Outcome of prolonged video-EEG monitoring in children with epilepsy

Abstract

Objective: This aim of this study was to evaluate usefulness and diagnostic efficacy of video-EEG monitoring in children with epilepsy in terms of differential diagnosis, epilepsy classification, management, presurgical evaluation, and nonepileptic events. Material and Methods: Three hundred eighty two children were evaluated concerning the nature of clinical behaviour, seizure classification, or work-up prior to epilepsy surgery. The patients were divided into two groups as younger than 6 years of age and older than 6.1. Seizure classification was performed using both ILAE 1981 and 1989 classifications. Localizing and lateralizing signs and nonepileptic events were also investigated. Results: One-hundred and seven (28%) of the patients were seizure free, 74 (19.4%) of them had nonepileptic events, 201 (52.6%) of them had real seizures. While the children younger than 6 years had more primary generalized seizures (37.2%) and epileptic spasm (16.3%), the children older than 6 years had more complex partial seizures (55.7%) and temporal lobe epilepsy (27.8%) (p<0.05). Contralateral head version (14.4%) was the most frequent lateralizing sign in both groups, and ipsilateral automatism (16.9%), contralateral dystonia (12.9%), and nose wiping (11.4%), were noted as well. Sixty eight percent of children with behaviour arrest had extratemporal lobe epilepsy, and 24% of them were younger than 6 years of age. Ictal fear was more common in temporal lobe epilepsy (64.2%). Forty three patients underwent epilepsy surgery. While 24 (56%) of them were performed resective surgery, 19 (44%) of them had vagal nerve stimulation. Conclusion: Prolonged video EEG monitoring is a mandatory method for assessment and successful management of children with refractory epilepsy, especially in patients enrolled for epilepsy surgery or suspected of having pseudoseizures and nonepileptic events. © 2010 by Türkiye Klinikleri.