Validation of a pediatric guideline on basic electroencephalogram interpretation for clinicians

Abstract

The incidence of epilepsy is high in sub-Saharan Africa and resource poor countries (RPCs). There are few neurologists and paediatric neurologists to manage people with epilepsy (PWE). Health care is often limited, particularly technological services, including electroencephalogram (EEG), video EEG monitoring, and Neuroradiology services. All these are important in the management of PWE.

Since 2008, informal electrophysiology training has been provided at the Red Cross War Memorial Hospital, in the Department of Paediatric Neurology. The Principal Investigator (PI) elected to develop a formal teaching course on EEG interpretation at the Red Cross War Memorial Hospital. A study was designed to evaluate the practical use of a handbook entitled “Handbook of Paediatric Electroencephalography: A guide to basic paediatric electroencephalogram interpretation.” This has been developed to fulfill the need for basic understanding and interpretation of EEG amongst clinicians caring for children in sub-Saharan Africa who may not have access to, or be able to afford, training at a recognized facility or on-line.

In 2008, the department of Paediatric Neurology at the Red Cross War Memorial Hospital had their first African fellow from Kenya. By 2011, seven participants had undergone EEG training.

A quantitative research approach and design was used in order to evaluate the handbook in terms of the accessibility of the contents and its practical use. Quantification included the recruitment of participants who constituted the population sample, a pilot study, and the collection of data from comparative assessments of participants’ use of the handbook, and from questionnaires completed by participants. This provided the researcher with the opportunity to improve and validate her knowledge of training in EEG interpretation. The researcher was able to quantify and compare the scores of participants using the handbook, as well as to compare their evaluative responses to its content and practical use. Eleven of thirteen participants completed the study. The pre-training results showed a median percentage of 50 which increased to 70 percent post-test. A comparison of the scores of trained versus not-trained revealed that those participants who had undergone one-on-one training on site at the unit fared much better both in their interpretations, conclusions, and reporting of EEG findings. The responses from the evaluative and comparative survey between the two groups showed no significant difference across all questions, the majority of the questions on the relative usefulness of the handbook being rated ‘agree’ and ‘strongly agree’, thus supporting the finding that all participants found the handbook useful whether they had received one-on-one training or not.

The post-training results in EEG interpretation showed a stronger trend towards statistical significance (p<0.06) with trained participants and with the not-trained. These findings lend support to the success and usefulness of the handbook as a basic guide to paediatric EEG interpretation. The handbook was not aimed at making the electroencephalography reader an expert at a specialist level, but rather to maximize the reliability of the reading of EEG when screening electroencephalograms for important key diagnostic markers which would alter the child’s management. This is the first published handbook on paediatric EEG in South Africa. The results of this study strongly suggest that the handbook is useful as a learning and reference tool in interpretation of paediatric EEG, both for individuals with access to one-on-one training as well as those without. It is intended that the handbook, in conjunction with one-on-one training, will form part of a post-graduate diploma course offered by the University of Cape Town on “basic electrophysiology and the management of children with epilepsy” for training neurologists and child neurologists, paediatricians and health care workers in sub-Saharan Africa.