Neurosurgery Blog: How Long Is Long Enough? The Utility Of Prolonged Inpatient Video EEG Monitoring (P5.045)

Thursday, April 17, 2014

How Long Is Long Enough? The Utility Of Prolonged Inpatient Video EEG Monitoring (P5.045)

Neurology recent issues

Objective: To highlight that prolonging video electroencephalogram (EEG) monitoring (VEM) is useful for the classification/localization of epileptic seizures (ES) but not nonepileptic seizures (NES).Background: There is currently no consensus on the required duration of VEM for the diagnosis of ES and NES. We sought to determine the benefits of prolonged length of stay, querying whether there was a point at which VEM became futile at yielding a diagnosis.Design/Methods: We retrospectively reviewed the records of all patients admitted for VEM between 1/2004 and 12/2008. We recorded the reason for admission, length of stay, and discharge diagnosis. A discharge diagnosis of nondiagnostic was assigned if patients had none of their habitual seizures during the admission. We progressively analyzed lengths of stay until we discovered significant differences in the rates of nondiagnostic admissions for stays exceeding specific limits, ranging from >= 4 to 14 days. We utilized chi-square analysis (Fisher's Exact Test, 2 sided), with p-values <0.05 considered statistically significant.Results: Five hundred ninety six patients were admitted for VEM. The majority (333, 55.9%) were admitted with presumed ES. The remaining patients were admitted for differential diagnosis of presumed NES (150, 25.2%) or spells of other, unknown etiology (113, 19%). Only 89/596 admissions (14.9%) were nondiagnostic. Patients admitted with presumed NES were significantly more likely to have a nondiagnostic admission (31/150, 20.7%) versus all others (58/446, 13%, p=0.033). There was no significant difference in the likelihood of having a nondiagnostic admission if monitoring was continued for any duration in patients with presumed ES. However, for patients admitted with presumed NES, a length of stay >= 5 days was associated with a significantly increased risk of the stay being nondiagostic (22/78, 28% versus 9/72, 12.5%, p=0.026).Conclusions: Prolonging VEM appeared to be useful for the proper classification/localization of ES but not NES.This study was not sponsored by a third party.

Disclosure: Dr. Moseley has nothing to disclose. Dr. Dewar has nothing to disclose. Dr. Haneef has nothing to disclose. Dr. Stern has received personal compensation for activities with UCB Pharma, Lundbeck, Cyberonics, Inc., and GlaxoSmithKline, Inc. Dr. Stern has received personal compensation in an editorial capacity for MedLink Neurology.

Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P5.045?rss=1