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The clinical utility of non-invasive video-electroencephalographic monitoring has been diversifying

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Abstract

Background

Inpatient long-term video-electroencephalographic (VEEG) monitoring has been used extensively for differential diagnosis of paroxysmal events. We evaluated the diagnostic yield and clinical utility of VEEG performed in a comprehensive epilepsy center.

Method

We retrospectively reviewed all cases of VEEG performed from May 2003 to April 2018. We analyzed the data to determine its clinical utility and diagnostic yield.

Results

A total of 1335 cases were reviewed. After excluding 147 cases of intracranial recording and 163 cases with incomplete medical records, 1025 cases of VEEG were included. The mean duration of VEEG was 2.3 ± 1.6 days (range = 1–14). A total of 763 VEEGs documented epileptic seizures or interictal epileptiform discharges (IEDs) to confirm the diagnosis of epilepsy. There were 99 psychogenic non-epileptic seizure, 36 status epilepticus, and 34 VEEGs which revealed generalized or focal slow activities without any clinical seizures or IEDs. VEEG was normal in 170 cases. The diagnostic yield of VEEG varied from 83.4 to 88.4% depending on its definition. The proportion of epilepsy in total cases of VEEG continued to decrease from 77.2 to 61.4%. In contrast, the proportion of normal VEEG steadily increased from 4.1 to 24.1% during the same time period.

Conclusions

This study ascertained how useful VEEG is and the utility of VEEG has been diversifying in clinical circumstances beyond epilepsy. VEEG can play a pivotal role in the diagnostic approach to epilepsy and its differential diagnoses.

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Abbreviations

AED:

Antiepileptic drug

BP:

Blood pressure

EEG:

Electroencephalography

HR:

Heart rate

IEDs:

Interictal epileptiform discharges

MRI:

Magnetic resonance imaging

OH:

Orthostatic hypotension

PNES:

Psychogenic non-epileptic seizure

POTS:

Paroxysmal orthostatic tachycardia syndrome

VEEG:

Video-electroencephalographic monitoring

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Acknowledgments

The authors wish to thank and acknowledge So-Young Do for her work on data processing.

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Authors and Affiliations

  1. Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea

    Yong Won Cho & Keun Tae Kim

  2. Department of Neurology, Georgetown University Hospital, Washington, DC, USA

    Gholam K. Motamedi

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  1. Yong Won Cho
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  2. Gholam K. Motamedi
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  3. Keun Tae Kim
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Correspondence to Keun Tae Kim.

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The study was approved by the ethics committee of the Keimyung University Dongsan Medical Center. The need for written informed consent was waived due to the study’s retrospective design.

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The authors declare that they have no conflict of interest.

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Cho, Y.W., Motamedi, G.K. & Kim, K.T. The clinical utility of non-invasive video-electroencephalographic monitoring has been diversifying. Neurol Sci 40, 2625–2631 (2019). https://doi.org/10.1007/s10072-019-04022-y

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  • DOI: https://doi.org/10.1007/s10072-019-04022-y

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