The role of melatonin to attain electroencephalograms in children in a sub-Saharan African setting

Ibekwe, Roland Chidi; Jeaven, Lata; Wilmshurst, Jo M.

doi:10.1016/j.seizure.2017.08.002

Cited by 12 publications

(10 citation statements)

References 25 publications

(46 reference statements)

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“…Melatonin was used for sedation prior to EEG in 35% (417) and successfully induced sleep 77% (321) of the time (Table ). This is consistent with recent reports of melatonin use for EEG sedation . Photic stimulation was performed in 29% (342) of EEG studies, and only 1% (4) of these demonstrated a photoparoxysmal response.…”

Section: Resultssupporting

confidence: 91%

A retrospective observational study of EEG findings and antiepileptic drug use among children referred for EEG to Zambia's University Teaching Hospital

et al. 2018

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SummaryObjectiveDespite the heavy burden of epilepsy in Sub‐Saharan Africa, there remains a relative paucity of neurophysiology services and limited published data on electroencephalography (EEG) features among African children. The aim of this study was to describe clinical characteristics, EEG findings, and antiepileptic drug (AED) use among children referred for EEG to the University Teaching Hospital in Zambia.Methods EEG referrals and reports from 2013–2015 were reviewed. Within the context of routine care, EEG studies were interpreted by readers with advanced training in child neurology and clinical neurophysiology. Clinical data provided in the referral including seizure semiology and EEG findings were systematically extracted and analyzed.ResultsA total of 1,217 EEG reports were reviewed, with 1,187 included in the analysis. Median age was 7 years (interquartile range [IQR] 3–11) and 57% were male. Seventy‐three percent of 554 had documented seizure onset before 5 years of age. Among the 23% with seizure etiology documented, 78% were associated with perinatal injuries and central nervous system (CNS) infections. EEG abnormalities were found in 75% of the studies. Clinical semiology per referral identified focal seizures in 29%, but EEG findings increased this proportion to 63% (p = 0.004). Sixty‐two percent were taking AEDs, with 85% on monotherapy. The most commonly used AED was carbamazepine (49%).There was no association between the choice of AED and clinical semiology (all p's > 0.05).SignificanceThis tertiary care center study identified >60% of referred children to have localization‐related epilepsies, with at least 18% of epilepsies being from potentially preventable causes. These findings are consistent with multi‐country, population‐based data from elsewhere in Africa. Seizure semiology assessed in routine, nonspecialist care does not predict AED choice, and the presence of focality is underestimated in routine care.

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Section: Resultssupporting

confidence: 91%

A retrospective observational study of EEG findings and antiepileptic drug use among children referred for EEG to Zambia's University Teaching Hospital

et al. 2018

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“…Review for full text was performed for 33 articles and only 16 articles met the inclusion criteria for the review (4 studies describing the efficacy of triclofos, while 11 studies explored the efficacy of melatonin, and one retrospective study compared the efficacy of selective melatonin receptor agonist, ramelteon, triclofos, and chloral hydrate). 3,5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21] Out of the five studies exploring triclofos for sleep EEG, only one was a two-arm RCT in which efficacy, safety, and palatability of triclofos and chloral hydrate were compared and one was a prospective observational study. Rest of the three were retrospective studies (►Supplementary Table S1; available in the online version).…”

Section: Results Of the Searchmentioning

confidence: 99%

“…Most of the studies used doses varying between 5 and 20 mg/day, but even those receiving a higher dose or repeat doses had minimal or no adverse effects, suggesting an excellent safety profile of melatonin. 9,10,13 Triclofos is a prodrug metabolized in the liver into the active form, trichloroethanol, which is considered pharmacologically as an active metabolite of chloral hydrate. 18 Triclofos sodium of 1 g is roughly equivalent to 600 mg of chloral hydrate.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-analysis of Efficacy and Safety of Melatonin and Triclofos for Inducing Adequate Sedation for Sleep Electroencephalogram in Children

