Abstracts

When seizures do not respond to medications, EEG-video monitoring is the gold standard. It allows to 1) make a diagnosis of epilepsy vs. non-epileptic events; and 2) correctly diagnose the seizure type and epilepsy syndrome, which in turn determines therapeutic options [Benbadis et al, Neurology 2000;55:1780-1784]. The purpose of this study was to analyze the eventual disposition of patients who undergo EEG-video monitoring at a typical referral epilepsy center.
We reviewed the diagnoses and dispositions of all patients (adults and children) who underwent EEG-video monitoring (23 hours or more) at our center (University of South Florida-Tampa General Hospital) over a 1-year period (2002). Epilepsy were classified as localization-related, idiopathic generalized epilepsy, and symptomatic/cryptogenic epilepsy.
A total of 251 EEG-video monitoring sessions were performed. Diagnoses and disposition were as follows:
[lowast] Non-epileptic: 75 (30%)
- Without epilepsy): 69 (psychogenic 61, others 8)
- Both epileptic and non-epileptic: 6
[lowast] Surgery
- Epilepsy surgery performed: 46 (18%)
- Surgery candidate but refused: 11
- Phase II but no resection: 1
[lowast] Vagus nerve stimulation: 7
[lowast] Seizures recorded, diagnosis of epilepsy confirmed and clarified: 47 (19%) (symptomatic/cryptogenic epilepsy 7, localization-related epilepsy 35, idiopathic generalized epilepsy 5)
[lowast] No seizures or event recorded
- No events but interictal epileptiform discharges: 19 (symptomatic/cryptogenic epilepsy 4, localization-related epilepsy 12, idiopathic generalized epilepsy 3)
- No event recorded, no interictal, no conclusion: 38 (15%)
The eventual outcome of EEG-video monitoring is diverse. The largest groups, as expected, are psychogenic nonepileptic seizures and surgery. Most patients with no events and no interictal epileptiform discharges were children evaluated for autism-like behaviors or Landau-Kleffner syndrome.