title: Ambulatory EEG: a cost-effective alternative to inpatient video-EEG in adult patients.
abstract: BACKGROUND
  Ambulatory electroencephalography (AEEG) is a monitoring technique that allows the recording of continuous EEG activity when patients are at home, without the necessity of admission to the hospital for prolonged video-EEG monitoring.
  
  
  METHODS
  This is a prospective cohort study performed in a Canadian academic centre in order to assess the yield and tolerability of AEEG in the adult population. Over a period of three years, 101 patients were included. The yield of AEEG was assessed by taking into account the questions asked by the clinician before and after the investigation.
  
  
  RESULTS
  One hundred and one patients undergoing AEEG were prospectively recruited during a three-year-period. Our population consisted of 45 males (44.6%) and 56 females (55.4%). The mean age of the group was 36.6 ± 16.1 years. Most of the patients had at least one previous routine EEG (93%). The primary reasons for the AEEGs were subdivided into four categories: a) to differentiate between seizures and non-epileptic events; b) to determine the frequency of seizures and epileptiform discharges; c) to characterize seizure type or localization; and d) to potentially diagnose epilepsy. The mean duration of AEEG recording was 32 ± 17 hours (15-96 hours). For 73 (72%) patients, the AEEG provided information that was useful for the management. For 28 (28%) patients, the AEEG did not provide information on diagnosis because no events or epileptiform activity occurred. In only 1 patient was the AEEG inconclusive due to non-physiological artefacts. Three patients were referred for epilepsy surgery without the necessity of video-EEG telemetry.
  
  
  CONCLUSIONS
  In this study, we found that AEEG has a high diagnostic yield (72%) and believe that careful selection of patients is the most important factor for a high diagnostic yield. The main use of AEEG is the characterization of patients with non-epileptic events, in patients with a diagnosis of epilepsy that is not clear, and quantification of spikes and seizures to improve the medical management. Ambulatory EEG is a cost-effective solution for increasing demands for in-hospital video-EEG monitoring of adult patients.
authors.affiliation: Clinical Neurophysiology Laboratory, Royal University Hospital, Saskatoon.
authors.forename: Dianne
authors.initials: D
authors.lastname: Dash
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Hernandez-Ronquillo
authors.forename: Farzad
authors.initials: F
authors.lastname: Moien-Afshari
authors.forename: Jose F
authors.initials: JF
authors.lastname: Tellez-Zenteno
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis; D006801:Humans; D007297:Inpatients; D011446:Prospective Studies; D012640:Seizures