as a speaker. Dr. Zepeda Garcia has nothing to disclose. Dr. Lam has nothing to disclose. Dr. Leung has nothing to disclose. Dr. L. Lee has received personal compensation for activities with Novartis Canada, EMD Serono Canada, and Biogen Idec as a consultant. Dr. Lim has received personal compensation for activities with UCB Pharma as a consultant. Dr. Mantia has nothing to disclose. Dr. Cohen has nothing to disclose. Dr. McKenzie has nothing to disclose. Dr. Nirola has nothing to disclose. Dr. Deki has nothing to disclose. Dr. Tshering has nothing to disclose. Dr. Sorets has nothing to disclose. Dr. Clark has nothing to disclose. Dr. Patenaude has nothing to disclose. Dr. Cole has received personal compensation for activities with Clarus Ventures and Sage Therapeutics as a consultant. Dr. Mateen has nothing to disclose.