The clinical utility of non-invasive video-electroencephalographic monitoring has been diversifying
- 96 Downloads
- 1 Citations
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.
Keywords
Video-electroencephalography monitoring Epilepsy monitoring unit Clinical utility Diagnostic yieldAbbreviations
- 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
Notes
Acknowledgments
The authors wish to thank and acknowledge So-Young Do for her work on data processing.
Compliance with ethical standards
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.
Conflict of interest
The authors declare that they have no conflict of interest.
References
- 1.Tatum WO, Rubboli G, Kaplan PW, Mirsatari SM, Radhakrishnan K, Gloss D, Caboclo LO, Drislane FW, Koutroumanidis M, Schomer DL, Kasteleijn-Nolst Trenite D, Cook M, Beniczky S (2018) Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clin Neurophysiol 129(5):1056–1082. https://doi.org/10.1016/j.clinph.2018.01.019 CrossRefPubMedGoogle Scholar
- 2.Burkholder DB, Britton JW, Rajasekaran V, Fabris RR, Cherian PJ, Kelly-Williams KM, So EL, Nickels KC, Wong-Kisiel LC, Lagerlund TD, Cascino GD, Worrell GA, Wirrell EC (2016) Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges. Neurology 86(16):1524–1530. https://doi.org/10.1212/wnl.0000000000002592 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Salinsky M, Kanter R, Dasheiff RM (1987) Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 28(4):331–334CrossRefGoogle Scholar
- 4.Marsan CA, Zivin LS (1970) Factors related to the occurrence of typical paroxysmal abnormalities in the EEG records of epileptic patients. Epilepsia 11(4):361–381CrossRefGoogle Scholar
- 5.Baldin E, Hauser WA, Buchhalter JR, Hesdorffer DC, Ottman R (2014) Yield of epileptiform electroencephalogram abnormalities in incident unprovoked seizures: a population-based study. Epilepsia 55(9):1389–1398. https://doi.org/10.1111/epi.12720 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Gregory RP, Oates T, Merry RT (1993) Electroencephalogram epileptiform abnormalities in candidates for aircrew training. Electroencephalogr Clin Neurophysiol 86(1):75–77CrossRefGoogle Scholar
- 7.So EL (2010) Interictal epileptiform discharges in persons without a history of seizures: what do they mean? J Clin Neurophysiol 27(4):229–238. https://doi.org/10.1097/WNP.0b013e3181ea42a4 CrossRefPubMedGoogle Scholar
- 8.Benbadis SR, Lin K (2008) Errors in EEG interpretation and misdiagnosis of epilepsy. Which EEG patterns are overread? Eur Neurol 59(5):267–271. https://doi.org/10.1159/000115641 CrossRefPubMedGoogle Scholar
- 9.Benbadis SR, O’Neill E, Tatum WO, Heriaud L (2004) Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Epilepsia 45(9):1150–1153. https://doi.org/10.1111/j.0013-9580.2004.14504.x CrossRefPubMedGoogle Scholar
- 10.Binnie CD, Rowan AJ, Overweg J, Meinardi H, Wisman T, Kamp A, Lopes da Silva F (1981) Telemetric EEG and video monitoring in epilepsy. Neurology 31(3):298–303CrossRefGoogle Scholar
- 11.Shih JJ, Fountain NB, Herman ST, Bagic A, Lado F, Arnold S, Zupanc ML, Riker E, Labiner DM (2018) Indications and methodology for video-electroencephalographic studies in the epilepsy monitoring unit. Epilepsia 59(1):27–36. https://doi.org/10.1111/epi.13938 CrossRefPubMedGoogle Scholar
- 12.Ghougassian DF, d’Souza W, Cook MJ, O’Brien TJ (2004) Evaluating the utility of inpatient video-EEG monitoring. Epilepsia 45(8):928–932. https://doi.org/10.1111/j.0013-9580.2004.51003.x CrossRefPubMedGoogle Scholar
- 13.Mohan KK, Markand ON, Salanova V (1996) Diagnostic utility of video EEG monitoring in paroxysmal events. Acta Neurol Scand 94(5):320–325CrossRefGoogle Scholar
- 14.Kumar-Pelayo M, Oller-Cramsie M, Mihu N, Harden C (2013) Utility of video-EEG monitoring in a tertiary care epilepsy center. Epilepsy Behav 28(3):501–503. https://doi.org/10.1016/j.yebeh.2013.06.015 CrossRefPubMedGoogle Scholar
- 15.Alving J, Beniczky S (2009) Diagnostic usefulness and duration of the inpatient long-term video-EEG monitoring: findings in patients extensively investigated before the monitoring. Seizure 18(7):470–473. https://doi.org/10.1016/j.seizure.2009.04.005 CrossRefPubMedGoogle Scholar
- 16.Jin B, Zhao Z, Ding Y, Guo Y, Shen C, Wang Z, Tang Y, Zhu J, Ding M, Wang S (2014) Diagnostic yield of inpatient video-electroencephalographic monitoring: experience from a Chinese comprehensive epilepsy center. Epilepsy Behav 34:77–80. https://doi.org/10.1016/j.yebeh.2014.03.010 CrossRefPubMedGoogle Scholar
- 17.Sutter R, Fuhr P, Grize L, Marsch S, Ruegg S (2011) Continuous video-EEG monitoring increases detection rate of nonconvulsive status epilepticus in the ICU. Epilepsia 52(3):453–457. https://doi.org/10.1111/j.1528-1167.2010.02888.x CrossRefPubMedGoogle Scholar
- 18.Theitler J, Dassa D, Gandelman-Marton R (2017) The yield of non-elective inpatient video-EEG monitoring in adults. Neurol Sci 38(6):961–965. https://doi.org/10.1007/s10072-017-2872-2 CrossRefPubMedGoogle Scholar