Epilepsia
Volume 43 Issue s3 Page 80 - March 2002
Laboratory Research Video-EEG Monitoring in Adults
Gregory D. Cascino
The routine EEG study may prove inadequate in selected patients with recurrent and unprovoked seizures. Video-EEG monitoring is an important diagnostic innovation that may be used to confirm the diagnosis of a seizure disorder and classify seizure type. The methodologies and clinical applications of video-EEG monitoring are reviewed. Long-term EEG recordings may be performed as an outpatient or in an epilepsy monitoring unit. Potential techniques for video-EEG monitoring include prolonged conventional routine EEG, ambulatory EEG, and computer-assisted EEG recordings. Periictal SPECT studies performed during long-term EEG recordings in the epilepsy monitoring unit may increase the diagnostic yield of a presurgical evaluation. Video-EEG monitoring is essential for surgical localization in patients with intractable partial epilepsy being considered for a focal cortical resection. The studies may also be necessary to confirm the presence of nonepileptical clinical episodes.

Epileptic Disord 2002 Sep;4(3):197-202
Short duration outpatient video electroencephalographic monitoring: the experience of a southern-Italian general pediatric department.
Del Giudice E, Crisanti AF, Romano A.
Department of Pediatrics, Child Neuropsychiatry Unit, Federico II University, Naples, Italy.
The authors assessed the event detection rate and clinical usefulness of short duration, outpatient video electroencephalographic monitoring (VEM), in the pediatric age group. The duration of monitoring was set at a two-hour period. One hundred consecutive patients aged 0-18 years were enrolled in the study. Patients belonged to one of the following groups: A) patients evaluated to differentiate between true epileptic seizures and nonepileptic events; B) patients with known epilepsy evaluated for a better definition of their seizure type; C) patients with isolated EEG abnormalities evaluated to identify unrecognised, subtle seizures. An additional group D, included patients with enhancement of spike activity induced by sleep. Eighty- seven patients experienced at least one event per week and 13% had less than one event weekly. The event detection rate was 53% overall, and 61% in the first group of 87 patients. In patients who had events recorded and characterized, epileptic seizures were identified in 37 children (69.8%), and non-epileptic events in 19 children (35.8%). Diagnostic yield was especially high in children with mental retardation who had predominantly non-epileptic events. VEM was judged successful and/or informative in 73 cases (73%), and turned out to be useful even in patients with a low baseline frequency of clinical events.


Mayo Clin Proc 2002 Oct; 77 (10): 1111-20
Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells.

Cascino GD.

Department of Neurology, Mayo Clinic, Rochester, Minn 55905, USA.

Video-electroencephalographic (EEG) monitoring is an important neurodiagnostic technique that may be used for selected patients who present with recurrent and unprovoked spells. For most patients who have epilepsy, the "routine" EEG is sufficient for physicians to classify seizure types and initiate medical therapy; however, routine EEG has substantial limitations for approximately 20% of patients who do not have epilepsy but are referred to comprehensive epilepsy programs because of medically refractory "seizures." These patients may have physiological or psychological disorders that may cause diagnostic confusion with epilepsy and result in the patients being treated unnecessarily with antiepileptic drugs. Video-EEG monitoring, ie, ictal EEG monitoring, performed either on an outpatient basis or in an epilepsy monitoring unit, can help physicians identify ictal EEG patterns that may be necessary for classifying seizure types and determining surgical localization. The sensitivity and specificity of EEG recordings during clinical episodes are superior to those of the routine interictal EEG. Video-EEG monitoring may prove to be an essential procedure for helping physicians confirm diagnoses of seizure disorders, classify seizure types, and select surgical candidates who have intractable epilepsy.