Efficacy of the Sequential Administration of Melatonin, Hydroxyzine, and Chloral Hydrate for Recording Sleep EEGs in Children

Abstract

Sedation of children for electroencephalography (EEG) recordings is often required. Chloral hydrate (CH) requires medical clearance and continuous monitoring. To try to reduce personnel and time resources associated with CH administration, a new sedation policy was formulated. This study included all children who underwent an EEG during a consecutive 3-month period following the implementation of the new sedation policy, which consists of the sequential administration of melatonin, hydroxyzine (if needed), and CH (if needed). The comparator group included all children with a recorded EEG during a consecutive 3-month period when the sedation policy consisted of the sole administration of CH. A total of 803 children with a mean age of 7.9 years (SD = 5.1, range = 0.5-17.7 years) were included. Sleep EEG recordings were obtained in 364 of 385 children (94.6%) using the old sedation policy and in 409 of 418 children (97.9%) using the new one. With the new sedation policy, the percentage of children requiring CH dropped from 37.1% to 6.7% (P < .001). Time to sleep onset and duration of sleep were not significantly different between the 2 policies. The new sedation policy was very well tolerated. The new sedation policy is very safe, is highly efficacious in obtaining sleep EEG recordings, and will result in substantial saving of time and personnel resources.

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

“…The induced sleep took effect rapidly and lasted long enough to permit electrode application or recording of sleep or both. There was no report of any immediate or later complications; this was similar to experiences in other centres [16,18]. Wassmer et al [10,13] also did not report any side effects, while Eisermann et al [22] and Milstein [26] reported increased sleepiness in a minority of their subjects.…”

“…This study supported that melatonin is effective for attaining sleep EEG recordings in our setting. 86% of the children were achieved stage 2 sleep which is within the range of 75-90% reported in the literature (Table 4) [8,10,[13][14][15][16][17][18] Melatonin has become increasingly popular as a sleep-inducer for both children and adults and has been found to be effective even among children with neurological abnormalities [19][20][21].Among neurophysiology units worldwide, there have been reports of its effectiveness in inducing sleep for EEG and the fact that it does not affect the sleep structure or the epileptiform discharges (Table 4) [8][9][10][16][17][18]22,23].…”

Melatonin versus chloral hydrate as the sedating agent in performing electroencephalogram in paediatric patients

“…11,12 Another paper also indirectly reflected the usefulness of melatonin by concluding that they reduced the use of chloral hydrate to obtain a sleep EEG in children by 30% with the sequential administration of melatonin and hydroxyzine before chloral hydrate. 13 The reported side effects of melatonin were minimal across all studies and there were even less behavioural disturbances when compared with sleep deprivation. 14 All these features suggested melatonin is an appropriate choice of sedative agent in EEGs.…”

Melatonin as an Alternative to Sedation in Pediatric Electroencephalography: Need to Exercise Caution!

“…3 Melatonin as an alternative to sedation in children undergoing sleep EEG recording has been reported to be highly efficacious by a few recent studies. 4,5 Various parameters like time to sleep onset and duration of sleep with melatonin administration were found to be similar to that with chloral hydrate. 4 Another study reported shorter sleep duration and drowsiness period with melatonin as compared with chloral hydrate.…”

“…4,5 Various parameters like time to sleep onset and duration of sleep with melatonin administration were found to be similar to that with chloral hydrate. 4 Another study reported shorter sleep duration and drowsiness period with melatonin as compared with chloral hydrate. 5 However, none of these studies have objectively looked into quality of EEG recordings (yield of EEGs in detecting epileptiform discharges with and without use of melatonin in same subjects) obtained while using melatonin for sedation.…”