Long-term video-EEG monitoring for paroxysmal events.

Background: Long term video-electroencephalography monitoring (VEM) has been widely used for the diagnosis, classification, and management of seizures. Few studies have systemically examined its safety issues and clinical utility. This prospective study investigates the general clinical application of long term VEM in the management of paroxysmal events.

Methods: This study cohort consisted of patients admitted to the inpatient VEM unit at Chang Gung Memorial Hospital (Lin-Kou). Standard 19 channel scalp electroencephalography (EEG), electrocardiography (ECG), and simultaneous video images were recorded continuously for 2 full days. Patient characteristics, and clinical, video-EEG and safety data were obtained and analyzed. The diagnosis and management of paroxysmal events before VEM were compared with those after VEM.

Results: Habitual events were recorded in 54.3% of the 129 patients, and VEM had a yield rate of 76% (events recorded or newly recorded interictal discharges) indetermining the nature of the events. Eleven patients had seizure clusters, but there was no status epilepticus or electrode-related injury. After VEM, the diagnostic categories were changed in 41.1% of the patients, and 40.3% had revisions in management.

Conclusions: Long term VEM is a safe diagnostic tool providing a high diagnostic yield rate and directing adjustment of management for patients with paroxysmal events.