Bettini Luca, Croquelois Alexandre, Maeder-Ingvar Malin, Rossetti Andrea O
Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland.
Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland; Institution de Lavigny, Switzerland.
Epilepsy Behav. 2014 Oct;39:55-8. doi: 10.1016/j.yebeh.2014.08.009. Epub 2014 Sep 7.
Although long-term video-EEG monitoring (LVEM) is routinely used to investigate paroxysmal events, short-term video-EEG monitoring (SVEM) lasting <24 h is increasingly recognized as a cost-effective tool. Since, however, relatively few studies addressed the yield of SVEM among different diagnostic groups, we undertook the present study to investigate this aspect.
We retrospectively analyzed 226 consecutive SVEM recordings over 6 years. All patients were referred because routine EEGs were inconclusive. Patients were classified into 3 suspected diagnostic groups: (1) group with epileptic seizures, (2) group with psychogenic nonepileptic seizures (PNESs), and (3) group with other or undetermined diagnoses. We assessed recording lengths, interictal epileptiform discharges, epileptic seizures, PNESs, and the definitive diagnoses obtained after SVEM.
The mean age was 34 (±18.7) years, and the median recording length was 18.6 h. Among the 226 patients, 127 referred for suspected epilepsy - 73 had a diagnosis of epilepsy, none had a diagnosis of PNESs, and 54 had other or undetermined diagnoses post-SVEM. Of the 24 patients with pre-SVEM suspected PNESs, 1 had epilepsy, 12 had PNESs, and 11 had other or undetermined diagnoses. Of the 75 patients with other diagnoses pre-SVEM, 17 had epilepsy, 11 had PNESs, and 47 had other or undetermined diagnoses. After SVEM, 15 patients had definite diagnoses other than epilepsy or PNESs, while in 96 patients, diagnosis remained unclear. Overall, a definitive diagnosis could be reached in 129/226 (57%) patients.
This study demonstrates that in nearly 3/5 patients without a definitive diagnosis after routine EEG, SVEM allowed us to reach a diagnosis. This procedure should be encouraged in this setting, given its time-effectiveness compared with LVEM.
尽管长期视频脑电图监测（LVEM）常用于调查阵发性事件，但持续时间小于24小时的短期视频脑电图监测（SVEM）越来越被认为是一种具有成本效益的工具。然而，由于相对较少的研究涉及不同诊断组中SVEM的诊断率，我们进行了本研究以调查这一方面。
我们回顾性分析了6年间连续的226份SVEM记录。所有患者均因常规脑电图检查结果不明确而被转诊。患者被分为3个疑似诊断组：（1）癫痫发作组，（2）精神性非癫痫发作（PNES）组，（3）其他或未确诊诊断组。我们评估了记录时长、发作间期癫痫样放电、癫痫发作、PNES以及SVEM后获得的最终诊断。
平均年龄为34（±18.7）岁，中位记录时长为18.6小时。在226例患者中，127例因疑似癫痫转诊——73例被诊断为癫痫，无1例被诊断为PNES，54例在SVEM后有其他或未确诊诊断。在SVEM前疑似PNES的24例患者中，1例患有癫痫，12例患有PNES，11例有其他或未确诊诊断。在SVEM前有其他诊断的75例患者中，17例患有癫痫，11例患有PNES，47例有其他或未确诊诊断。SVEM后，15例患者有明确诊断，不是癫痫或PNES，而96例患者的诊断仍不明确。总体而言，129/226（57%）的患者可得出明确诊断。
本研究表明，在近3/5常规脑电图检查后未明确诊断的患者中，SVEM使我们能够做出诊断。鉴于与LVEM相比其时间效益，在这种情况下应鼓励采用该检查方法。
