Usefulness of long-term video-electroencephalography monitoring for identifying the seizure type in patients with epilepsy

Abstract

  Objective: The identification of seizure type is necessary to treat epilepsy. It is usually based on intermittent electroencephalography (EEG) findings and medical interviews conducted in an outpatient clinical setting but is difficult to accurately determine in some cases. We evaluated the usefulness of long-term video-EEG (VEEG) monitoring and examination by a specialist for the precise determination of seizure type. Methods: We retrospectively analyzed data from the medical records of 139 cases who underwent VEEG for more than 12 hours for epileptic seizure assessment at our hospital between April 2015 and March 2019. Results: Seizure was detected in 115 (82.7%) of the 139 cases. The seizure capture rate was high in patients with daily seizures and intellectual disabilities. Seizure types or non-epileptic seizures were identified in 113 of 115 cases (98.3%) which seizures were detected. Among patients treated by a pediatric neurology specialist, the proportion of those with an unchanged seizure type according to the treating specialist's judgment was significantly higher than patients treated by non-specialist (p=0.025) ; therefore, examination by a specialist was considered useful for the identification of seizure type. However, the seizure type was newly revealed in 62.8% of patients who underwent VEEG even after seeing a specialist. Conclusions: The diagnosis of seizure type is highly accurate in cases examined by a specialist, therefore consultation with a specialist is useful for identification of seizure type. On the other hand, even after consultation with a specialist, VEEG is useful for the identification of seizure type and treatment of epilepsy and should be conducted in patients with intractable seizures.