Event capture in EMU: referral patterns and utility of studies

We examined the EMU referral patterns based on indications for video-EEG (vEEG) tests. The yield of vEEG studies and predictors of study outcomes were investigated. We also evaluated the clinical impact of vEEG.

We identified vEEG tests which primary aimed at capturing events for diagnostic purposes. Study outcomes were dichotomized into those that captured habitual events (positive) and those that did not (negative). The clinical impact of vEEG was assessed based on changes in diagnosis and antiseizure medications (ASM) after the test.

Based on the purpose of EMU referral, a total of 153 patients were divided into 4 groups in this study: (I) Spells clarification in people with spells; (II) Event differentiation in people with epilepsy; (III): Reassessment of the prior diagnosis of epilepsy; (IV): Classification of seizure or epilepsy types. Delayed referrals were observed in patient groups III and IV. Habitual events were recorded in 89 patients, with 90 % occurring within 72 h. Baseline event frequency, prior EEG or image findings, and age were predictors of the study outcome. The admission diagnosis was changed after a positive or negative test in 11 and 9 patients, respectively. VEEG findings led to ASM escalation or de-escalation in 69 patients.

The referral patterns differ among studies based on study indications, and certain patient groups experienced delayed referrals. Predictive factors for the outcome include patient characteristics and medical history. Both positive and negative vEEG tests are valuable in correcting the misdiagnosis of epilepsy and guiding ASM treatments.