What is the role of video-EEG in the diagnosis of epileptic seizures?

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Video-EEG monitoring is the criterion standard for classifying the type of seizure or syndrome or for diagnosing pseudoseizures; that is, for establishing a definitive diagnosis of spells with impairment of consciousness. This study can be performed to rule out an epileptic etiology with a high degree of confidence if the patient has demonstrable impairment of consciousness during the spell in question. Video-EEG is also used to characterize the type of seizure and epileptic syndrome to optimize pharmacologic treatment and for presurgical workup.

However, video-EEG monitoring is an expensive and laborious study; therefore, monitoring all patients is impractical. Only those whose condition does not respond to treatment or in whom pseudoseizures are suspected should undergo video-EEG. Referral to an epilepsy center should be reserved for patients whose seizures are refractory to treatment. There is now a formal definition of patients who have medically refractory epilepsy: individuals who have tried 2 adequate doses of AED without a clinical response. Some frontal-lobe seizures are considered pseudoseizures for many years until appropriate diagnosis is made by means of video-EEG.

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