Usefulness of video-EEG monitoring in children

Video-EEG monitoring (v-EEG) was originally restricted to the evaluation for epilepsy surgery. It is now widely available and often utilized to clarify the nature of paroxysmal events or to identify the epileptic syndrome. It is important to define carefully the diagnostic value of this high-cost and time-consuming procedure. Few data on children are available. In this study, we have evaluated the utility of this procedure and the factors leading to a successful recording in children. We retrospectively reviewed 380 v-EEG done in 320 children. The rate of event detection was 59%. The v-EEG recorded a seizure in 40% (n=150), a non-epileptic event in 19% (n=73), and both seizure and non-epileptic events in 3% (n=11). Only 9% remained without diagnosis after v-EEG. The frequency of the usual events was the only factor contributing to a successful recording. This procedure confirmed the diagnosis of epilepsy in 43% of patients but excluded it in 25% of them. In children with epilepsy, the v-EEG allowed to define a new syndrome (30% of patients) or to improve clinical description and to identify the origin of the seizures (30%). The treatments were modified in 66% of patients following the v-EEG. Continuous video-EEG monitoring is an efficient and valuable procedure in the diagnosis and management of epilepsy and paroxysmal disorders in children.