Abstracts

Rationale: The purpose of video electroencephalographic telemetry (vEEGT) is to record ictal and interictal epileptiform activity and to ascertain the level of concordance between the two. Rapid withdrawal or discontinuation of anti-epileptic drugs (AEDs) is needed to facilitate seizure occurrence. The long-term safety of AED rapid withdrawal is unclear and both short and long-term outcomes have yet to be explored.Methods: A prospective analysis of 150 patients admitted over 5 years to our telemetry unit under the care of an epileptologist with direct nursing observation and EEG technician support. Patients were subjected to a standardized rapid AED withdrawal protocol in order to facilitate seizure evaluation via vEEGT. We assessed the yield and safety of telemetry investigations and epilepsy surgery outcomes.Results: VEEGT answered the study question in 84.8% of cases but failed to record ictal events 15.2% of the time. These findings altered management in 93% of cases and likely improved quality of life by decreasing AED consumption and reducing seizure frequency. Overall, 34% of the cohort received epilepsy surgery. The probability of a good outcome (Engel Class I/II) at 24 months was 78% in the surgery group and 40% in the non-surgery group. The ratio of non-epileptic:epileptic events was highest in the first 2 days of vEEGT. Diagnostic yield was maximal at 5 days, with no benefit of longer monitoring. The overall complication rate was 5.3%; 1 patient experienced back sprain, 1 had a fall, 1 endured rotator cuff injury, 1 had a minor intravenous site-related skin infection, and 4 patients required admission to the emergency department in the first month after telemetry for management of seizure clustering.Conclusions: VEEGT with early cessation of AED therapy is safe and effective. It is a reliable strategy for therapeutic planning, including epilepsy surgery. Surgical outcomes are favourable and support the use of this technique under the supervision of a team comprising epileptologists, nurses, and EEG technologists.