UTILITY OF CONTINUOUS VIDEO-EEG MONITORING IN A VETERAN POPULATION: REVIEW OF 144 CONSECUTIVE PATIENTS
Abstract number :
1.106
Submission category :
Year :
2002
Submission ID :
1315
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
P. Jay Foreman, Lillian M. Wilder, Richard A. Hrachovy. Neurology, Section of Clinical Neurophysiology, Baylor College of Medicine, Houston, TX; Neurology, Clinical Neurophysilogy Section, Houston Veterans Administration Medical Center, Houston, TX
RATIONALE: Video-EEG monitoring (VEEG) is an established diagnostic technique for the evaluation of patients with epilepsy. We sought to determine the effectiveness of VEEG in the evaluation of veteran patients, which represents a somewhat unique older population.
METHODS: We reviewed the results of 156 consecutive VEEG monitoring studies performed at the Houston Veterans Administration Medical Center on 144 patients. Reasons for referral included characterization of atypical spells, poor response to antiepileptic treatment, prior routine epilepsy evaluation that was unrevealing, and evaluation for possible seizure surgery. Mean age was 51 years. There were132 males (92%) and 12 females (8%). Average length of continuous VEEG monitoring was 85 hours. In all cases, the entire record was reviewed by a clinical neurophysiologist (RAH, PJF).
RESULTS: Our results revealed 46 patients (32%) with epileptiform activity (focal or generalized). Of these 36 patients (78%) had focal temporal epileptiform abnormalities, as characterized by either interictal epileptiform activity or focal seizures. Review of the entire records revealed 18 of these patients had independent bilateral temporal epileptiform activity (50%). Extratemporal epilepsy accounted for only 6 patients and generalized epileptiform activity was seen in 4 patients.
31 patients had nonepileptic seizures (21%) and 26 patients (18%) had events attributable to other causes (e.g. syncope, post-tussive syncope, panic attacks, REM sleep behavior disorder, obstructive sleep apnea). Multiple findings were present in 12 patients (8%) most often epileptogenic activity and nonepileptic seizures.
CONCLUSIONS: Overall, the diagnostic utility of continuous VEEG monitoring was 67% for providing either a new diagnosis, confirming a prior diagnostic suspicion, or revealing the presence of multiple diagnoses. Furthermore, this study substantiates previous reports that temporal lobe epilepsy is often associated with bilateral epileptiform abnormalities and extends the observation that bitemporal spikes may go undetected on routine EEG and are more frequently seen with continuous VEEG monitoring and inspection of the entire record.
[Supported by: Houston Veterans Administration Medical Center]