Clinical Pattern of Epilepsy and their Electroencephalogram Findings

Background: Electroencephalogram (EEG) is a primary diagnostic tool for epilepsy in Nepal. There is virtually rare literature and published data on clinical pattern of epilepsy and their EEG finding in Nepal. Therefore, I attempted to study the clinical pattern of epilepsy and their EEG findings along with the effectiveness of EEG as a primary diagnostic tool for epilepsy and about its other better options. Methods: A descriptive retrospective study was conducted in tertiary care hospital, Chitwan, Nepal. Demographic profile, provisional diagnosis and EEG findings of epileptic patients between February 2011 to March 2014 were included and descriptive analysis was performed. Results: The incidence of epilepsy was higher in males than in females (57.2% vs. 48.8%). The majority of patients (54.7%) referred for EEG lie in the age group of 11-30 years. More than half (61.12%) of the seizures remained unclassified. Among the classified seizure, the incidence of generalized seizure is higher than partial seizure (75.85% vs 23.21%). Similarly, majority (55.8%) of the initial EEG recordings of the patients with provisional diagnosis of epilepsy were found to be normal and more than one third EEG records (38.1%) were unclassified Conclusion: Routine twenty-minute EEGs are easy to perform and are well tolerated by patients; however, in more than half of the patients with provisional diagnosis of epilepsy, the initial EEG does not show epileptiform activity and the paroxysmal events due to its low sensitivity. Despite of EEG being the primary diagnostic tool for epilepsy in Nepal, diagnosis should not completely rely on its reading for critically ill patients and for patients with recurrent seizure. Twenty-four hour EEG recording or Video-EEG monitoring (VEEG) or by repeating the routine EEG (up to four recordings) may be a more useful for diagnosis and treatment of epilepsy.