THE DIAGNOSTIC UTILITY OF INPATIENT VIDEO-EEG MONITORING IN PEDIATRICS

Objectives: Continuous EEGVideo monitoring is helpful for the accurate diagnosis of known or suspected seizures. In pediatrics, inpatient monitoring is usually preferred to outpatient monitoring because it allows synchronized video-EEG recordings during the paroxysmal events. The goals of this study were to assess the current use of inpatient video-EEG monitoring in pediatrics and its diagnostic utility.

Methods: Retrospective analysis of pediatric patients admitted to a tertiary referral hospital inpatient video-EEG monitoring unit over a 5-year period. Demographics, referral sources and length of stay were assessed. Diagnostic groups were designated as follows: Group I (diagnostic positive), recorded epileptic seizure with abnormal EEG; Group II (diagnostic negative), recorded non-epileptic event with normal EEG; Group III (inconclusive), no recorded events with normal EEG; and Group IV (supportive), no recorded events but abnormal EEG. Utility of monitoring was rated by the percent of patients whose diagnosis was ascertained or further specified because of the recording of typical events for which they were referred (either epileptic of nonepileptic). Results: 576 children between the ages of two weeks and 18 years were admitted to the hospital from May 2000 to June 2005. Length of monitoring ranged from 4-to-288 hours. 131 patients (23%) were monitored for more than 48 hours, 189 (33%) between 24–48 hours, and 256 (44%) for less than 24 hours. 239 patients (41%) were referred by epileptologists, 299 (52%) by child neurologists, 11 (2%) by adult neurologists, and 26 (5%) by pediatricians. 398 (69%) of all patients were in Group I; 30 (5.2%) were in Group II; 38 (6.6%) in Group III; and 110 patients (19%) in Group IV. In this study, video-EEG monitoring captured 74% of epileptic and nonepileptic events and the hospitalization established or enhanced the diagnosis or clinical management in 428 patients (74.3%) of cases.

Conclusion: Video-EEG monitoring has a high yield in the diagnosis and characterization of paroxysmal events, whether epileptic or non epileptic in nature. Our findings support the assumption that video-EEG monitoring has a high diagnostic yield and often influences patient management.