Diagnostic utility of prolonged ambulatory video-electroencephalography monitoring.

Epilepsy Behav

Department of Neuroscience (Level 5, Daly Wing), St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia. Electronic address:

Published: April 2024

AI Article Synopsis

  • A large-scale retrospective study in Australia aimed to evaluate the effectiveness of ambulatory video-EEG as a diagnostic tool for seizure-related concerns during a period from April 2020 to June 2021.
  • Out of 600 reports analyzed, nearly half captured diagnostic events, with significant findings including the prevalence of both epileptic and non-epileptic events, as well as a high rate of missed unreported seizures.
  • The study found that recording duration influenced outcomes, with 85% of reports resolving the initial clinical question when at least one diagnostic event was captured.

Article Abstract

Objectives: Ambulatory video-electroencephalography (video-EEG) represents a low-cost, convenient and accessible alternative to inpatient video-EEG monitoring, however few studies have examined their diagnostic yield. In this large-scale retrospective study conducted in Australia, we evaluated the efficacy of prolonged ambulatory video-EEG recordings in capturing diagnostic events and resolving the referring question.

Methods: Sequential adult and paediatric ambulatory video-EEG reports from April 2020 to June 2021 were reviewed retrospectively. Data collection included patient demographics, clinical information, and details of events and EEG abnormalities. Clinical utility was assessed by examining i) time to first diagnostic event, and ii) ability to resolve the referring questions - seizure localisation, quantification, classification, and differentiation (differentiating seizures from non-epileptic events).

Results: Of the 600 reports analysed, 49 % captured at least one event, and 45 % captured interictal abnormalities (epileptiform or non-epileptiform). Seizures, probable psychogenic events (mostly non-convulsive), and other non-epileptic events occurred in 13 %, 23 % and 21 % of recordings respectively, with overlap. Unreported events were captured in 53 (9 %) recordings, and unreported seizures represented more than half of all seizures captured (51 %, 392/773). Nine percent of events were missing clinical, video or electrographic data. A diagnostic event occurred in 244 (41 %) recordings, of which 14 % were captured between the fifth and eighth day of recording. Reported event frequency ≥ 1/week was the only significant predictor of diagnostic event capture. In recordings with both seizures and psychogenic events, unrecognized seizures were frequent, and seizures may be missed if recording is terminated early. The referring question was resolved in 85 % of reports with at least one event, and 53 % of all reports. Specifically, this represented 46 % of reports (235/512) for differentiation of events, and 75 % of reports (27/36) for classification of seizures.

Conclusion: Ambulatory video-EEG recordings are of high diagnostic value in capturing clinically relevant events and resolving the referring clinical questions.

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Source
http://dx.doi.org/10.1016/j.yebeh.2024.109652DOI Listing

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