Abstracts

RATIONALE: Video-EEG monitoring is essential in distinguishing epilepsy and non-epileptic disorders. Video-EEG monitoring is often performed in the inpatient setting, which is costly. Selective use of outpatient short-term video-EEG (STVEEG) may obviate the need for inpatient video-EEG recordings in some patients. METHODS: We reviewed the clinical records of 120 consecutive patients undergoing STVEEG at Mayo Clinic Rochester from April 16, 1999 to March 16, 2000. All patients were referred for the evaluation of symptoms in which epilepsy was a diagnostic consideration. One to two hour recordings were performed in each patient. RESULTS: Thirty-six patients (30%) were less than 18 years old (mean 7.3years), and 84 patients were 18 or older (mean 42.9 years). Forty-nine (40.8%) were male. Symptoms typical of those for which the patient was referred were successfully recorded in 64 patients (53.3%). In these patients, the final diagnosis based on STVEEG was non-epileptic spells (75.7%), primary generalized seizures (14.9%), partial seizures (8.1%), and indeterminate in 1.4%. Symptoms were recorded in 69.6% of patients reporting daily spells, compared to 34.4% in those with less frequent symptoms (P<0.001, Chi-squared test). Diagnostic yield was not affected by patient report of the existence of precipitating factors, patient gender or age, or the presence of interictal epileptiform abnormalities. Among the 64 patients in whom symptoms were recorded, the diagnosis based on STVEEG was considered sufficient by the clinician in 51 (79.7%). Thirteen patients with symptoms recorded during STVEEG were admitted for further inpatient long-term video-EEG monitoring, in which a different diagnosis was reached in two (15.4%). Thirteen of 56 patients with non-diagnostic STVEEG were admitted for prolonged video-EEG monitoring, in which a diagnosis was established in 11 (84.6%). CONCLUSIONS: Outpatient short-term video EEG is a useful and less expensive alternative to inpatient video-EEG in some clinical situations. STVEEG is particularly helpful in patients with daily clinical events.