The Importance of 24h-Video-EEG-Monitoring in the Diagnosis of Epilepsy in Children and Youth

Objective: The objective of this study was to investigate the importance and significance of 24-hour-video-EEG monitoring in children and adolescents without stopping antiepileptic therapy.

Methods: Medical reports, EEG and monitoring findings of all children between 0 and 17 years, who received 24-hour-video-EEG monitoring from 1.8.2015 to 1.5.2018 at the children’s hospital Kaufbeuren, were evaluated. A one-year follow-up was performed for each patient. Children were divided into four groups: (1) Children with epilepsy diagnosis before the monitoring, (2) children with pathological EEGs and spikes without epilepsy diagnosis, (3) children with pathological EEGs without spikes and (4) children with normal EEGs before the monitoring.

Results: Epilepsy was newly diagnosed for 28 (26.7%) children and ruled out in 17 (16.2%) children. Monitoring led to a change in epilepsy classification in 8 (7.6%) children and in 29 (27.6%) patients epilepsy was reclassified. Antiepileptic treatment was modified in 50 (47.6%) cases. 27 (25.7%) children were seizure-free during the first year after the monitoring. In 20 (19.0%) cases there was a spike-free EEG for the year following the monitoring. The correlation between seizure freedom rate and new diagnosis of epilepsy was statistically significant (Phi = 0.35, p = 0.007). The correlation between seizure freedom rate and reclassification of epilepsy was also statistically significant (Phi = 0.35, p = 0.007). Frequency of epilepsy diagnosis was different in the patient groups (p < 0.001). Also the exclusion of epilepsy (p < 0.001) and the reclassification of epilepsy (p = 0.002). At patients with pathological EEGs and spikes compared to children with pathological EEGs without spikes epilepsy was more often diagnosed (p = 0.047). Epilepsy was more often ruled out in patients with pathological EEGs without spikes compared to patients with pathological EEGs and spikes (p = 0.037). Epilepsy was more often reclassified in patients with pathological EEGs and spikes compared to patients with epilepsy diagnosis (p = 0.013). No complications during monitoring were documented.

Conclusion: Monitoring for diagnostic purposes can be recommended, particularly in children with pathological EEGs with spikes without epilepsy diagnosis due to the diagnostic benefit, the increased seizure freedom rate as well as spike-free EEGs later on. When considering the non-invasiveness, lack of complications, diagnostic benefit and clinically relevance 24-hour-video-EEG monitoring is of great importance in the diagnosis of epilepsy in children and adolescents.