R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Epilepsy Res. 2011 Nov;97(1-2):12-9. doi: 10.1016/j.eplepsyres.2011.06.014. Epub 2011 Jul 23.
World-over, the majority of patients undergoing video-EEG monitoring (VEM) are in their second or third decades. Although elderly represent the fastest growing segment of population with epilepsy, only few of them undergo VEM. We critically evaluated the utility of VEM in the diagnosis and long-term management of older adults with paroxysmal behavioral events.
148 consecutive patients aged 45 and above, who underwent long-term (≥8 h) inpatient VEM from 1996 to 2009 formed the study cohort. Utilizing a structured proforma, we gathered their demographic, clinical, electrophysiological and long-term outcome data. VEM was considered as "useful" when it changed the diagnosis and/or management; it was "corroborative" when it helped the treating physician to confirm the diagnosis and "not useful" when it neither helped to improve the diagnosis nor the management.
The mean age was 51.3 (SD 6.4) years; mean duration of VEM was 69.3 h. Out of 117 patients with a diagnosis of epileptic seizures referred for presurgical evaluation or classification, VEM was "useful" or "corroborative" in 111 patients (94.8%; p=0.0001). It was also "useful" or "corroborative" in 29 out of 31 patients (93.5%) referred with a suspicion of associated or pure psychogenic non-epileptic seizures (p=0.0001). None developed any complications during monitoring. At a mean follow-up of 37.7 months there was significant reduction in AED usage in patients with epilepsy (p=0.0001) and epilepsy with associated PNES (p=0.001). At a mean follow-up of 34.2 months, all patients with pure PNES were event-free and medication-free at last follow-up (p=0.002). Twenty-three patients (19.6%) underwent surgery, all except one remaining seizure-free at a mean follow-up of 39.2 months.
VEM is a safe and cost-effective investigation strategy in older-adults. It aided in improving the diagnosis, offered better treatment including surgery and helped in excluding non-epileptic paroxysmal events in majority.
在世界范围内，大多数接受视频脑电图监测 (VEM) 的患者处于第二或第三个十年。尽管老年人是癫痫患者中增长最快的群体，但只有少数人接受 VEM。我们批判性地评估了 VEM 在诊断和长期管理老年突发性行为事件中的作用。
1996 年至 2009 年间，我们连续对 148 名年龄在 45 岁及以上的患者进行了长期（≥8 小时）住院 VEM，这些患者构成了研究队列。利用结构化的表格，我们收集了他们的人口统计学、临床、电生理和长期结局数据。当 VEM 改变诊断和/或管理时，我们认为它是“有用的”；当它帮助治疗医生确认诊断时，我们认为它是“佐证的”；当它既不能帮助改善诊断也不能帮助管理时，我们认为它是“无用的”。
平均年龄为 51.3（SD 6.4）岁；VEM 的平均持续时间为 69.3 小时。在 117 名被诊断为癫痫发作并接受手术评估或分类的患者中，111 名（94.8%；p=0.0001）的 VEM 是“有用的”或“佐证的”。在 31 名怀疑伴有或单纯心因性非癫痫性发作的患者中，29 名（93.5%）患者的 VEM 也是“有用的”或“佐证的”（p=0.0001）。在监测过程中，没有发生任何并发症。在平均 37.7 个月的随访中，癫痫患者（p=0.0001）和癫痫伴伴发性心因性非癫痫性发作患者（p=0.001）的 AED 使用率显著降低。在平均 34.2 个月的随访中，所有单纯心因性非癫痫性发作患者在最后一次随访时均无发作且无需用药（p=0.002）。23 名患者（19.6%）接受了手术，除 1 例外，所有患者在平均 39.2 个月的随访中均无发作。
VEM 是一种安全且具有成本效益的老年患者研究策略。它有助于改善诊断，提供更好的治疗，包括手术，并有助于排除大多数非癫痫性阵发性事件。
