Abstracts

Rationale: Achieving sleep during an EEG recording in children is important because it reduces the amount of artifacts and may increase the yield of seizure activity. In recent years, combined sleep deprivation and melatonin with H1 antihistamine has been successfully used as an alternative way of inducing sleep, particularly in children undergoing MRI or EEG. Our aim was to assess the efficacy of melatonin with H1 antihistamine as an alternative sedation method for recording sleep EEG in children.

Methods: Parents were requested to sleep deprive their children the day prior to the EEG (under aged 1 year, keep awake for at least 2 hours prior to the start of the recording; in 1-3 years age group, put their children to bed 2 hours after regular sleeping time and to awaken at their usual wake-up time; in 3-7 years age group, reduce their total normal sleep time by 6 hours; over aged 7 years, reduce their total normal sleep time by 4 hours). Children undergoing EEG who were unable to cooperate or required sleep EEG, received oral melatonin (1mg for under aged 1 year, 2mg for 1-5 years, 4mg for over 5 years) and H1 antihistamine (ketotifen 2.5/5.0/10ml or hydroxyzine 10mg) 1 hour prior to the recording. We defined success of inducing sleep as the appearance of sleep spindles, excluding cases that required additional chloral hydrate.

Results: A total of 189 patients (males/females = 107/82) with a median age of 11.1 years (range 0.2-17.9 years) were included in this retrospective study. Forty-seven patients(24.9%) had any neuropsychiatric comorbidities and 68.8% of patients were taken anticonvulsants. Success rate of new sedation strategy was totally 84.1% and 30 patients were received additionally chloral hydrate. Four patients showed some adverse events such as post-sedative irritability or prolonged drowsiness. But none of patients with melatonin only related emergent adverse events. New strategy was efficacious in all age group and in children with neuropsychiatrric problems (59.6%). For adequate inducing sleep, education of sleep deprivation was the most important factor and powder formulation of melatonin were more efficient.

Conclusions: New sedation strategy of combined sleep deprivation and melatonin with H1 antihistamine is effective and safe in inducing sleep for EEG recording, and will result in substantial saving of time and personnel resources.

Funding: Please list any funding that was received in support of this abstract.: None.