Abstracts

Rationale: Video-EEG (vEEG) monitoring has grown significantly in its utility and availability. Few studies have reported the utility of vEEG monitoring in children. We aimed to describe the patient characteristics and to analyze the clinical utilization of vEEG monitoring in our tertiary pediatric epilepsy monitoring unit.Methods: The medical record was retrospectively reviewed in the 108 children who were consecutively admitted for video-EEG monitoring from March to July, 2014. A standardized data collection form was used. Each admission’s resolution, EEG and MRI findings, and long term outcome were analyzed. We delineated our admissions into three categories: “characterization of spells or epilepsy syndrome (Group A),” “localization of epileptic foci as a pre-surgical evaluation (Group B)”, and “safe medication change or adjustment (Group C)"". In total, there were 95 patients in Group A, 12 in Group B, and 1 in Group C. Median age of admissions for Group A was 96 months (range: 9-221 months) and Group B was 151.5 months (range: 63-207 months). Median age of seizure onset for Group A was 48.5 months (range: 0-217 months) and Group B was 19 months (range: 1-144). Median duration of vEEG monitoring was 2 days (range: 1-4) and 4 days (range: 1-11) for Group A and Group B, respectively.Results: EEG was abnormal in 61 out of 95 patients (64%) in Group A and 12 out of 12 patients (100%) in Group B. Among 61 patients with abnormal EEGs in Group B, 38 had focal epileptiform abnormalities, 10 had generalized epileptiform abnormalities, 10 had both focal and generalized epileptiform abnormalities, and 3 had slowing only. Among 12 patients in Group B, 11 demonstrated focal epileptiform abnormalities and only 1 patient demonstrated both focal and generalized epileptiform abnormalities. Sixty-two out of 95 patients in Group A had events during vEEG monitoring; however, 33 did not. Five out of 12 patients in Group B had seizures during, while 7 did not. MRI findings were abnormal in 43 out of 95 of Group A. In group B, 8 out of 12 had a lesion on MRI such as cortical dysplasias, abnormal gyral patterns, mesial temporal sclerosis, gliosis, heterotropia, encephalomalacia, and neoplasm. In Group B, ictal SPECT scan was attempted in 7 patients and was successful in 5 patients. Of our 108 patients, 61% met their admission purpose; 65% in Group A and 33% in Group B. Forty-four percent had a change on treatment plan. Sixty-eight percent had long term improvement, such as decrease in seizure frequency, cessation of seizure activity, or conclusion of non-epileptic events.Conclusions: The latency from seizure onset to vEEG monitoring was found to be quite long in this cohort. More than 60% met the purpose of admission. Most patients achieved improvement in long-term outcome following vEEG monitoring. Based on the finding that vEEG monitoring failed to capture typical episodes in some cases, it would be helpful to consider lengthening the monitoring duration at times.