Abstracts

To characterize the clinical, interictal EEG and video-EEG findings of the first 60 patients evaluated at the recently established epilepsy monitoring unit (EMU) in Kingston, Jamaica., All available clinical data, demographics, results of interictal EEG and video-EEG findings for the first 60 patients was examined retrospectively. Recommendations for management based on telemetry findings were identified and outcomes over varying periods of follow-up to May 2006 were determined., Between October 2004 and May 2006, 60 patients were admitted to the EMU. Two-thirds were female. The age distribution ranged from [lt]1 year to 91 yrs. 71% of all patients were from Kingston. 5% were resident overseas and the remainder were from other parishes of Jamaica. The commonest initial clinical diagnosis was possible epilepsy or complex partial seizures. Duration since clinical onset ranged from [lt]1 year to 44 years. 41% had symptoms for less than 2 years. In 22% of all patients routine EEGs had not been done or were unavailable. Epileptiform activity was noted in only 13% of patients whose EEGs were available. 65% of patients had normal or non-specific non-epileptiform routine EEG findings.
Patients were monitored for periods from 3 to 144 hours with 95% monitored for 24-48 hours. The number of clinical events recorded ranged from 0 to 38 per patient, with the most occurring in patients with non-epileptic seizures (NES). 27/60 (45%) of all patients were determined to have localization related epilepsy (LRE), temporal lobe epilepsy (TLE) in the majority 19/27 (32% of all patients). 21 patients that had normal or non specific routine EEG findings proved to have LRE on V-EEG. 8 were shown to have NES. 2 patients had both TLE and NES. Following V-EEG, the most common management decision was manipulation of AEDs. The majority (63%) experienced cessation or marked reduction in events after institution of appropriate management guided by the results of monitoring. However 6/8 patients with NES developed worsening psychopathology despite cessation of NES., Utilization of the EMU was greater in patients with short duration of symptoms whereas patients with longstanding epilepsy appear not to be utilizing this new facility adequately. These patients and their physicians, may be resigned to a life with suboptimal control and may not be accessing a potentially helpful resource. LRE, in particular TLE, was the final diagnosis in most patients. The commonest recommendation was adjustment of AEDs, with a satisfactory outcome noted in most. The subsequent deterioration in most patients with NES despite correct classification underscores the need for better psychiatric care.
This study demonstrates the known utility of V-EEG monitoring in refining diagnostic accuracy. Its availability is expected to reduce the burden of undiagnosed or incorrectly diagnosed patients and will facilitate the introduction of epilepsy surgery into the range of therapeutic options available in the Caribbean.,