The clinical utility of non-invasive video-electroencephalographic monitoring has been diversifying

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Abstract
Inpatient long-term video-electroencephalographic (VEEG) monitoring has been used extensively for differential diagnosis of paroxysmal events. We evaluated the diagnostic yield and clinical utility of VEEG performed in a comprehensive epilepsy center. We retrospectively reviewed all cases of VEEG performed from May 2003 to April 2018. We analyzed the data to determine its clinical utility and diagnostic yield. A total of 1335 cases were reviewed. After excluding 147 cases of intracranial recording and 163 cases with incomplete medical records, 1025 cases of VEEG were included. The mean duration of VEEG was 2.3 ± 1.6 days (range = 1-14). A total of 763 VEEGs documented epileptic seizures or interictal epileptiform discharges (IEDs) to confirm the diagnosis of epilepsy. There were 99 psychogenic non-epileptic seizure, 36 status epilepticus, and 34 VEEGs which revealed generalized or focal slow activities without any clinical seizures or IEDs. VEEG was normal in 170 cases. The diagnostic yield of VEEG varied from 83.4 to 88.4% depending on its definition. The proportion of epilepsy in total cases of VEEG continued to decrease from 77.2 to 61.4%. In contrast, the proportion of normal VEEG steadily increased from 4.1 to 24.1% during the same time period. This study ascertained how useful VEEG is and the utility of VEEG has been diversifying in clinical circumstances beyond epilepsy. VEEG can play a pivotal role in the diagnostic approach to epilepsy and its differential diagnoses.

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