Abstracts

Rationale: Video-EEG (VEEG) monitoring is a diagnostic tool that is used to help confirm the diagnosis of epilepsy, characterize seizure type, and localize epileptic foci. Within the literature, the utility of VEEG is variable and dependent on patient demographics as well as purpose and length of monitoring. To investigate this within our population, we analyzed VEEG outcomes in consecutive adult patients referred to our metropolitan tertiary care epilepsy center. Methods: The outcome of 100 consecutive adult elective VEEG admissions at Long Island Jewish Hospital from July 2011 to January 2012 was reviewed. These patients were referred for admission from both clinic and faculty private practice. The questions to be answered by the admission were documented in the clinic note prior to admission. Our analysis included: 1. What was the question to be answered by VEEG? 2. Was the question answered by VEEG monitoring? 3. When the question was not answered, why? 4. Did the outcome of monitoring alter medical or surgical management? Results: The admission question was answered in 77 patients (see table for admission question). Of the 23 patients whom the question remained unanswered, 14 did not have events, 4 did not wish to continue monitoring, and 4 had events suspicious for simple partial seizures or auras without EEG correlate. In 1 patient, the reason the question was not answered was unclear (see chart). The mean length of stay was 3.08 days (SD 1.93) in the patients for whom the question was answered. The mean length of stay was 2.74 days (SD 1.60) in those for whom the question was not (p= 0.218). In the patients whom the admission question was answered, 48 had medications adjusted upon discharge: 11 had medications solely increased, 2 had medications solely decreased, 11 had a new medication added, 8 had one medication stopped and 16 had multiple medication adjustments. Default practice was to resume baseline anti-epileptic drug regimen, which occurred in 29 patients. Fifteen of 23 patients admitted for seizure localization proceeded with surgical evaluation. Of these patients, 5 proceeded with epilepsy surgery (craniotomy) to date. Conclusions: We demonstrated in our population that VEEG is a useful tool to aid in seizure localization, diagnosis and characterization since the question of admission was answered in the majority of patients (77%). The main reason for not answering the admission question was lack of events. We also demonstrated that results of VEEG monitoring affect outcome both medically and surgically. Medications were altered upon discharge in approximately 2/3 of patients whom the question was answered. Fifteen percent of total admissions proceeded with epilepsy surgical evaluation and 5% underwent craniotomy for epilepsy surgery.