Clinical characteristics of video-EEG patients: Limited utility of prolonging VEEG study duration beyond 5 days for spell classification

Çelik, Şenay Yıldız; Headley, Alison J.; Shih, Jerry J.

doi:10.1016/j.yebeh.2019.106827

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…17,18 On the other hand, some have shown limited benefit after 5 days. 19 However, it is important to carefully define the diagnostic value of this high-cost and time-consuming procedure in addition to consideration of other costly and time-consuming evaluations such as brain MRI scan or genetic testing and/or treatments. In many pediatric centers, the average stay is 1.2-1.5 days.…”

Section: Discussionmentioning

confidence: 99%

Staring Spells: An Age-based Approach Toward Differential Diagnosis

et al. 2022

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Evaluations to rule out epileptic vs nonepileptic staring spells may entail unnecessary evaluations that can be costly and time consuming. Our study aims to identify common etiologies for staring spells across 3 different pediatric age groups and to propose an age-based clinical guidance to help determine which patients warrant further workup. Methods: This was a single-center retrospective chart analysis of 1496 patients aged 0.0-17.9 years presenting with confirmed staring spell diagnosis from January 2011 to January 2021. The patients were divided into 3 groups based on their age: 0.0-2.9, 3.0-12.9, and 13.0-17.9 years. Patient information collected included demographics, clinical presentation, comorbidities, and final diagnosis. Multilevel likelihood ratios and a receiver operating characteristic curve were determined using 8 of the 11 clinical variables. A total of 1142 patients who met the inclusion criteria were included for the final analysis. The most common final diagnosis was attention-deficit hyperactivity disorder (ADHD) (35%), followed by normal behavior (33%). Generalized and focal epilepsy were diagnosed in 8% and 4% of the patients, respectively. In the 0.0-2.9-year age group, normal behavior was the final diagnosis in 72% patients. In the 3.0-12.9-year and 13.0-17.9-year age groups, ADHD was the most frequent final diagnosis in 46% and 60%, respectively. Overall, ADHD and normal behaviors remain the most common final diagnoses. Multilevel likelihood ratios can be used to develop an age-based guidance to differentiate between epileptic and nonepileptic staring spell diagnoses.

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Section: Discussionmentioning

confidence: 99%

Staring Spells: An Age-based Approach Toward Differential Diagnosis

et al. 2022

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“…Much of the literature examining optimal recording duration comes from inpatient epilepsy monitoring units (EMUs) and suggests that capture of first event occurs between 2 and 3 days (48 and 72 hours) of recording. [3][4][5] However, it is difficult to generalize results from EMU research to in-home EEG monitoring, as routine medication washouts and activation procedures can be achieved with continuous clinical monitoring to increase the likelihood of events occurring sooner. 6 Such procedures 6 may not only be unsafe in the outpatient setting, but also uncomfortable or unnecessary for some patients.…”

Section: Introductionmentioning

confidence: 99%

How much time is enough? Establishing an optimal duration of recording for ambulatory video EEG

Klein¹,

Pang

Slater

et al. 2021

Epilepsia Open

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Objective Ambulatory video EEG allows for extended recording of EEG in the comfort of a patient's home. However, the optimal duration of recording to capture clinical events is yet to be established. The current study uses retrospective analyses to identify an optimal recording duration for at‐home video EEG. Methods A retrospective review was performed utilizing an anonymized database of ambulatory video EEG recordings performed between March and September 2020 with a national in‐home EEG provider. Only completed assessments with neurologists' reads of raw data were reviewed, resulting in 3644 unique studies divided into three age cohorts: pediatrics (n = 941), adult (n = 2020), and geriatric (n = 683). Cohorts were characterized by assessment yield and time to first typical clinical event, as well as subsequent typical events over duration of recording. Results Frequency distributions reveal over half of first events are captured within 12 hours, but longer recording durations capture a much wider majority of both first typical events, as well as the mean number of subsequent events (5 clinical events). In 72 hours, over 97% of first events were observed in adult and geriatric patients, as well as over 95% of the mean number of subsequent events. In children, time to first event was significantly earlier than either adult or geriatric samples, with 98% of first events, and 92.8% of the mean number of subsequent events being observed in 48 hours. Significance These results from a large‐scale, national dataset of patients using in‐home EEG monitoring suggests recording at least 48 hours in duration for children, and at least 72 hours in duration for adult and geriatric samples, is optimal to maximize the likelihood of observing typical clinical events to facilitate diagnosis.

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“…The average duration of monitoring (mean: 6.9 days) in our study is slightly longer than other institutions which ranged between 2 and 4 days. The reported rate of conclusive studies from these institutions were between 60 % and 78 % [8][9][10][11]. The cost of prolonged duration of monitoring in our institution is offset by the higher proportion of patients (87 %) receiving a definitive diagnosis.…”

Section: Discussionmentioning

confidence: 78%

“…Predicting an optimal duration of vEEG monitoring is challenging. Variable optimal duration of monitoring have been recommended by different studies, ranging between 2 and 6 days with the majority suggesting 5 days [8,9,13,20,21]. However, based on our findings, artificially limiting duration of monitoring to 5 days will reduce the number of conclusive studies in our cohort by 65.8 %.…”

Section: Discussionmentioning

confidence: 79%

A retrospective study of the correlation between duration of monitoring in the epilepsy monitoring unit and diagnostic yield

Adenan

Khalil²,

Loh³

et al. 2022

Epilepsy & Behavior

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Clinical characteristics of video-EEG patients: Limited utility of prolonging VEEG study duration beyond 5 days for spell classification

Cited by 10 publications

References 34 publications

Staring Spells: An Age-based Approach Toward Differential Diagnosis

Staring Spells: An Age-based Approach Toward Differential Diagnosis

How much time is enough? Establishing an optimal duration of recording for ambulatory video EEG

A retrospective study of the correlation between duration of monitoring in the epilepsy monitoring unit and diagnostic yield

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Clinical characteristics of video-EEG patients: Limited utility of prolonging VEEG study duration beyond 5 days for spell classification

Cited by 10 publications

References 34 publications

Staring Spells: An Age-based Approach Toward Differential Diagnosis

Staring Spells: An Age-based Approach Toward Differential Diagnosis

How much time is enough? Establishing an optimal duration of recording for ambulatory video EEG

A retrospective study of the correlation between duration of monitoring in the epilepsy monitoring unit and diagnostic yield

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Clinical characteristics of video-EEG patients: Limited utility of prolonging VEEG study duration beyond 5 days for spell classification