Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort

Abstract

We evaluate outcome of in-home diagnostic ambulatory video-EEG monitoring (AVEM) performed on a nationwide cohort of patients over one calendar year, and we compare our findings with outcomes of inpatient adult and pediatric VEM performed during the same year at two academic epilepsy centers. Methods: This is a retrospective cohort study. We obtained AVEM outcome data from an independent ambulatory-EEG testing facility. Inpatient VEM data from a 4-bed adult epilepsy center and an 8-bed pediatric epilepsy center were also included. Primary outcome measure was composite percentage of VEM records with epileptiform activity on EEG tracings or at least one video-recorded pushbutton event. We assessed patient-reported symptoms documented in AVEM event diaries. Results: Of 9221 AVEM recordings performed across 28 states, 62.5% attained primary outcome. At least one patient-activated pushbutton event was captured on video in 54% of AVEM recordings (53.6% in adults, 56.1% in children). Epileptiform activity was reported in 1657 (18.0%) AVEM recordings (1473 [88.9%] only interictal, 9 [0.5%] only ictal, 175 [10.6%] both interictal and ictal). Most common patient-reported symptomatology during AVEM pushbutton events was behavioral/autonomic/emotional in adults and children. Compared to AVEM, inpatient VEM captured more confirmed representative events in adult and pediatric samples. Conclusions: AVEM is useful for non-urgent diagnostic evaluation of events. 1. Introduction Despite cost, accessibility, and convenience advantages of diagnostic ambulatory video-EEG monitoring (AVEM) over inpatient VEM, some clinicians tend to favor inpatient VEM even when inpatient level-of-care may not be medically needed, mainly because of two

The real-world economic impact of home-based video electroencephalography: the payer perspective

“…In contrast, 74% of inpatient VEEG patients were in the hospital for at least 2 days for their index VEEG. These findings are consistent with previous US data; for example, a recent retrospective cohort study by Syed et al 19 examined diagnostic VEEG monitoring among $10,000 patients in the US and found a median of 4 days for length of adult inpatient VEEG and 1 day for pediatric inpatient VEEG.…”

“…Conversely, disadvantages of inpatient VEEG include the artificial environment of the hospital, access to hospitals/ neurologists may be limited or inconvenient for some patients, and the high cost of services rendered in an inpatient setting 12 . A recent retrospective cohort study by Syed et al 19 examined outcomes of in-home diagnostic video-EEG monitoring among $10,000 patients over a 1-year period and found that, although selected outcomes are similar on outpatient and inpatient monitoring, outpatient monitoring for non-urgent and non-surgical epileptic events is a useful method to evaluate paroxysmal events that may be considered when inpatient level-of-care is not medically necessary. In such patients, outpatient monitoring may potentially avoid the high-cost of inpatient monitoring and avoid other inconveniences associated with inpatient VEM.…”

“…In such patients, outpatient monitoring may potentially avoid the high-cost of inpatient monitoring and avoid other inconveniences associated with inpatient VEM. Outpatient monitoring may also benefit patients who report seizures or epileptic events that occur in certain environments or with specific triggers that may not be replicated in the hospital setting 19 . A German population-based retrospective analysis of health insurance data showed that VEEG is under-used, even in severely drug-refractory patients 25 .…”

Editorial: Outcome of ambulatory video-EEG monitoring in a ˜10,000 patient nationwide cohort

“…The large cohort study of aVEM reported in Seizure provides important information about the utility of aVEM on a large scale. Taken in proper context, aVEM data in the Syed et al study supports prior ambulatory EEG studies from smaller single-center datasets comprised of at most 500 patients [11] and reinforces the utility of aVEM in nonurgent diagnostic evaluation of patients with seizures as Syed et al and others suggest [4][5][6][7][8]. T feasibility of analyzing "big data" in an effort to compare types of longterm video-EEG monitoring.…”

“…In this issue of Seizure, Syed et al retrospectively analyze a huge database of reports approaching 10,000 ambulatory video-EEG monitoring (aVEM) studies across 28 states from a single independent ambulatory EEG testing facility [5]. Composite results of aVEM were subsequently compared to a cohort undergoing in-patient video-EEG at a National Association of Epilepsy Centers Level IV epilepsy center derived from a 4-bed adult unit and 8-bed pediatric unit.…”