Abstracts

Rationale: There is a paucity of literature regarding utilization of video in routine electroencephalograms (rvEEG). Video review during routine EEG to diagnose epilepsy, nonepileptic events, or dysmorphic facial features has been published, however more comprehensive reasons for and subjective usefulness is unknown. The purpose of this study is to determine the utilization and subjective usefulness of and reasons for video review in routine EEG. Methods: For three consecutive months, a one page questionnaire developed for this study was completed daily by the epileptologist assigned to read routine EEGs. Total number of EEGs reviewed, total number of videos reviewed, reviewer, reasons for video review, presence of EEG technician notation, pre-video review interpretation, and usefulness of video review were recorded. Reasons for video review were divided into four categories: 1. Always review, 2. Identify patient state (gender, wake/sleep, setting/level of consciousness/etc.), 3. Suspicious EEG (a. normal variant, b. artifact, c. suspect epileptiform/ictal activity, d. definite epileptiform/ictal activity), and 4. Other (may write in reason.) Post-video interpretation recorded for Categories 3a-c. All routine EEGs in which video was recorded were included. Results: 211 (67%) videos of 314 total rvEEGs were reviewed for the following reasons. Category 1: 80 (38%) with two epileptologists always selecting this category, Category 2: 94 (45%) (5 gender, 46 wake/sleep, 46 setting/ level of consciousness), Category 3: 104 (49%), and Category 4: 21 (9%) (See Table 1.) Of 125 rvEEGs in Categories 3 and 4, 74 (59%) had EEG technician notations. Of 95 with post-video interpretation, 14 (15%) had change from pre-video interpretation. Category 4 write in reasons for video review included technician comments on behaviors/typical patient events, nonepileptic events, clinical response to external stimulus, frontal intermittent rhythmic activity, neonatal EEGs, and video necessary due to technician notation asynchronous with stimulus/behaviors. Subjective usefulness for video review included 6/172 (3%) not useful, 74/172 (43%) useful, and 92/172 (53%) necessary. Conclusions: Utilization of video review during routine EEG reading is common and if reviewed, is considered clinically useful. Clinically useful reasons for video review included: identify patient state, confirm normal variants and artifacts, determine correlating clinical manifestations for suspicious EEG and definite epileptiform/ictal electrographic patterns, determine clinical response to external stimulus, and diagnose nonepileptic events. EEG technician notations were not always present and at times, asynchronous with clinical activities. Video review resulted in 15% rate of change in EEG interpretation. Video enhances the clinical usefulness of routine EEG for many reasons, including diagnosing epilepsy.