Video-EEG/polygraphy in status epilepticus.

Area of Science:

• Neurology
• Clinical Neurophysiology

Background:

• Status Epilepticus (SE) management relies on time-dependent protocols, but diagnostic ambiguities complicate acute care, leading to delays and errors.
• Continuous Video-EEG/Polygraphy (V-EEG/PG) offers a solution to practical challenges in SE management.

Purpose of the Study:

• To analyze the role of continuous V-EEG/PG in resolving diagnostic ambiguities in Status Epilepticus management.
• To assess V-EEG/PG's utility in guiding therapeutic decisions based on objective electro-clinical correlation.

Main Methods:

• Retrospective narrative analysis of five clinical vignettes from a tertiary-care center.
• Case selection focused on three key management challenges: Time, Etiology, and Differential Diagnosis.
• V-EEG/PG utility evaluated by its capacity for objective electro-clinical correlation.

Main Results:

• V-EEG/PG confirmed cessation of SE, preventing progression to refractory SE.
• It guided etiological triage, helping exclude SE in metabolic disease and avoiding unnecessary high-dose anti-seizure medications.
• V-EEG/PG ensured diagnostic accuracy, differentiating true SE from mimics and preventing chronic misdiagnosis and toxicity.

Conclusions:

• Effective SE management requires a shift towards an electro-clinical strategy, with continuous V-EEG/PG as a pivotal diagnostic tool.
• V-EEG/PG should be considered a standard of care in ambiguous acute care settings for high-risk patients.
• This approach resolves diagnostic ambiguities and improves patient outcomes in critical care settings.