Video-EEG in the pursuit of documented coexistence of epileptic and psychogenic nonepileptic seizures: how long is too long? - a case report

Abstract

Continuous Vídeo-EEG monitoring remains the gold-standard tool to confirm or disregard the diagnosis of epilepsy in selected cases in which a differential diagnosis is required and not clearly established in the basis of outpatient procedures. However, it may be a tiresome and stressful experience for patients and it is certainly an expensive test. Thus, we wonder how far (considering both financial and emotional costs) should we pursue the goal of documenting all suspicious events. An illustrative case is presented.

Comparing standard medical care for nonepileptic seizures in Chile and the United States

“…Video-EEG has been in use for the past two to three decades in LA. Even though vEEG availability is limited in LA, it is nevertheless used, where available, to diagnose PNES [10,13,14,25,[28][29][30][31][32] and often recommended to be used whenever possible to avoid misdiagnosing patients. Even when vEEG is not available, patients with seizures will still be seen by neurologists and epileptologists.…”

“…Reviewing existing literature in LA reveals that a few studies focused on the prevalence of ES in patients diagnosed with PNES [10,11,26], and some have reviewed retrospective data for PNES identification purposes [13,27]. Stressing the treatment gap for PNES, literature in LA, largely from Argentina and Brazil, reveals that vEEG usage is highly suggested as a diagnostic tool (where available) to correctly diagnose the patients [10,[13][14][15]25,26,[28][29][30][31][32][33][34]. Studies in LA have identified higher frequencies of psychiatric comorbid diagnoses, such as anxiety and dissociation, than studies in the US [11,15,25,27,35,36].…”