J Psychiatrists’ Association of Nepal Vol .5, No.

1, 2016
ORIGINAL ARTICLE

A study on EEG findings: An Experience from a Tertiary Care

Center of Nepal

Joshi S1, Shakya R2

1.Lecturer, Department of Psychiatry, PAHS, Lagankhel, Lalitpur, Nepal 2. Associate Professor,

Department of Psychiatry, PAHS, Lagankhel, Lalitpur, Nepal

E-mail *Corresponding author: [email protected]

Abstract

Introduction: The electroencephalography (EEG) is the recording of brain’s spontaneous electrical activity over a
period of time (15-20) minutes recorded from multiple electrodes placed on the scalp. It is used in seizure disorder,
organicity, and psychiatric conditions. There is a paucity of literature with regard to the application of EEG in
various conditions in our setting.
Objective: The current study aims to explore the EEG findings of different cases and their associations in various
clinical scenarios.
Method: It is a retrospective study on the patients who underwent EEG in the EEG room of Department of
Psychiatry at Patan Academy of Health Sciences (PAHS), Nepal for a year. Information was obtained from EEG
register and reports. Data were analyzed using IBM SPSS version 23. Frequency distribution was studied and Chi
Square test was applied for categorical variables. The only continuous variable studied was the age for which mean,
median and standard deviation were computed and the suitable statistical tool was applied after normality testing.
Result: Of the total 164 patients studied, mean age was 21.93 years and 51.2% were male. The common reason for
EEG referral was to rule out seizure disorder (80.5%), requested mostly from the department of Psychiatry. EEG
abnormality was seen in 43.3% with EEG diagnosis of generalized epilepsy in 26.21% and slow wave (46.2%) as
the most common EEG finding. Abnormal EEG detection rate was almost similar in both the genders and
predominant in those with a clinical diagnosis of seizure disorder (47.88%). The EEG abnormality detection rate
was significant in those referred from the Department of Psychiatry and Paediatrics.
Conclusion: : EEG is a relatively inexpensive and non-invasive test for detection of electrical activity in the brain.
Though requested for seizure or related disorders, it can also find its place in organic pathology, monitoring
treatment response among others.

Keywords: Electroencephalogram, EEG Findings, Seizure, Nepal

INTRODUCTION estimated worldwide prevalence of 5–30

Electroencephalography (EEG) is the recording persons per 1000.2 The other applications are in
of electrical activity produced by the firing of the diagnosis of coma, encephalopathy, and
neurons within the brain which is recorded for brain death.3 It is also used in sleep studies and
about 20 to 40 minutes from multiple electrodes monitoring seizure during Electroconvulsive
placed on the scalp. It is one of the tools to Therapy (ECT). Though gives a measure of
assess cerebral function which is based on the cerebral function, the role of EEG in organic
work by Hans Berger in the 1930s.1 The main conditions is limited with the advent of newer
use of this noninvasive test is in epilepsy to imaging modalities like CT and MRI. The use of
detect seizure activity, a common problem with this neurophysiological tool has been minimum

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 J Psychiatrists’ Association of Nepal Vol .5, No.1, 2016

