Comparing Diagnostic Yield of Video Ambulatory EEG and Inpatient Video EEG
Abstract number :
1.132
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2019
Submission ID :
2421127
Source :
www.aesnet.org
Presentation date :
12/7/2019 6:00:00 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Shirin Jamal Omidi, University of Texas Health Science Center at Houston; Liang Zhu, University of Texas Health Science Center at Houston; M R Sandhya Rani, University Hospitals, Cleveland Medical; Samden D. Lhatoo, University of Texas Health Science Cent
Rationale: Addition of video to Ambulatory Electroencephalogarphy (AEEG) has enabled capture of patients' episodes in their natural environment, without restricting ambulation, as in the Epilepsy Monitoring Units (EMU), thus realizing an 'EMU-at-home' setting. However, few studies compare diagnostic yield of these two settings. In this study, we compared diagnostic yield of outpatient Video AEEG (VAEEG) and in-patient VEEG (IVEEG) in a large university hospital setting. Methods: This study is a retrospective chart review of all adult patients who underwent VAEEG and all adults admitted to the EMU in a large university hospital system setting, from January 2013 to December 2017. Pretest probability scores were determined separately for generalized seizures, focal seizures, and psychogenic nonepileptic seizures (PNES) in each patient. The scoring was performed using a scoring system that required history details from patients and witnesses, episode semiology and prior investigations. Scores were finally compared to VAEEG and AMU outcome reports. Diagnostic yields of VAEEG and IVEEG were determined by habitual events captured on video. Results: : In our study, 736 patient (mean age 49.8+-18.8 years), completed VAEEG while 1580 patients (mean age 44.1+-16.9 years), had an EMU study. Among patients with at least one event captured, typical events were recorded on camera in 58/545(14%, VAEEG) and 802/899 (89%, EMU) (p<0.0001), where 6/58 (10%) and 397/802 (50%) were epileptic episodes respectively (p<0.0001). In the VAEEG and EMU groups, diagnostic yield for epilepsy was 6/736 (0.8%) vs 397/1580 (25%) respectively (p<0.0001), while for nonepileptic events it was 52/736 (7%) vs. 405/1580 (26%) (p<0.0001). Pretest probability scores had a 75% predictive value for predicting final results of both tests. Conclusions: This study demonstrates a higher yield in diagnosis of epilepsy and non-epileptic events with IVEEG . We observed that more patients experienced non-epileptic episodes during VAEEG, but much fewer events were captured by camera, rendering definite diagnosis challenging. These findings reflect, in part, a low threshold for requesting VAEEG, and emphasize that pretest probability may improve selection and therefore increase diagnostic yield of VAEEG and IVEEG. Funding: No funding
Neurophysiology