Long-term EEG-video-audio monitoring: detection of partial epileptic seizures and psychogenic episodes by 24-hour EEG record review.
Twenty-seven patients with medically refractory paroxysmal disorders underwent EEG-video-audio (EVA) monitoring in an inpatient neurology-neurosurgery unit over 1-15 (mean 8.9) days. Fast visual review of all EEG records (5,784 h) and subsequent analysis of synchronized EVA patterns demonstrated a total of 208 partial epileptic seizures (ES) in 12 individuals and 87 psychogenic episodes (PE) in 15 subjects. Clinical ES lasted 83.3 s on the average and were most frequent from day 7 to 9 of monitoring (42.3%) and during sleep (56.4%). PE were longer in duration (mean 724.5 s), most numerous during the first 2 days of monitoring (41.4%), and occurred exclusively during wakefulness. Subjects with PE signaled (by pressing on a push button) more events (35.6%) than did the individuals with ES (27.9%). Multiple observers raised the proportion of alarms to 69.0% of PE compared to 39.9% of ES. Following the alarm, nurses reached the patients' bedside within a brief time (mean 22.2 s). To differentiate partial ES from PE or to establish the association of these disorders, EVA monitoring is best performed around the clock over a period of 1-2 weeks. The limited number of paroxysmal events, especially ES, signaled by the patients should be considered when designing studies of the effectiveness of pharmacologic, surgical, and other treatments.
Pierelli
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F
Department of Laboratory Medicine, University of Washington School of Medicine, Seattle.
Chatrian
G E
GE
Erdly
W W
WW
Swanson
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PD
D000293:Adolescent; D000328:Adult; D002648:Child; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000451:nursing / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000451:nursing / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010361:Patients; D012815:Signal Processing, Computer-Assisted; D014743:Videotape Recording