The Clinical Utility of Long-Term Video-EEG Monitoring in Patients Hospitalized for New-Onset Seizures
Yao Cheng1, Fnu Rameez2, Shan Abbas1, David Burdette1, Evan Tank1, Edward Chen1, Rachel Fabris1, Erin Okazaki1, Mohammad Haykal3
1Spectrum Health, 2University of Michigan, 3Beaumont Health Neurology
Objective:
The objective of this study is to evaluate if long-term EEG monitoring (LTM) increases the detection rate of epileptiform abnormalities and seizures as compared to a standard 30-minute EEG in patient’s with first time seizures.
Background:
The usage of LTM has increased in the hospital setting for patients with altered mental status and paroxysmal spells, however, there is limited data regarding the utility of long term EEG monitoring in patients hospitalized for a new-onset seizure.
Design/Methods:
This was a retrospective cohort study including adult patients (>18 years) admitted to two tertiary care hospitals between 1/1/2014 and 12/31/2019. Patients who were given a clinical diagnosis of seizure and were initiated with LTM (monitoring duration of greater than 30 minutes) were included in this study. 295 consecutive patients were initially identified. Patients with a prior diagnosis of seizure/epilepsy or an alternative diagnosis to seizure were excluded. 84 patients qualified for the study.
Results:
41/84 (49%) patients had EEG recordings of 12-24 hours and 16/84 (19%) had recordings for >24 hours. Drowsy and Sleep states were captured in 82/84 (97.6%). 25/84 (30%) patients were found to have epileptiform activity. Of those, 18/25 (72%) had epileptiform activity occurring within the first 30 minutes. 3/25 (12%) had their first epiletiform activity between 30 and 120 minutes and 4/25 (16%) between 2-12 hours.
Conclusions:
This study raises the possibility of increasing EEG yield with a longer recording period when compared to a 30-minute EEG record. EEG findings that prompted management changes were noted after 30 minutes in just under a third of those found to have epileptiform activity on EEG. This suggests a longer EEG recording period especially in patients with a high clinical suspicion of first-time seizure, may be helpful in determining management. Further prospective studies with a larger sample size, would be of benefit and provide further insight.