Objective: Determine pediatric routine EEG (rEEG) utility in a single-reader high-volume tertiary children’s hospital with long-term follow-up

Background: The value of rEEGs, especially in children, varies widely, in part due to different cohort size, short rEEG duration, follow-up duration, and inter-reader variability.

Method: In a retrospective single-institution cohort study of children who completed a rEEG during 2014, all interpreted by the same pediatric clinical neurophysiologist (CS), characteristics and outcomes in the intervening years up to 2023 were extracted, with seizure outcomes categorized as: 1) never developed epilepsy with follow-up, 2) no follow-up, 3) developed epilepsy on anti-seizure medication (ASM), 4) developed epilepsy off ASM, and 5) 1 event with no ASM.

Results: In 977 children with 1042 rEEGs, age at rEEG ranged from 1 day to 26 years (median 6 years), with a standardly prolonged 61-minute rEEG. About 47% of rEEGs were abnormal with one or more abnormalities (interictal spikes 91%, slowing 93%, seizures 14%, hypsarrhythmia 1.2%); 53% were normal. Approximately 39.5% of patients were lost-to-follow-up. In those with follow-up (n=630), an abnormal rEEG predicted subsequent epilepsy in 84%, and a normal rEEG had a negative predictive value of 59%, with 64% sensitivity and 80% specificity. Additionally, an overall 2.6% mortality rate from all causes was noted.

Conclusion: Capitalizing on the unique single-center single-reader at a high-volume tertiary children’s hospital with long-term outcome, this study may elucidate more precise rEEG predictive values and patient outcomes than prior studies. More work is needed to improve pediatric rEEG diagnostic and outcome prediction.

Joyce Wu
Ann & Robert H. Lurie Children's Hospital of Chicago
United States

Emily Gost
Ann & Robert H. Lurie Children's Hospital of Chicago
United States

Cynthia Stack
Ann & Robert H. Lurie Children's Hospital of Chicago
United States