Lagunju Ike Oluwa Abiola, Oyinlade Alexander Opebiyi, Atalabi Omolola Mojisola, Ogbole Godwin, Tedimola Olushola, Famosaya Abimbola, Ogunniyi Adesola, Ogunseyinde Ayotunde Oluremi, Ragin Ann
Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
Department of Radiology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
Pan Afr Med J. 2015 Dec 3;22:328. doi: 10.11604/pamj.2015.22.328.7065. eCollection 2015.
Electroencephalography (EEG) remains the most important investigative modality in the diagnostic evaluation of individuals with epilepsy. Children living with epilepsy in the developing world are faced with challenges of lack of access to appropriate diagnostic evaluation and a high risk of misdiagnosis and inappropriate therapy. We appraised EEG studies in a cohort of Nigerian children with epilepsy seen in a tertiary center in order to evaluate access to and the impact of EEG in the diagnostic evaluation of the cases.
Inter-ictal EEG was requested in all cases of pediatric epilepsy seen at the pediatric neurology clinic of the University College Hospital, Ibadan, Nigeria over a period of 18 months. Clinical diagnosis without EEG evaluation was compared with the final diagnosis post- EEG evaluation.
A total of 329 EEGs were recorded in 329 children, aged 3 months to 16 years, median 61.0 months. Clinical evaluation pre-EEG classified 69.3% of the epilepsies as generalized. The a posteriori EEG evaluations showed a considerably higher proportion of localization-related epilepsies (33.6%). The final evaluation post EEG showed a 21% reduction in the proportion of cases labeled as generalized epilepsy and a 55% increase in cases of localization-related epilepsy(p<0.001).
Here we show that there is a high risk of misdiagnosis and therefore the use of inappropriate therapies in children with epilepsy in the absence of EEG evaluation. The implications of our findings in the resource-poor country scenario are key for reducing the burden of care and cost of epilepsy treatment on both the caregivers and the already overloaded tertiary care services.
脑电图（EEG）仍然是癫痫患者诊断评估中最重要的检查方式。发展中国家的癫痫患儿面临着难以获得适当诊断评估以及误诊和不适当治疗风险高的挑战。我们评估了在一家三级中心就诊的一组尼日利亚癫痫患儿的脑电图研究，以评估脑电图在这些病例诊断评估中的可及性及其影响。
在尼日利亚伊巴丹大学学院医院儿科神经科门诊，对18个月内就诊的所有小儿癫痫病例均进行了发作间期脑电图检查。将未经脑电图评估的临床诊断与脑电图评估后的最终诊断进行比较。
共对329名年龄在3个月至16岁（中位数61.0个月）的儿童进行了329次脑电图记录。脑电图检查前的临床评估将69.3%的癫痫分类为全身性癫痫。事后脑电图评估显示，与定位相关的癫痫比例相当高（33.6%）。脑电图检查后的最终评估显示，标记为全身性癫痫的病例比例降低了21%，与定位相关的癫痫病例增加了55%（p<0.001）。
我们在此表明，在没有脑电图评估的情况下，癫痫患儿存在误诊风险，因此会使用不适当的治疗方法。我们的研究结果在资源匮乏国家的情况下的意义，对于减轻护理负担以及癫痫治疗对护理人员和本已不堪重负的三级护理服务的成本至关重要。
