Video-EEG in the first 24 hours after the first unprovoked seizure in patients with normal neurological examination and head CT scan

Abstract

Purpose: to determine the yield of Video-Electroencephalogram (VEEG) in the first 24 h in patients with a first unprovoked seizure and normal neurological examination, laboratory findings, and cranial CT scans. Methods: we analyzed retrospectively the yield of VEEG performed in these patients in the emergency department. All the patients were subsequently seen in the Epilepsy Clinic, and the epilepsy diagnosis was confirmed. Results: we included 19 patients who met the inclusion criteria; all of them underwent VEEG with the 10–20 system within the first 24 h after the seizure. The duration of the recordings averaged at 108.53 min and may or may not have included intermittent photic stimulation and sleep recording; 74% of the recordings were abnormal, with 26% being normal. Among the abnormal cases, epileptogenic activity was found in 47% and seizures in 26% of the patients; because both findings could be present in the same VEEG, 63% of all the VEEG showed epileptogenic alterations or seizures. The VEEG anomalies were recorded before the 20th minute (standard VEEG duration) in 58% of patients who exhibited epileptogenic activity and/or seizures, and after the 20th minute in 42%. Conclusion: conducting approximately 100-minute VEEGs within the first 24 h after a first unprovoked seizure can enhance the diagnostic yield in patients with epilepsy. However, the study has the limitations of its sample size and retrospective nature.