Ambulatory EEG: a cost‐effective alternative to inpatient video‐EEG in adult patients

Abstract

IntroductionAmbulatory electroencephalography (AEEG) is a monitoring technique that allows the recording of continuous EEG activity when patients are at home, without the necessity of admission to the hospital for prolonged video‐EEG monitoring.MethodsThis is a prospective cohort study performed in a Canadian academic centre in order to assess the yield and tolerability of AEEG in the adult population. Over a period of three years, 101 patients were included. The yield of AEEG was assessed by taking into account the questions asked by the clinician before and after the investigation.ResultsOne hundred and one patients undergoing AEEG were prospectively recruited during a three‐year‐period. Our population consisted of 45 males (44.6%) and 56 females (55.4%). The mean age of the group was 36.6±16.1 years. Most of the patients had at least one previous routine EEG (93%). The primary reasons for the AEEGs were subdivided into four categories: a) to differentiate between seizures and non‐epileptic events; b) to determine the frequency of seizures and epileptiform discharges; c) to characterize seizure type or localization; and d) to potentially diagnose epilepsy. The mean duration of AEEG recording was 32±17 hours (15‐96 hours). For 73 (72%) patients, the AEEG provided information that was useful for the management. For 28 (28%) patients, the AEEG did not provide information on diagnosis because no events or epileptiform activity occurred. In only 1 patient was the AEEG inconclusive due to non‐physiological artefacts. Three patients were referred for epilepsy surgery without the necessity of video‐EEG telemetry.ConclusionIn this study, we found that AEEG has a high diagnostic yield (72%) and believe that careful selection of patients is the most important factor for a high diagnostic yield. The main use of AEEG is the characterization of patients with non‐epileptic events, in patients with a diagnosis of epilepsy that is not clear, and quantification of spikes and seizures to improve the medical management. Ambulatory EEG is a cost‐effective solution for increasing demands for in‐hospital video‐EEG monitoring of adult patients.

Diagnostic yield of short-term video-EEG monitoring for epilepsy and PNESs: A European assessment

“…However, in another analysis evaluating the role of short-term video-EEG monitoring on 45 children younger than 12 years of age with frequent intractable seizures undergoing SVEM (a video-EEG was done on an outpatient basis until an event was recorded or for a minimum period of 6 h), a diagnostic accuracy of 40% was found for epileptic seizures, which is broadly similar to ours (57%) [13]. A recent Canadian study on ambulatory computer-assisted EEG in 101 patients reported that this procedure proved useful in 72% of them; while this percentage is notable, also in view of the lack of accompanying videos, it has to be put in the context of longer recording times (mean: 32 h up to 96 h) [14]. Furthermore, all these variations might be due to patient selection and different diagnostic criteria.…”

The value of home video with ambulatory EEG: A prospective service review

“…Work using standard ambulatory EEG recording has shown that the method can have an excellent diagnostic yield, making it a cost effective alternative to inpatient investigation. 3,4 Such factors are particularly important in children, where an interruption to home routines can result in upset to the child and prevent them from continuing with their normal activities which may provoke the event(s) under consideration. Additionally, inpatient recordings can be a significant inconvenience to parents with work commitments and other dependents.…”

Outpatient ambulatory EEG as an option for epilepsy surgery evaluation instead of inpatient EEG telemetry

“…We believe that the use of aEEG in preoperative planning should be restricted to cases of TLE and to patients with a high frequency of seizures [13]. To be useful for epilepsy surgery decisions, an aEEG recording must show an adequate number of seizures and interictal abnormalities.…”