Referral patterns and diagnoses at a single Neurophysiology Center in Quetta, Pakistan: An audit of 1600 Cases

Neurophysiologic tests such as EEG, video EEG, Polysomnography (PSG), Nerve conduction studies (NCS) and electromyography (EMG) are the next steps after neurological examinations. These tests play a significantly important role in the decision-making and management of various neurological diseases. Data regarding the availability and frequency of these tests are not being compiled in Pakistan eventually resulting in a lack of awareness about these tests among physicians as well as patients. This motivated us to conduct a medical audit to assess frequencies, mode of referral, and final conclusion of these tests in detail. A total of 1600 tests were included. Among these, 677 were EEGs, 6 were VEEGs, 923 were NCS/EMGs, and 11 were PSGs. In EEGs 7% were of neonates, 58% were in children under age of 18 years and 35% were beyond 18 years. 65% were normal and 35% were with seizures. Among NCS/EMGs, 23% were normal, 15% were carpal tunnel syndromes, 7% were radiculopathies, 7% were sensory motor axonal polyneuropathies and 9 % were mononeuropathies other than CTS. GBS and CIDP were 6.5% and 1 % respectively. In the sleep studies 8 tests were positive for obstructive sleep apnea (OSA), 2 for the restless legs syndrome and 1 for the narcolepsy. In VEEG 2 studies demonstrated typical routine or habitual seizures, 3 were normal and 1 showed typical non epileptic psychogenic seizures. EMG/NCS referrals were highest followed by EEGs. EMG/NCS tests were mostly referred by orthopedic and neurosurgeons while EEGs were predominantly referred by pediatricians. The tendency for VEEG and sleep study was very uncommon among neurologists and physicians. Over all non neurologist referrals were more than neurologist’s referrals