Abstracts

Rationale: Video-electroencephalography (EEG) telemetry is the simultaneous recording of the ictal EEG pattern and the paroxysmal behavior. Conservative drug tapering with or without sleep deprivation may be used to precipitate seizures, especially in the potential candidates for epilepsy surgery. In this study we evaluate safety and yield of a rapid tapering of patients’ antiepileptic medication(s) plus early sleep deprivation in most patients to provoke seizures, also we present seizure outcome of patients. Methods: This is a prospective cohort study started in November of 2006. Over a 1.5-year period (2006-2008), patients that met the indications for video-EEG monitoring were admitted by an epileptologist to our hospital. In patients without past history of status epilepticus, AED(s) were decreased to half previous dose on the day of admission and fully discontinued at the end of the first day of admission. If history of status epilepticus was positive, AED(s) were tapered daily by 25%. A descriptive analysis was used in accordance with the level of measurement of the variables. Results: In total, 34 patients were monitored in the determined period. Mean hospital stay for monitoring was 4.5 days (SD = 1.9) and in 29 patients (85%) the monitoring was conclusive in 5 days or less. On average, 5 seizures and 3.5 non-epileptic events were recorded. In nine patients (26.5%) non epileptic events were recorded. In 23 patients, epileptic events were recorded and fifteen of these patients (65%) were identified as candidates for epilepsy surgery. Of these 15, 4 (36%) needed intracranial recording and eleven patients (74%) were identified as definite candidates for epilepsy surgery without the necessity to perform intracranial investigation. In the latter group, epilepsy surgery was performed in 6 (54%), and surgery has not been performed in 5 (46%), because they are in the waiting list for surgery. Of the 6 patients that received surgery, 4 (67%) became seizure free or Engel class I, and 2 (33%) have rare disabling seizures or Engel class II. In the remaining 8 (35%) of these 25 patients that were not candidates for surgery, the diagnosis was elucidated, these included: Non-epileptic evens plus epilepsy (3), confirmation of epilepsy diagnosis (2), primary generalized epilepsy (2), second recording required for definitive diagnosis (1). In two cases no events were recorded Conclusions: Our monitoring answered the study question regarding the nature of the spells in 94% of the patients. Only in two cases telemetry did not answer the question due to no event being recorded. Despite the non-conservative method of reducing AEDs, complication occurred only in one patient (3%) and was a minor complication (back sprain). We conclude that rapid tapering of AEDs is safe and has a high yield for diagnosis with minimal complications, associated with good seizure outcome.