in psychiatry despite the known relationship which was categorized in the interval of 10. A
between epilepsy and psychosis and other suitable measure of central tendency was
psychiatric manifestations, especially with the computed after Shapiro-Wilk normality test. A
temporal lobe abnormalities.4 Patients are sent binary logistic regression was performed to
for EEG for various reasons, usually for seizure, ascertain the effect of age on the likelihood that
pseudo seizure, organicity and psychosis. patients have abnormal EEG. A p value of less
There is a paucity of reported literature on EEG than 0.05 was considered significant.
findings although many institutes conduct EEG
in Nepal now. The current study was conducted RESULT
in Patan Academy of Health Sciences (PAHS), a The demographic characteristics are given in
tertiary care health sciences center at Lalitpur, (Table 1). The majority of the patients belonged
Nepal which started its EEG services from 2014. to the age group 11-20 years, comprising 29.87%
It aims to bridge the current knowledge gap (49) of the total study population. The median
and explore the EEG findings among different age was 19 years with an interquartile range of
cases requested for EEG and their associations. 17.50. Males were slightly more (51.2%) than
females. Most of the patients (36%) did not have
MATERIAL AND METHOD any clinical diagnosis mentioned at the time of
This is an analytical retrospective study requesting for EEG. Those diagnosed with
conducted at the Department of Psychiatry, seizure disorder (31.7%) were the second highest
PAHS of 18month (Ashadh 2072 to Poush 2073) among those referred for EEG evaluation. The
The patients requested for EEG underwent a reason for referral for EEG was the exclusion of
routine non-sleep deprived EEG using the seizure disorder in the majority of cases (80.5%).
international standardized 10–20 system of More than half (58.5%) of the EEGs were
electrode placement. Photic stimulation and requested by the department of Psychiatry and
hyperventilation methods were used during the 15.9% of the EEG requests did not contain the
EEG recordings where age was not a barrier. All details of the referring departments.
EEGs were done by one technician with the Table 2 illustrates the findings of EEG where the
same EEG machine (16 channels RMS digital). abnormality was seen in 43.3% (71). Among
All records were reported by the same them, 26.21% (48) had generalized epilepsy and
psychiatrist. 14.02% (23) had localization related epilepsy.
All the patients referred for EEG were The most common abnormal pattern in EEG was
considered for the study. Data of 164 patients slow wave (46.2%) and the location was
were taken from EEG register and EEG reports. generalized (29.3%) followed by frontal lobe
A structured proforma was used to record the (5.5%).
information on the variables like age, sex, On further analysis of the patients with
probable clinical diagnosis and reasons for abnormalities in EEG, most of them belonged to
referral. EEG findings and EEG diagnosis were the age group of 1-10 years with the median age
tabulated from EEG reports. EEG results were of 14 years. The logistic regression model, used
categorized as normal and abnormal. EEG to predict the effect of age on the likelihood that
findings were categorized as Localization the patients develop abnormal EEG, was
Related Epilepsy (LRE) and Generalized statistically significant χ2(1) = 5.125, p = 0.024.
Epilepsy (GE) for focal epileptiform activity and The model explained 41.0% (Nagelkerke R2) of
generalized epileptic activity respectively. the variance in EEG abnormality and correctly
Data were entered in Microsoft Excel (MS Office classified 68.9% of cases. Increasing age was
2013, Microsoft Corporation, Washington, associated with a decreased likelihood of having
United States) and analyzed in IBM SPSS v23 for EEG abnormality with odds ratio 0.976 (95% CI
Windows (IBM Statistical Package for Social 0.954 – 0.998) p = 0.030. The patients who had
Sciences, 2015 IBM Corporation, New York, abnormal EEG were younger overall (mean age
United States). Frequency distribution was 18.91 years vs 24.24 years).
studied and Chi Square test was applied for
categorical variables to test for associations. The
only continuous variable studied was the age

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 J Psychiatrists’ Association of Nepal Vol .5, No.1, 2016

Table no. 1: Socio-demographic Profile of and Pediatricians (33.8%) (χ(1)=20.152, p = 0.000)

Patients with EEG evaluation had abnormal EEG with statistically significant
associations. (Tables 3 and 4).
Variable Categories Number %
Age <1 2 1.21 Table no. 2: Showing EEG Findings of Patients
1-10 38 23.17
11-20 49 29.87 Characteristics Categories Number %
21-30 41 25 Abnormality Present 71 43.3
31-40 18 10.97 Absent 93 56.7
41-50 7 4.26 EEG diagnosis Normal 93 56.70
51-60 4 2.43 Generalized 48 26.21
61-70 4 2.43 epilepsy
71-80 0 0 Localization related 23 14.02
>81 1 0.60 epilepsy
Gender Male 84 51.2 Abnormality Slow wave 43 46.2
Female 80 48.8 Type Spike and Wave 8 4.9
Clinical Not mentioned 59 36.0 Spike wave 8 4.9
Diagnosis Slow wave and 4 2.4
Seizure Disorder 52 31.7 Spike and Wave
Seizure with Comorbid 15 9.1 Slow wave and 3 1.8
Psychiatric Illness Spike wave
Organic Pathology 13 7.9 Sharp wave 1 0.6
Substance Use Disorder 8 4.9 Sharp wave and 2 1.2
Dissociative Disorder 7 4.3 Spike wave
Depression 5 3 Slow wave and 2 1.2
Depression with 5 3 Sharp wave
dissociative disorder Abnormality Generalized 48 29.3
Reason for To rule out Seizure 132 80.5 Site Hemisphere 2 1.2
referral Frontal 9 5.5
Organicity work up 30 18.3 Fronto temporal 3 1.8
To evaluate treatment 2 1.2 Fronto parietal 2 1.2
response Occipito frontal 3 1.8
Referring Psychiatry 96 58.5 Temporo parietal 2 1.2
departmen Paracentral 2 1.2
t
Paediatrics 30 18.3
Not Available 26 15.9
Medicine 9 5.5 DISCUSSION:
Surgical 3 1.8 Since seizure is more common in a younger age
in developing countries and EEG is requested
The gender distribution was almost equal with mostly for the exclusion of seizure, this might
male (49.29%) and female (50.7%). The Chi explain the reason for EEG referral for age
Square test did not show any statistically group distribution in our study.5,6Similar
significant association between the occurrence of finding was reported in various studies.7-10
positive EEG result between the two genders Studies suggest male at higher risk for seizure
(χ(1)=0.185, p = 0.753). The abnormality and epilepsy.5This explains the higher
detection rate was more in seizure disorder proportion of male in our study for EEG
(35.21%) and those with comorbid psychiatric evaluation which was supported by different
disorders (12.67%). Similarly, the cases referred studies.7,10
for the exclusion of seizure had EEG
abnormality in 74.64% which is statistically
insignificant (χ(1)=2.71 p = 0.09) and so are the
other reasons of referral for EEG. The referral
from Psychiatrists (46.47%) (χ(1)=7.5, p = 0.006)

