Lessons from the video-EEG telemetry unit

Epilepsy is a clinical diagnosis, based primarily on patient and witness histories. Where there is diagnostic uncertainty or when epilepsy surgery is being considered, long-term video-EEG monitoring in a telemetry unit remains the gold standard investigation for diagnostic clarification or presurgical localisation. We present six illustrative cases, highlighting important points that emerged during video-EEG review including potential pitfalls in video-EEG interpretation, and how the investigation helped with diagnosis and subsequent management. The diagnostic process strongly emphasises seizure semiology, more so than EEG.