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

Purpose: Limited access to electroencephalograms (EEGs) in sub-Saharan Africa results in a high patient load attending the few neurophysiology units. The state of sleep in children improves yield and reduces artefact of EEGs. Melatonin induces "natural sleep" without the risk of airway compromise. This study evaluated the effectiveness of oral melatonin to attain electroencephalograms in South African children. Method: Children undergoing EEG who were unable to cooperate or required sleep EEG, received oral melatonin (3 mg < 15 kg; 6 mg > 15 kg). A retrospective control group received chloral hydrate. Outcome measures were the proportion of children who slept, useful EEG study data, sleep latency and duration, artefacts and EEG study abnormalities. Results: 173 children were recruited, 88 (51%) male, median age 4 years 9 months (range 0-14 years). 87% achieved stage 2 sleep. Median sleep latency was 44.5 min and duration of sleep was 25 min (range 18.5-29 min). Children had no post -sedation irritability, persistent drowsiness, nor any other adverse events or deferments for inter-current illnesses. Sedation with melatonin was less successful in children with developmental and behavioural problems (chi(2) = 6.18, P = 0.046), with a higher rate of artefacts (chi(2)=5.83, P = 0.05). 33.5% (n = 58) had abnormal EEG studies, which was comparable to a historical cohort sedated with chloral hydrate (45.5%) (chi(2) = 1.22, P = 1.27). Also for artefacts (79% melatonin group versus 86% chloral hydrate group) (chi(2) = 0.63, P = 0.42). Conclusions: Melatonin is effective and safe in inducing sleep for EEG recording in our setting. (C) 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.