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 J Psychiatrists’ Association of Nepal Vol .5, No.1, 2016

Table no. 3: Distribution Of Abnormal EEG as Table no. 3: Distribution Of Abnormal EEG as
per Demographics per Demographics
Predictors of abnormal Test P value
Characteristics Categories N (%) Total
EEG
Age <1 2 2
Age Logistic 0.030
1-10 28 38
Regression
11-20 15 49 Gender Chi Square 0.753
21-30 12 41
Referring psychiatry Chi Square 0.007
31-40 5 18 Department pediatrics Chi Square 0.000
41-50 1 7
medicine Chi Square 1.0
51-60 4 4
Reason for Rule out Chi Square 0.099
61-70 2 4 referral seizure
71-80 0 0 Organicity Chi Square 0.229
>81 1 1 work up
Gender Male 35 84
(49.29%) EEG has been well established as a tool for
Female 36 80 investigating seizure and epilepsy6. Hence,
(50.70%) requesting for EEG for patients with seizure
Clinical Not mentioned 23 59 disorder with and without psychiatric illness
Diagnosis (32.39%)
(47.88%) in this study is understandable which
Seizure 25 52
is shared by Kwaso .11
Disorder (35.21%)
Seizure with 9 15
Compared to our study (43.3%), the study by
Comorbid (12.67%) Shrestha et al had more EEG abnormality
Psychiatric (58.3%).7 The major abnormality pattern in EEG
Illness in our study and Molokomme was slow waves
Organic 8 13 10. However, spike and wave where reported in

Pathology (11.26%) Chowdhary et al.as common EEG pattern. 8

Substance Use 3 8 The majority had EEG abnormality in our study
Disorder (4.22%) and that of Shrestha et al.7 However, Bhagat et al
Dissociative 1 7 reported normal EEG in the majority which was
Disorder (1.4%)
done among the epileptics.9 This difference is
Depression 1 5
expected as EEG is a cross sectional record of the
(1.4%)
Depression 1 5
brain activity and 50% of patients with epilepsy
with (1.4%) can have normal EEG, and therefore, does not
dissociative exclude epilepsy.12
disorder The seizures were not classified during the time
Reason for To rule out 53 132 of referral in the studies. Nevertheless, in our
referral Seizure (74.64%) study (as per EEG diagnosis) and that of Bhagat
Organicity 16 30 et al generalized epilepsy were comparatively
work up (22.53%) more than localized epilepsy.9 On the contrary, a
To evaluate 2 2 study from Bangladesh reported more
treatment (2.81%)
localization related epilepsy than generalized.8
response
Studies from different countries have shown the
Referring Psychiatry 33 96
department (46.47%) range of patients with generalized seizures as
Paediatrics 24 30 50–69%, and partial seizures as 31–50%.13-16 The
(33.8%) disparity between the seizure types clinically
Not available 9 26 and as per EEG could be the misdiagnosis of
(12.67%) secondary generalized seizure with generalized
Medicine 4 9 tonic clonic seizure and lack of adequate
(5.63%) information and standardized classification.
Surgical 1 3 EEG referral from Psychiatrists reported
(1.4%)

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