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The Sleep-Deprived Electroencephalogram
Evidence and Practice
Thomas H. Glick, MD
Arch Neurol. 2002;59:1235-1239.
Background Sleep deprivation for the initial electroencephalogram for suspected
seizures is a widespread but inconsistent practice not informed by balanced
evidence. Daily practice suggests that nonneurologists are confused by the
meaning and value of, and indications for, "sleep" (tracing) vs "sleep deprivation"
(and other alternatives). They need specific, informed guidance from general
neurologists on best practices.
Objectives To document illustratively the variability of neurologists' practices,
the level of relevant information among nonneurologists, and the current state
of published evidence; and to stimulate formulation of consensus advisories.
Design and Setting I surveyed knowledge and practices of (1) nonneurologists in a community
teaching hospital; (2) local and national neurologists and epileptologists;
(3) electroencephalogram laboratory protocols; and (4) textbook accounts and
recommendations and the relevant journal literature. National professional
organizations were contacted for advisories or guidelines.
Results Most nonneurologists surveyed misunderstood "sleep" vs "sleep-deprived"
electroencephalograms and their actual protocols. They are unaware of evidence
on benefits vs burdens. Neurologists' practices are inconsistent. Experts
generally agree that sleep deprivation produces substantial activation of
interictal epileptiform discharges beyond the activation of sleep per se.
However, most published recommendations and interviewed epileptologists do
not suggest sleep deprivation for the initial electroencephalogram because
of "inconvenience" (burdens) for the patient. Evidence-based or reasoned guidance
is minimal, and professional societies have not issued advisories.
Conclusion Confusion over sleep deprivation, disparities between evidence and recommendations,
and inconsistent practices create a need for expert consensus for guidance,
as well as comparative research on alternative methods of increasing diagnostic
yield.
From the Department of Neurology, Harvard Medical School, Boston, Mass,
and Division of Neurology, Department of Medicine, The Cambridge Health Alliance,
Cambridge, Mass.
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