title: Electroencephalography as a tool for evidence-based diagnosis and improved outcomes in children with epilepsy in a resource-poor setting.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
authors.forename: Ike Oluwa Abiola
authors.initials: IO
authors.lastname: Lagunju
authors.affiliation: Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
authors.forename: Alexander Opebiyi
authors.initials: AO
authors.lastname: Oyinlade
authors.affiliation: Department of Radiology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
authors.forename: Omolola Mojisola
authors.initials: OM
authors.lastname: Atalabi
authors.affiliation: Department of Radiology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
authors.forename: Godwin
authors.initials: G
authors.lastname: Ogbole
authors.affiliation: Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
authors.forename: Olushola
authors.initials: O
authors.lastname: Tedimola
authors.affiliation: Department of Paediatrics, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
authors.forename: Abimbola
authors.initials: A
authors.lastname: Famosaya
authors.affiliation: Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
authors.affiliation: Department of Radiology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
authors.forename: Ayotunde Oluremi
authors.initials: AO
authors.lastname: Ogunseyinde
authors.affiliation: Department of Radiology, Northwestern University, Chicago, Illinois, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Ragin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis*; D019317:Evidence-Based Medicine; D005260:Female; D006295:Health Resources; D006801:Humans; D007223:Infant; D008297:Male; D011203:Poverty
keywords: EEG; Electroencephalography; childhood; diagnosis; epilepsy; outcome and resource-poor countries