Omitting Hyperventilation in Electroencephalogram during the COVID-19 Pandemic May Reduce Interictal Epileptiform Discharges in Patients with Juvenile Myoclonic Epilepsy

Background: To prevent the spread of coronavirus disease 2019 (COVID-19), hyperventilation (HV) activation has been avoided in electroencephalograms (EEGs) since April 2020. The influence of omitting HV in EEG on epilepsy diagnosis remains uncertain for patients with epilepsies other than child absence epilepsy. We hypothesized that EEGs with HV would show more interictal epileptiform discharges (IEDs) than EEGs without HV in patients with juvenile myoclonic epilepsy (JME). Methods: We reviewed the EEGs of seizure-free patients with JME who underwent EEG, both with and without HV, from January 2019 to October 2021, in our institution, and compared IEDs between EEG with and without HV. Results: This study analyzed 23 JME patients. The IED-positive rate was significantly higher in EEG with HV (65.2%) than in EEG without HV (34.8%, p = 0.016). The mean +/- standard deviation number of IEDs per minute was significantly larger during HV (1.61 +/- 2.25 x 10(-1)) than during non-activation of both first EEG (0.57 +/- 0.93 x 10(-1), p = 0.039) and second EEG (0.39 +/- 0.76 x 10(-1), p = 0.009). Conclusions: In JME patients, performing HV during EEG may increase IEDs and appears to facilitate the accurate diagnosis of epilepsy.