The role of video-EEG monitoring in the diagnosis of epilepsy

EEG video monitoring is the only highly accurate informative study that records brain signals and records the patient’s video. There are no contraindications and age restrictions for the study. The method is absolutely safe and painless. The diagnostic method plays an important role in the diagnosis of paroxysmal conditions and disorders of the nervous system. According to American neurophysiologists, a minute of EEG recording at night will tell much more about the human nervous system than a whole hour of recording in the daytime when the brain is awake.  

Indications for EEG video monitoring

EEG monitoring is considered an expensive and difficult method. Medical professionals distinguish a number of indications in which diagnostics are especially necessary:

• epilepsy of any form and epileptic syndromes;
• primary convulsive seizure;
• diagnosis of epileptic and non-epileptic paroxysm;
• pharmacoresistant seizures (the need to identify; pseudoepileptic seizures and clarification of the form of epilepsy);
• genetic predisposition to epilepsy;
• differential diagnosis of disturbed sleep (insomnia or constant sleepiness throughout the day);
• diagnosis of epileptic non-paroxysmal disorders that are associated with epileptic activity during sleep;
• monitoring the patient’s condition and evaluating the effectiveness of treatment;
• statement of remission;
• preparation for the abolition of antiepileptic drugs;
• cognitive and behavioral disorders in young children.

EEG diagnoses: disturbed sleep, epilepsy, psychotic abnormalities and other neurological disorders.

If the routine EEG does not detect violations of bioelectrical activity, long-term EEG monitoring is performed. The effectiveness of the routine method for diagnosing paroxysmal conditions is up to 50%, depending on the case. Epileptiform activity is recorded in 3% of cases among healthy adult patients and in 10% of adolescents.

Also, video monitoring is carried out in case of panic attacks.

The role of EEG video monitoring in the diagnosis of epilepsy

Registration of video monitoring not only specifies the presence of epilepsy, but also determines the form of pathology. Using this method of diagnosing epileptiform phenomena, even if the seizure is not recorded during the recording. The method determines not one, but several foci of epileptiform activity.

For the differential diagnosis of an epileptic seizure, the EEG data is correlated with the clinical picture of the seizure. The longer it takes to record the state of the brain, the more likely it is that a seizure will be registered. Evaluation of the electrogenesis of the brain is carried out . If there is no epileptiform activity during the day, we are talking about confirmation of a non-epileptic nature. These symptoms include trance, amnesia, and impaired coordination. 

Epileptoform activity does not always indicate the presence of epilepsy. Mandatory symptoms must be present, which confirm the presence of pathology. Long-term monitoring evaluates not only the bioelectrical activity during wakefulness, but also during sleep, at the time of awakening and falling asleep. Health professionals distinguish specific sleep disorders from epileptic symptoms. Sleep registration will allow you to assess the symptoms that occur during wakefulness and falling asleep.

The patient’s breathing and snoring, myogram and oculogram are monitored . The epileptologist compares the symptoms that appear with specific sleep phases. In patients with drug-resistant epilepsy, a comorbidity of non-epileptic and epileptic paroxysmal states is observed . If epileptic and non-epileptic seizures were recorded during the EEG , the degree of compensation for the epileptic process and the presence of paroxysms are determined.

If the patient has a long-term clinical remission, the question of further treatment is decided. The state of electrogenesis of the brain is taken into account . Long-term registration of the state of the brain assesses the effectiveness of treatment, determines the degree of compensation for epilepsy. The attending physician decides whether there is a need to cancel or change treatment therapy. Typically, antiepileptic and anticonvulsant drugs are used for treatment .  

When conducting EEG monitoring , the role of the morphological cerebral focus is established. The presence of not one, but several foci with epileptiform activity is determined, therefore the question of surgical intervention is being resolved. This diagnostic study establishes the epileptic nature of cognitive disorders and behavior changes, after which adequate therapy is selected, and the effectiveness of treatment is assessed.  

In one and the research centers, a study was conducted in which 4 children and 165 adult patients took part. The study proved that the diagnosis was confirmed for 57 children. The non-epileptic nature of the paroxysm was established in 12 cases. Special syndromic forms are present in 20 pediatric patients. Cases of epilepsy with tonic-clonic seizures – among two children. Meotemporal epilepsy occurs in one child. Rolandic epilepsy – in three patients. West syndrome was diagnosed in four babies, Rett syndrome – in one. Childhood absence- epilepsy was found in three children, Panayotopoulos syndrome – in two. Epilepsy with electrical sleep status – in three people. The etiology and type of epileptic seizure was determined in 85 cases.

Among adult patients, the following indicators are observed: for the first time, epilepsy was diagnosed in 8 patients. The type and etiology of an epileptic seizure was determined in 95 cases. Among 12 adult patients, the epileptic nature of the disease was excluded. The presence of non-epileptic paroxysms was determined in 13 people with verified epilepsy. The effectiveness of the prescribed treatment is observed in 25 cases. 

Thus, EEG monitoring is effective in many clinical cases. The clinical picture of epilepsy is determined, the diagnosis is refuted or confirmed, various paroxysms and etiology are diagnosed.

However, it should be remembered that functional tests with hyperventilation are prohibited in such cases:

• patients who have recently suffered a stroke;
• subarachnoid hemorrhage;
• serious pathologies of the respiratory system;
• sickle cell anemia;
• arterial hypertension;
• heart failure;

As such, there are no contraindications for diagnostics.

The study has a wide list of indications, which are presented above. There are a number of advantages of this diagnostic method in comparison with other methods. This laborious method requires little training and effort. The data obtained are considered to be as informative as possible and make it possible to assess the effectiveness of treatment, to interpret the patient’s condition.

The medical professional who interprets the results obtained must be qualified and experienced. If a long-term monitoring of the brain is carried out, the patient leads a normal life, moving around, communicating, eating. Physical activity leads to a change in the state of the brain, which must be recorded. Other states of the patient are also recorded, namely, wakefulness, sleep, and a transitional state. Before conducting, the patient should consult with the attending physician, who will select a specific type of EEG monitoring.