Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study
IntroductionParoxysmal seizure-like events can be a diagnostic challenge. Inpatient video-electroencephalography (EEG) monitoring (VEM) can be a valuable diagnostic tool, but recommendations for the minimal duration of VEM to confirm or rule out epilepsy are inconsistent. In this study, we aim to de...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-10-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1281652/full |
| _version_ | 1797655162151501824 |
|---|---|
| author | Katharina Timpte Ulrike Rosenkötter Philipp Honrath Yvonne Weber Stefan Wolking Jan Heckelmann |
| author_facet | Katharina Timpte Ulrike Rosenkötter Philipp Honrath Yvonne Weber Stefan Wolking Jan Heckelmann |
| author_sort | Katharina Timpte |
| collection | DOAJ |
| description | IntroductionParoxysmal seizure-like events can be a diagnostic challenge. Inpatient video-electroencephalography (EEG) monitoring (VEM) can be a valuable diagnostic tool, but recommendations for the minimal duration of VEM to confirm or rule out epilepsy are inconsistent. In this study, we aim to determine whether VEM of 48 or 72 h was superior to 24 h.MethodsIn this monocentric, retrospective study, we included 111 patients with paroxysmal, seizure-like events who underwent at least 72 h of VEM. Inclusion criteria were as follows: (1) Preliminary workup was inconclusive; (2) VEM admission occurred to confirm a diagnosis; (3) At discharge, the diagnosis of epilepsy was conclusively established. We analyzed the VEM recordings to determine the exact time point of the first occurrence of epileptic abnormalities (EAs; defined as interictal epileptiform discharges or electrographic seizures). Subgroup analyses were performed for epilepsy types and treatment status.ResultsIn our study population, 69.4% (77/111) of patients displayed EAs during VEM. In this group, the first occurrence of EAs was observed within 24 h in 92.2% (71/77) of patients and within 24–72 h in 7.8% (6/77). There was no statistically significant difference in the incidence of EA between medicated and non-medicated patients or between focal, generalized epilepsies and epilepsies of unknown type. Of the 19 recorded spontaneous electroclinical seizures, 6 (31.6%) occurred after 24 h.DiscussionA VEM of 24 h may be sufficient in the diagnostic workup of paroxysmal seizure-like events under most circumstances. Considering the few cases of first EA in the timeframe between 24 and 72 h, a prolonged VEM may be useful in cases with a high probability of epilepsy or where other strategies like sleep-EEG or ambulatory EEG show inconclusive results. Prolonged VEM increases the chance of recording spontaneous seizures. Our study also highlights a high share of subjects with epilepsy that do not exhibit EAs during 72 h of VEM. |
| first_indexed | 2024-03-11T17:10:09Z |
| format | Article |
| id | doaj.art-3ce7a9adfc4a42c18fcd131d65263df7 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T17:10:09Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-3ce7a9adfc4a42c18fcd131d65263df72023-10-20T06:21:12ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-10-011410.3389/fneur.2023.12816521281652Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational studyKatharina TimpteUlrike RosenkötterPhilipp HonrathYvonne WeberStefan WolkingJan HeckelmannIntroductionParoxysmal seizure-like events can be a diagnostic challenge. Inpatient video-electroencephalography (EEG) monitoring (VEM) can be a valuable diagnostic tool, but recommendations for the minimal duration of VEM to confirm or rule out epilepsy are inconsistent. In this study, we aim to determine whether VEM of 48 or 72 h was superior to 24 h.MethodsIn this monocentric, retrospective study, we included 111 patients with paroxysmal, seizure-like events who underwent at least 72 h of VEM. Inclusion criteria were as follows: (1) Preliminary workup was inconclusive; (2) VEM admission occurred to confirm a diagnosis; (3) At discharge, the diagnosis of epilepsy was conclusively established. We analyzed the VEM recordings to determine the exact time point of the first occurrence of epileptic abnormalities (EAs; defined as interictal epileptiform discharges or electrographic seizures). Subgroup analyses were performed for epilepsy types and treatment status.ResultsIn our study population, 69.4% (77/111) of patients displayed EAs during VEM. In this group, the first occurrence of EAs was observed within 24 h in 92.2% (71/77) of patients and within 24–72 h in 7.8% (6/77). There was no statistically significant difference in the incidence of EA between medicated and non-medicated patients or between focal, generalized epilepsies and epilepsies of unknown type. Of the 19 recorded spontaneous electroclinical seizures, 6 (31.6%) occurred after 24 h.DiscussionA VEM of 24 h may be sufficient in the diagnostic workup of paroxysmal seizure-like events under most circumstances. Considering the few cases of first EA in the timeframe between 24 and 72 h, a prolonged VEM may be useful in cases with a high probability of epilepsy or where other strategies like sleep-EEG or ambulatory EEG show inconclusive results. Prolonged VEM increases the chance of recording spontaneous seizures. Our study also highlights a high share of subjects with epilepsy that do not exhibit EAs during 72 h of VEM.https://www.frontiersin.org/articles/10.3389/fneur.2023.1281652/fullepilepsy monitoring unitinterictal epileptic dischargesinterictal epileptiform abnormalitydifferential diagnosisantiseizure medication |
| spellingShingle | Katharina Timpte Ulrike Rosenkötter Philipp Honrath Yvonne Weber Stefan Wolking Jan Heckelmann Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study Frontiers in Neurology epilepsy monitoring unit interictal epileptic discharges interictal epileptiform abnormality differential diagnosis antiseizure medication |
| title | Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study |
| title_full | Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study |
| title_fullStr | Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study |
| title_full_unstemmed | Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study |
| title_short | Assessing 72 h vs. 24 h of long-term video-EEG monitoring to confirm the diagnosis of epilepsy: a retrospective observational study |
| title_sort | assessing 72 h vs 24 h of long term video eeg monitoring to confirm the diagnosis of epilepsy a retrospective observational study |
| topic | epilepsy monitoring unit interictal epileptic discharges interictal epileptiform abnormality differential diagnosis antiseizure medication |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1281652/full |
| work_keys_str_mv | AT katharinatimpte assessing72hvs24hoflongtermvideoeegmonitoringtoconfirmthediagnosisofepilepsyaretrospectiveobservationalstudy AT ulrikerosenkotter assessing72hvs24hoflongtermvideoeegmonitoringtoconfirmthediagnosisofepilepsyaretrospectiveobservationalstudy AT philipphonrath assessing72hvs24hoflongtermvideoeegmonitoringtoconfirmthediagnosisofepilepsyaretrospectiveobservationalstudy AT yvonneweber assessing72hvs24hoflongtermvideoeegmonitoringtoconfirmthediagnosisofepilepsyaretrospectiveobservationalstudy AT stefanwolking assessing72hvs24hoflongtermvideoeegmonitoringtoconfirmthediagnosisofepilepsyaretrospectiveobservationalstudy AT janheckelmann assessing72hvs24hoflongtermvideoeegmonitoringtoconfirmthediagnosisofepilepsyaretrospectiveobservationalstudy |