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

Klein, Hans; Pang, Trudy; Slater, J. D. H.; Ramsay, R. Eugene

doi:10.1002/epi4.12517

Cited by 14 publications

(14 citation statements)

References 22 publications

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“…Thus, some have recommended long-term monitoring longer than 3 days in these patients. 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.…”

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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“…Overreporting has been observed in several avEEG studies with similarly high proportions 8–10,20,21 . Additionally, we note the low count of cardiac events, which makes a cardiogenic etiology less likely.…”

Section: Discussionmentioning

confidence: 49%

“…Overreporting has been observed in several avEEG studies with similarly high proportions. [8][9][10]20,21 Additionally, we note the low count of cardiac events, which makes a cardiogenic etiology less likely. The question remains as to what NCEs most likely represent: irrelevant nonepileptic symptoms, or seizures not detectable on scalp EEGs because of deep origin or involving insufficient cortical extent.…”

Section: Discussionmentioning

confidence: 91%

Over‐ and underreporting of seizures: How big is the problem?

Hannon,

Fernandes,

Wong

et al. 2024

Epilepsia

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ObjectiveClinical decisions on managing epilepsy patients rely on patient accuracy regarding seizure reporting. Studies have noted disparities between patient‐reported seizures and electroencephalographic (EEG) findings during video‐EEG monitoring periods, chiefly highlighting underreporting of seizures, a well‐recognized phenomenon. However, seizure overreporting is a significant problem discussed within the literature, although not in such a large cohort. Our aim is to quantify the over‐ and underreporting of seizures in a large cohort of ambulatory EEG patients.MethodsWe performed a retrospective data analysis on 3407 patients referred to a diagnostic service for ambulatory video‐EEG between 2020 and 2022. Both patient‐reported events and events discovered on review of the video‐EEG were analyzed and classified as epileptic, psychogenic (typically clinical motor events, without accompanying EEG change), or noncorrelated events (NCEs; without perceivable clinical or EEG change). Events were analyzed by state of arousal and indication for referral. Subgroup analysis was performed in patients with focal and generalized epilepsies.ResultsA total of 21 024 events were recorded by 3407 patients. Fifty‐eight percent of reported events were NCEs, whereas 27% of all events were epileptic. Sixty‐four percent of epileptic seizures were not reported by the patient but discovered by the clinical service on review of the recording. NCEs were in the highest proportion in the awake and drowsy arousal states and were the most common event type for the majority of referral indications. Subgroup analysis found a significantly higher proportion of NCEs in the patients with focal epilepsy (23%) compared to generalized epilepsy (10%; p < .001, chi‐squared proportion test).SignificanceOur results reaffirm the phenomenon of underreporting and highlight the prevalence of overreporting. Overreporting likely represents irrelevant symptoms or electrographic discharges not represented on scalp electrodes, identification of which has important clinical relevance. Future studies should analyze events by risk factors to elucidate relationships clinicians can use and investigate the etiology of NCEs.

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“…Our simulation study highlights the need for patients' stratification in the clinical use of HVEM and judicious interpretation of HVEM results. Thus, recordings lasting up to 1 week may be suitable merely for diagnosing patients with nonepileptic events and for evaluating patients with daily seizures ( 8 ). However, according to our results, it may take an HVEM study five times longer to capture sufficient seizures as part of a presurgical epilepsy evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Because ASM reduction at home is unsafe, the likelihood of capturing seizures depends on the seizure frequency in each patient. It was recently reported that more than 97% of first clinical events and more than 95% of the mean number of subsequent clinical events were observed in adult and pediatric patients during 72 and 48 h of HVEM, respectively ( 8 ). However, most captured events in this study were non-epileptic (24.8 times more than epileptic in adults and 10 times more in children).…”

Section: Introductionmentioning

confidence: 99%

What is the optimal duration of home-video-EEG monitoring for patients with <1 seizure per day? A simulation study

et al. 2022

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Ambulatory “at home” video-EEG monitoring (HVEM) may offer a more cost-effective and accessible option as compared to traditional inpatient admissions to epilepsy monitoring units. However, home monitoring may not allow for safe tapering of anti-seizure medications (ASM). As a result, longer periods of monitoring may be necessary to capture a sufficient number of the patients' stereotypic seizures. We aimed to quantitatively estimate the necessary length of HVEM corresponding to various diagnostic scenarios in clinical practice. Using available seizure frequency statistics, we estimated the HVEM duration required to capture one, three, or five seizures on different days, by simulating 100,000 annual time-courses of seizure occurrence in adults and children with more than one and <30 seizures per month (89% of adults and 85% of children). We found that the durations of HVEM needed to record 1, 3, or 5 seizures in 80% of children were 2, 5, and 8 weeks (median 2, 12, and 21 days), respectively, and significantly longer in adults −2, 6, and 10 weeks (median 3, 14, and 26 days; p < 10−10 for all comparisons). Thus, longer HVEM than currently used is needed for expanding its clinical value from diagnosis of nonepileptic or very frequent epileptic events to a presurgical tool for patients with drug-resistant epilepsy. Technical developments and further studies are warranted.

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

Cited by 14 publications

References 22 publications

Staring Spells: An Age-based Approach Toward Differential Diagnosis

Staring Spells: An Age-based Approach Toward Differential Diagnosis

Over‐ and underreporting of seizures: How big is the problem?

What is the optimal duration of home-video-EEG monitoring for patients with <1 seizure per day? A simulation study

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