Intensive monitoring in refractory epilepsy

Sutula, Thomas P.; Sackellares, J. Chris; Miller, Jeremy; Dreifuss, Fritz E.

doi:10.1212/wnl.31.3.243

Cited by 68 publications

(38 citation statements)

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“…A small number of studies have also assessed the proportion of patients in whom VT resulted in a change in the preadmission diagnosis or management 18 – 21. In the most recent and largest of these studies, Ghougassian et al reported that 58% of 131 patients admitted to a tertiary unit had a change from their provisional preadmission diagnosis due to VT 22.…”

Section: Discussionmentioning

confidence: 99%

Long term monitoring in refractory epilepsy: the Gowers Unit experience

Yogarajah

Powell

Heaney

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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The study revealed that LTM led to an alteration in the diagnosis of 71% of patients referred to a tertiary centre for diagnostic clarification of possible epilepsy. Although LTM is relatively expensive, time consuming and of limited availability, this needs to be balanced against the considerable financial and social cost of misdiagnosed and uncontrolled seizures. This service evaluation supports the use of performing LTM (either video or ambulatory) in a specialist setting in patients who present diagnostic difficulty.

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Section: Discussionmentioning

confidence: 99%

Long term monitoring in refractory epilepsy: the Gowers Unit experience

Yogarajah

Powell

Heaney

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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“…However, very few published studies specifically examined the proportion of patients in whom the inpatient VEM resulted in a change in the preadmission diagnosis or management (7). Sutula et al (7) reported 40 patients who were studied for an average of 8 weeks with video‐EEG monitoring. The diagnostic category was changed as a result of the monitoring in 19 (47.5%), and AEDs were changed in 25 (60%).…”

Section: Discussionmentioning

confidence: 99%

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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“…First, the number of spikes and seizures was significantly greater in rat recordings (Hellier et al, 1998;Sutula et al, 1981;Wilson et al, 1996). Therefore, the need for extremely high sensitivity and specificity was not as critical in these rat models, and this was particularly true for the seizure detection algorithms that relied on spike frequency.…”

Section: Seizure Detectionmentioning

confidence: 99%