Abstracts

Rationale: Continuous EEG monitoring is widely used for the diagnosis, seizure classification, and presurgical evaluation of patients with seizure disorders. In pediatrics, inpatient monitoring is usually preferred to outpatient monitoring because it allows synchronized video-EEG recordings during the various paroxysmal events. But only few studies have specifically evaluated the utility of continuous EEG monitoring in pediatric population. We sought to assess the current use and diagnostic utility of continuous EEG monitoring in pediatrics. Methods: We retrospectively reviewed the clinical indication and diagnostic utility of video-EEG monitoring in a series of 470 children that were done in NBIMC, over 2 years. Patient’s age (283 boys and 187 girls) ranged from 1 day to 17 years. The mean length of stay was 31.2 hours (range: 24 to 96 hours). Referred diagnosis were classified as “suspected seizure as initial presentation”, “suspected seizure in preexisting neurological condition”, “suspected neonatal seizures”, “suspected seizures in infants”, “ suspected seizures in patients with cardio surgery conditions and ICU patients” and “suspected seizures in abnormal behavior with preexisting psychiatric condition”. Video-EEG monitoring outcomes were classified as “normal”, “abnormal” and 'epileptogenic”.Results: Total of 243 (51.7%) patients were referred as suspected or witnessed seizure as initial presentation, 73(15.5%) patients had seizure with preexisting neurological condition, 62 (13.2%) patients were referred as suspected neonatal seizures, 45 (9.6%) patients were infants 1 month to 12 months of age referred as ALTE or abnormal movements suspected to be seizures, 21(4.5%) patients were patients with cardio surgery procedures or conditions and unresponsive ICU patients and 26 (5.5%) patients were referred as changed behavior in previously diagnosed psychiatric conditions. 46.2% of all studies were reported as “normal”, 37.9% were “abnormal”, 16% were found to be “epileptogenic”. There were 118 patients (25%) age 6 to 12 years of age, followed by 113 patients (24%) 1 to 12 month of age. The least number (8%)of patients were in age group 3 to 6 years of age. Conclusions: Clinical usefulness is age-specific and varies significantly in different referred diagnosis. In our study we showed that video-EEG monitoring is particularly useful in diagnosis of initial presentation of seizure in age group of 6 to 12 years of age. However, there is also the need for prospective and preferably randomized investigations to determine the optimal screening procedures and the comparative cost-effectiveness of the service under different modalities of use.