The Utility and Yield of Long-Term Video Ambulatory EEG
Abstract number :
3.116
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2018
Submission ID :
501990
Source :
www.aesnet.org
Presentation date :
12/3/2018 1:55:12 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Shirin Jamal Omidi, University Hospitals, Case Western University School of Medicine; Shahram Amina, University Hospitals, Case Western University School of Medicine; Michael Devereaux, Case Western University School of Medicine; Guadalupe Fernandez-BacaV
Rationale: Video Ambulatory Electroencephalography (VAEEG) potentially overcomes some of the limitations of Ambulatory EEG (AEEG): difficulty differentiating artifacts from ictal/interictal phenomena, and characterization of event semiology. VAEEG is now more widely used due to its inherent advantages of patient convenience, particularly for those with severe disabilities, learning difficulties, challenging behaviors, and hospital phobias. In this study we analyze use of VAEEG in a large university hospital system setting over a 5-year period. Methods: Retrospective chart review of all adult patients for whom VAEEG was requested during the period January 2013 to December 2017. Pretest probability was calculated according to history and previous investigations and compared to diagnostic outcome after VAEEG. Results: Of 1016 VAEEG requests, 733 patients aged between 15-98 years (66.2% female, 33% male), completed the test. 698 patients had had at least one clinical event. Only 34 patients who pressed the pushbutton for habitual events were within camera view, and an additional 11 seizures from 4 patients were captured on camera without button pushes. VAEEG provided a diagnostic yield of epilepsy in only 13.2% (focal epilepsy in 8.7%, generalized epilepsy in 4.5%). The contribution of actual video capture of habitual events in the diagnosis of epilepsy was 0.5% and for nonepileptic events 4% (total 4.6%); whereas the diagnostic yield for AEEG without video, defined as the presence of ictal or interictal epileptiform discharges was 13.5%. Kruskal-Wallis test showed a good correlation between the pretest probability scores of both generalized and focal seizures, and respective confirmation of diagnosis by VAEEG (p Conclusions: This study suggests that there is low yield of epilepsy diagnosis with VAEEG. On the other hand, there was significant correlation between high pretest probability and subsequent confirmation of diagnosis by VAEEG. This suggests that this test is optimally used only when there is good pretest probability of diagnostic confirmation. Funding: This study did not receive any funding.