Evaluating the Utility of Inpatient Video‐EEG Monitoring

Abstract

Summary:Purpose: Inpatient video-EEG monitoring (VEM) is widely used for the diagnosis, seizure classification, and presurgical evaluation of patients with seizure disorders. It is resource intensive and relatively expensive, so its utility continues to be debated. Few studies have specifically evaluated the utility of inpatient VEM in altering diagnosis or management of patients with seizure disorders. We sought to assess the proportion of patients for whom the preadmission diagnosis and management were altered after inpatient VEM of patients admitted for diagnostic and presurgical evaluation of seizure disorders.Methods: Data from a consecutive cohort of patients admitted over a 3-year period to an inpatient VEM unit in a tertiary referral hospital were retrospectively analyzed. The preadmission diagnosis and management by the referring neurologist was compared with the diagnosis and management after the VEM.Results: Of 131 patients, 91 (70%) were admitted for diagnostic evaluation and 39 (30%) for a presurgical workup. Mean evaluative period was 5.6 days. Mean number of seizures recorded was 2.9. No seizures were recorded in 31% of patients. Interictal EEG showed epileptiform changes in 56 (43%). In 76 (58%), the diagnosis was altered as a result of the VEM, with the greatest change being an increase in the nonepileptic diagnosis group (7% to 31%) and the generalized diagnosis group (5% to 11%). Management was changed after the VEM in 95 (73%).Conclusions: The results of this study demonstrate that inpatient VEM has a high yield in changing diagnosis and management. Future long-term cost-benefit studies of the management changes resulting from VEM evaluation will aid in further reinforcing its role.

How long is long enough? The utility of prolonged inpatient video EEG monitoring

“…At our institution, over 85% of admissions were diagnostic, with less than 15% being inconclusive. Such data compares favorably to inconclusive rates of 15-38% reported in previous studies (Ghougassian et al, 2004;Benbadis et al, 2004;Noe and Drazkowski, 2009). The value of such monitoring is apparent when considering the potential consequences of misdiagnosis.…”

“…Chief amongst these are that it is resource intensive and that seizure occurrence is seldom predictable. VEM requires a considerable investment of patient and physician time, consumes hospital resources, and is major cost to payers (Ghougassian et al, 2004). These shortcomings must be balanced with the costs of not performing VEM, including more frequent emergency room visits, lost time at work/school secondary to recurrent seizures, and ineffective prescription drug use.…”

Localizing Seizure-Onset Zones in Presurgical Evaluation of Drug-Resistant Epilepsy by Electroencephalography/fMRI: Effectiveness of Alternative Thresholding Strategies

“…All patients were evaluated by longterm video-EEG for diagnosis and seizure classification. 29 Patients 1, 5, 6, and 9 were also recorded with subdural foramen ovale electrodes according to Wieser et al 30 Patients 8 and 11-16 underwent invasive EEG recording with subdural strips and placement of depth electrodes along the longitudinal axis of the hippocampus according to Spencer. 31 Presurgical classification of the underlying epileptic syndrome was as follows: 10 patients (1-10) with MTLE; 4 patients (11, 14 -16) with LTLE, 1 patient (12) with frontal lobe epilepsy, and 1 patient (13) with parietal lobe epilepsy.…”

Video-electroencephalography: a necessity

“…Es llamativo que entre los pacientes a los que se realiza el vídeo-EEG sigue habiendo muchos pacientes que entraron con el diagnóstico de epilepsia y salieron con el diagnóstico de pseudocrisis. En el trabajo de Ghougassian, un 7% de pacientes estaban diagnosticados de pseudocrisis al llegar a la Unidad de vídeo-EEG, pero eran un 31% al acabar el estudio 20 . En este estudio sobre la utilidad del vídeo-EEG, un 58% de los pacientes estudiados sufrió un cambio en su diagnóstico.…”