The value of combined ambulatory cassette-EEG and video monitoring in the differential diagnosis of intractable seizures

Shihabuddin, Bashir; Abou‐Khalil, Bassel; Fakhoury, Toufic

doi:10.1016/s1388-2457(99)00081-4

Cited by 14 publications

(13 citation statements)

References 14 publications

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“…Some patients may report that the lack of “day‐to‐day” stress and reduced physical activity in the EMU results in a reduction in their seizure frequency. Future developments in ambulatory VEM (13) may allow monitoring to improve the yield in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Parnell et al (9), in a retrospective study correlating history and examination, sleep-deprived EEG, and MRI imaging abnormality with outcomes after 4 days of VEM, noted a high correlation of MRI abnormality (along with epileptiform features on EEG) to the eventual diagnosis of epilepsy after VEM. Shihabuddin et al (13), looking at ambulatory recordings in "diagnostic" cases, found they were able to discontinue AEDs in 40% of those monitored. They emphasised this technique's utility in those suspected of having nonepileptic events.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Utility of Inpatient Video‐EEG Monitoring

et al. 2004

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating the Utility of Inpatient Video‐EEG Monitoring

et al. 2004

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“…The estimated prevalence of PNES is between 2 to 33 per 100,000 individuals, making PNES one of the more common conversion disorders in the community (3). It has been reported that between 11 and 54% of patients admitted for inpatient video‐EEG monitoring (VEM) are diagnosed as having PNES (1,4–7). A significant proportion of patients requiring intubation for status epilepticus are ultimately diagnosed with PNESs, resulting in potentially serious morbidity to the patient, and considerable cost to the community (8).…”

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confidence: 99%

“Convulsive” Nonepileptic Seizures Have a Characteristic Pattern of Rhythmic Artifact Distinguishing Them from Convulsive Epileptic Seizures

et al. 2004

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Summary:Purpose: Approximately 30% of patients admitted for video-EEG monitoring have psychogenic nonepileptic seizures (PNES). Differentiation of "convulsive" PNES from convulsive seizures can be difficult. The EEG often displays rhythmic movement artifact that may resemble seizure activity and confound the interpretation. We sought to determine whether time-frequency mapping of the rhythmic EEG artifact during "convulsive" PNES reveals a pattern that differs from that of epileptic seizures.Methods: EEGs from 15 consecutive patients with "convulsive" PNESs were studied with time-frequency mapping by using NEUROSCAN and compared with 15 patients with convulsive epileptic seizures. Fast Fourier transforms (FFTs) were performed to determine the dominant frequency for 1-to 2-s windows every 2 s through the seizures. Results:The dominant frequency remained stable within a narrow range for the duration of the PNES, whereas in the epileptic seizures, it evolved through a wide range. The coefficient of variation of the frequency during the seizures was considerably less for patients without epilepsy (median, 15.0%; range, 7.2-23.7% vs. median, 58.0%; range, 34.8-92.1%; p < 0.001). The median frequency did not differ significantly between groups (4.2 vs. 4.6 Hz; p = 0.290).Conclusions: "Convulsive" PNES display a characteristic pattern on time-frequency mapping of the EEG artifact, with a stable, nonevolving frequency that is different from the evolving pattern seen during an epileptic seizure. Key Words: Psychogenic nonepileptic seizures-Time-frequency mapping-EEG.Individuals with psychogenic nonepileptic seizures (PNES) have recurrent episodes of altered movement, sensation, or experience that resemble epileptic seizures but are not associated with abnormal electrical activity in the brain (1). The etiology of PNES remains unclear; however, they are presumed to relate to underlying psychogenic disturbances, with multiple factors including personality traits playing a role in both etiology and prognosis (2).PNES represent a common diagnostic and management problem, not just for the neurologist, but also for general practitioners, emergency departments, and other treating physicians. The estimated prevalence of PNES is between 2 to 33 per 100,000 individuals, making PNES one of the more common conversion disorders in the community (3).

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“…The use of combined ambulatory EEG and video recording of hospital in-patients has been reported by Shihabuddin et al .,[8] who used a time and date generator to synchronize the ambulatory cassette EEG recording with the video recording. A similar approach may be possible in out-patients.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory electroencephalogram in children: A prospective clinical audit of 100 cases

et al. 2013

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Ambulatory electroencephalogram has been used for differentiating epileptic from nonepileptic events, recording seizure frequency and classification of seizure type. We studied 100 consecutive children prospectively aged 11 days to 16 years that were referred for an ambulatory electroencephalogram to a regional children's hospital. Ambulatory electroencephalogram was clinically useful in contributing to a clinical diagnosis in 71% of children who were referred with a range of clinical questions. A diagnosis of epileptic disorder was confirmed by obtaining an ictal record in 26% and this included 11 children that had previously normal awake and or sleep electroencephalogram. We recommend making a telephone check of the current target event frequency and prioritising those with typical events on most days in order to improve the frequency of recording a typical attack.

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The value of combined ambulatory cassette-EEG and video monitoring in the differential diagnosis of intractable seizures

Cited by 14 publications

References 14 publications

Evaluating the Utility of Inpatient Video‐EEG Monitoring

Evaluating the Utility of Inpatient Video‐EEG Monitoring

“Convulsive” Nonepileptic Seizures Have a Characteristic Pattern of Rhythmic Artifact Distinguishing Them from Convulsive Epileptic Seizures

Ambulatory electroencephalogram in children: A prospective clinical audit of 100 cases

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