Bennett-Back O, Uliel-Siboni S, Kramer U
Pediatric Neurology Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Dana-Dwek Children's Hospital, Tel Aviv University, Tel Aviv, Israel.
Eur J Paediatr Neurol. 2016 Nov;20(6):848-854. doi: 10.1016/j.ejpn.2016.05.017. Epub 2016 Jun 2.
Video EEG (VEEG) is performed for most pediatric patients in order to evaluate unclear paroxysmal events and improve our understanding of difficult to control epileptic patients.
To characterize the video EEG studies on children who are not candidates for surgery in order to identify the parameters that affect results in level of improving the rate of acquisition, as well as improving the ability to expect the likelihood of epilepsy and of gathering new information as a result of the VEEG.
Retrospective chart analysis of all consecutive patients who underwent VEEG in two VEEG monitoring units.
323 children of a mean age of 7 years (STD 4.73, range 0-17 years) were monitored for a mean duration of 2 days (STD 1.65, range 1-10 days). The main reasons for monitoring were: evaluation of unclear events (n = 234), evaluation of previously diagnosed epilepsy (n = 36) and confirmation of Electrical Status Epilepticus in Sleep (ESES) (n = 34). The main event types for evaluation were: staring episodes (n = 67), myoclonic jerks (n = 35) and abnormal eye movement (n = 22). Suspected events were captured in 70% of the patients. There was a positive correlation between acquisition of suspected events and each of the following: duration of the monitoring, the frequency of investigated events per history, the type of investigated events. A prior interictal epileptic activity on routine EEG was a positive predictor of an event to be epileptic (p = 0.003). Amongst the group of known epileptic patients, VEEG had role in changing diagnosis in 53% of patients. Many of them had focal interictal epileptiform activity in their routine EEG.
Selecting patients with frequent events and longer monitoring periods increase the yield of VEEG. Looking carefully into clinical characteristics of the patient prior to VEEG can clarify diagnosis therefore render the VEEG test superfluous to subgroups of patients. Prior routine epileptic EEG, coexistence of other seizure types, behaviors accompanying the investigated habitual behavior and abnormalities in other investigations (MRI, cognitive function and EEG) are the parameters that can predict diagnosis of epilepsy. Precise diagnosis in known epileptic patients as a result of VEEG is more likely for those with focal interictal epileptiform discharges in routine EEG.
大多数儿科患者需进行视频脑电图（VEEG）检查，以评估不明原因的发作性事件，并增进我们对难治性癫痫患者的了解。
对不适合手术的儿童进行视频脑电图研究，以确定影响结果的参数，包括提高采集率，以及提高预测癫痫可能性的能力，和通过VEEG获取新信息的能力。
对在两个VEEG监测单元接受VEEG检查的所有连续患者进行回顾性病历分析。
323名儿童，平均年龄7岁（标准差4.73，范围0 - 17岁），平均监测时长2天（标准差1.65，范围1 - 10天）。监测的主要原因包括：评估不明事件（n = 234）、评估先前诊断的癫痫（n = 36）以及确诊睡眠期癫痫性电持续状态（ESES）（n = 34）。评估的主要事件类型包括：凝视发作（n = 67）、肌阵挛抽搐（n = 35）和异常眼动（n = 22）。70%的患者捕捉到了可疑事件。可疑事件的采集与以下各项均呈正相关：监测时长、每次病史中所调查事件的频率、所调查事件的类型。常规脑电图检查中发作间期癫痫样活动是事件为癫痫的阳性预测指标（p = 0.003）。在已知癫痫患者组中，VEEG在53%的患者中对改变诊断有作用。他们中的许多人在常规脑电图检查中有局灶性发作间期癫痫样活动。
选择事件频繁且监测期较长的患者可提高VEEG的检出率。在VEEG检查前仔细研究患者的临床特征可明确诊断，从而使VEEG检查对部分患者亚组来说是多余的。先前的常规癫痫脑电图检查、其他发作类型的共存、所调查习惯性行为伴随的行为以及其他检查（MRI、认知功能和脑电图）中的异常是可预测癫痫诊断的参数。对于在常规脑电图检查中有局灶性发作间期癫痫样放电的已知癫痫患者，VEEG更有可能做出准确诊断。
