EEGs for Children with Epilepsy Sorely Missed

Chances are, if you are a diagnostic technologist, you haven’t run EEGs on a lot of kids with epilepsy lately. This is according to a new study of how COVID-19 has changed the care of children with epilepsy.

Nearly all neurologists polled for this study said they had curtailed their EEG testing, with about half saying it was used only for urgent cases. The ramifications of this finding are unclear.

Electroencephalography (EEG) plays an important role in diagnosing and treating epilepsy. It helps neurologists determine the type of epilepsy and syndrome as well as subtle seizures that can be otherwise easily missed.

For children this is especially important because a quick and accurate diagnosis can be crucial in preventing developmental delays and greater lifelong disability.

In response to this urgency, a global research team, based in the U.S., has started collecting data on the impact that the pandemic is having on children with epilepsy. A paper summarizing their findings was just published in the Journal of Child Neurology.

Among their findings: epilepsy surgeries have been cancelled, drug regimens have been altered, and EEG testing ground to nearly a halt in some cases. The result has meant “profound changes” the care of children with epilepsy, the authors write.

The authors surveyed 212 child neurologists and pediatric epileptologists from six continents in April 2020, when the coronavirus was peaking in the U.S. and elsewhere. Respondents were mostly from Asia and North America, but also from Europe, South American, Africa, and Oceania. Seventy-one were from the United States.

The pandemic curtailed EEG testing for nearly all respondents globally (90.6 percent). Here’s a breakdown of just how much:

• 6 percent had no access to EEG
• 5 percent could access only inpatient EEG
• 8 percent could access outpatient EEG only for urgent cases
• 0 percent had more limited EEG access but could still obtain studies for most cases

Without EEGs, many clinicians said they could use home video to evaluate children if the quality was good. This is particularly important for infantile spasms cases. Others, however, were reluctant to diagnose by video. That’s because other movements may mimic infantile spasms and “misdiagnosis of children without infantile spasms could result in inappropriate exposure to the side effects of treatment.”

This is another example of the many still incalculable health effects COVID-19 will have on patients. The fallout will need to be carefully studied so care gaps can be filled as soon as possible.

For children with epilepsy, the authors write, key issues in the coming months and years will include prioritizing a global backlog of children who require epilepsy surgery; optimizing access to EEG; and returning to evidence-based treatment when crisis standards of care pose higher risk than exposure to the novel coronavirus.

The sooner we get there, the better.

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