Value of combined video EEG and polysomnography in clinical management of children with epilepsy and daytime or nocturnal spells

Abstract

A B S T R A C TPurpose: Sleep disorders are common in epilepsy. Additionally, events of staring, jerking, or nocturnal behaviors are common presentations in neurology or sleep practice. Moreover, sleepiness and nocturnal awakenings are common symptoms in children with epilepsy and differentiation form ongoing seizures and sleep disorders is needed. However, limited data exist for the best evaluation methods. This study evaluated the usefulness of combined video electroencephalography (EEG) and polysomnography (PSG) studies (vEEG/PSG). Methods: Polysomnography custom database was searched for combined vEEG/PSG studies, performed from July 2010 to April 2014, which identified 240 studies. From chart review, data were collected for presenting symptoms, sleep disorder and epilepsy/neurology diagnoses, and EEG and PSG results. Results: Most common indications for performing combined vEEG/PSG were correlating sleep events with seizure occurrence, evaluating sleepiness, nocturnal awakenings and nocturnal events. Sleep physician evaluation and/or PSG were abnormal in 94% of the studies. The EEG was abnormal in 53% and events or seizures were recorded in 40% of the studies. Hence, vEEG/PSG addressed the diagnostic questions. Additionally, as compared to children with epilepsy, a significantly larger number of children with spells/parasomnia had a normal sleep evaluation including a normal PSG (9 Vs 37%, p = 0.00003).Conclusions: This study demonstrates that combined video EEG and polysomnography is useful in addressing the common management questions in children with epilepsy and suspicious nocturnal events. Additionally, sleep disorders are more common in children with epilepsy than parasomnia. Hence sleep evaluation is important in children with epilepsy. Further prospective studies are needed.

Sleep-Related Hypermotor Epilepsy: Etiology, Electro-Clinical Features, and Therapeutic Strategies

“…Due to this, combined VEEG and PSG, utilizing 19-channel EEG and other physiological parameters, can assist in diagnosing suspicious nocturnal events and differentiating between the presence of a parasomnia, seizure activity, or both. 4,118,119 Considering the identification of semiology is highly dependent on clinician expertise and skills, some scholars have postulated that the relative time and stage of occurrence during sleep of minor and major episodes could represent objective and simple criteria to discriminate SHE from DOA. The occurrence of at least one major event (complex arousal ambulatory movements in DOA 120 and complex hypermotor seizures in SHE 4 ) outside stage N3 sleep was highly suggestive of SHE (accuracy = 0.898, specificity = 0.949, sensitivity = 0.793), whereas the occurrence of at least one minor event (simple and rising arousal movements in DOA, 120 MME and PAs in SHE 4 ) during stage N3 sleep was highly suggestive of DOA (accuracy = 0.73, specificity = 0.723, sensitivity = 0.733).…”

The additional diagnostic benefits of performing both video-polysomnography and prolonged video-EEG-monitoring: When and why

“…Both modalities including VPSG and pVEEG-M were judged to be necessary only in a few cases. Other authors have highlighted the usefulness of performing both investigations as well ( Phillips et al, 2013 , Sivathamboo et al, 2019 , Jain et al, 2019 ). VPSG includes electroencephalography, electrooculography, electromyography and cardiorespiratory recordings and gives information about sleep stages, respiratory and motor events during sleep ( Berry et al, 2020 ).…”

Advanced Bioelectrical Signal Processing Methods: Past, Present and Future Approach—Part II: Brain Signals

“…It can be also used to diagnose sleep disorders, coma, depth of anesthesia, encephalopathies, and brain death [35][36][37]. To the sleep disorders monitored with among the others EEG belong the followings: sleep apnea, insomnia, nocturnal awakenings, excessive sleepiness, narcolepsy, parasomnias, anxiety, restless leg syndrome (RLS), or rapid eye movement (REM) sleep behavior [38][39][40][41][42][43][44].…”