Panda

Sharawat

Suthar

2021

JNRP

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Introduction Triclofos and melatonin are commonly used oral sedatives in children for obtaining a sleep electroencephalogram (EEG) record. There has been no systematic review till now to compare the efficacy and safety of these two medications. Objectives The review intended to compare the efficacy of oral triclofos and melatonin in children <18 years of age for inducing adequate sedation for obtaining a sleep EEG record. We also attempted to compare the adverse effects, impact on EEG record, the yield of epileptiform abnormalities, and sleep onset latency in both groups. Methods A systematic search was conducted on “MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science, and Google Scholar” till November 30, 2020, with the following keywords/the Medical Subject Headings (MESH) terms while searching: “sleep EEG,” “electroencephalogram,” “triclofos,” “melatonin” OR “ramelteon” AND “epilepsy,” “seizure,” OR “convulsion.” ROB 2.0 and ROBINS-I tool was used to determine the risk of bias. To assess heterogeneity in studies, Higgins and Thompson's I 2 method was utilized. When I 2 was more than 50%, a random effects model was utilized and a fixed-effect model was used for other parameters. To assess the presence of publication bias, Egger's test was used. Results For describing the efficacy of triclofos in 1,284 and melatonin in 1,532 children, we selected 16 articles. The indirect comparison between the pooled estimate of all children receiving individual medications revealed comparable efficacy in obtaining successful sleep EEG record with a single dose (90 vs. 76%, p = 0.058) and repeat dose (p = 0.054), detection of epileptiform abnormalities (p = 0.06), and sleep onset latency (p = 0.06), but more proportion of children receiving triclofos had adverse effects (p = 0.001) and duration of sleep was also higher with triclofos (p = 0.001). Conclusion Efficacy of triclofos and melatonin are comparable in inducing sleep for recording EEG in children, although triclofos is more likely to cause adverse effects. However, the level of evidence is low for this conclusion and the weak strength of recommendation for the results of this review is likely to change in the future after completion of controlled trials exploring these two medications.

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“…Imaging times were coordinated with child sleeping and nap times. We used melatonin, a neurohormone recognised for its regulation of sleep via the circadian rhythm ( Abdelgadir et al., 2018 ) which has been shown to be safe and effective for inducing sleep in children in our setting without the risk of respiratory compromise or the requirement of specialist monitoring ( Ibekwe et al., 2017 ; Johnson et al., 2002 ).…”

Section: Discussionmentioning

confidence: 99%

“…Children were encouraged to play quietly to encourage sleeping afterwards, and anthropometric data collection was integrated into this routine. The child and caregiver were given a warm meal, and the child was given melatonin (dosage 3–6 mg) ( Ibekwe et al., 2017 ; Paediatric Formulary Committee, 2016 ) with yoghurt to improve the taste to promote sleep-initiation ( Johnson et al., 2002 ). The children were wrapped warmly and encouraged to sleep in their natural position – either swaddled on their mother’s back (common practice in this community) or lying on a bed in a low-lit room.…”

Section: Methodsmentioning

confidence: 99%

Neuroimaging young children and associations with neurocognitive development in a South African birth cohort study

et al. 2020

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Magnetic resonance imaging (MRI) is an indispensable tool for investigating brain development in young children and the neurobiological mechanisms underlying developmental risk and resilience. Sub-Saharan Africa has the highest proportion of children at risk of developmental delay worldwide, yet in this region there is very limited neuroimaging research focusing on the neurobiology of such impairment. Furthermore, paediatric MRI imaging is challenging in any setting due to motion sensitivity. Although sedation and anesthesia are routinely used in clinical practice to minimise movement in young children, this may not be ethical in the context of research. Our study aimed to investigate the feasibility of paediatric multimodal MRI at age 2–3 years without sedation, and to explore the relationship between cortical structure and neurocognitive development at this understudied age in a sub-Saharan African setting. A total of 239 children from the Drakenstein Child Health Study, a large observational South African birth cohort, were recruited for neuroimaging at 2–3 years of age. Scans were conducted during natural sleep utilising locally developed techniques. T1-MEMPRAGE and T2-weighted structural imaging, resting state functional MRI, diffusion tensor imaging and magnetic resonance spectroscopy sequences were included. Child neurodevelopment was assessed using the Bayley-III Scales of Infant and Toddler Development. Following 23 pilot scans, 216 children underwent scanning and T1-weighted images were obtained from 167/216 (77%) of children (median age 34.8 months). Furthermore, we found cortical surface area and thickness within frontal regions were associated with cognitive development, and in temporal and frontal regions with language development (beta coefficient ≥0.20). Overall, we demonstrate the feasibility of carrying out a neuroimaging study of young children during natural sleep in sub-Saharan Africa. Our findings indicate that dynamic morphological changes in heteromodal association regions are associated with cognitive and language development at this young age. These proof-of-concept analyses suggest similar links between the brain and cognition as prior literature from high income countries, enhancing understanding of the interplay between cortical structure and function during brain maturation.

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The role of melatonin to attain electroencephalograms in children in a sub-Saharan African setting

Abstract: Melatonin is effective and safe in inducing sleep for EEG recording in our setting.

Cited by 12 publications

References 25 publications

A retrospective observational study of EEG findings and antiepileptic drug use among children referred for EEG to Zambia's University Teaching Hospital

A retrospective observational study of EEG findings and antiepileptic drug use among children referred for EEG to Zambia's University Teaching Hospital

Systematic Review and Meta-analysis of Efficacy and Safety of Melatonin and Triclofos for Inducing Adequate Sedation for Sleep Electroencephalogram in Children

Neuroimaging young children and associations with neurocognitive development in a South African birth cohort study

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