Clinical characteristics of video-EEG patients: Limited utility of prolonging VEEG study duration beyond 5 days for spell classification

The objective of the study was to identify the probability of establishing a diagnosis based on the duration of video-electroencephalogram (VEEG) monitoring. Additional aims were to determine whether there is a relationship between clinical characteristics of epilepsy monitoring unit (EMU) patients and VEEG results. We studied EMU length of stay and assessed the utility of prolonging studies in patients who had not yet received a diagnosis. Clinical characteristics in 212 consecutive patients admitted for scalp VEEG monitoring were recorded. We collected data including reason for admission, frequency of seizures/spells, gender, age, age at seizure onset, handedness, family history, history of neurologic disease, current and past antiepileptic drugs (AEDs), and prior work-up. Subjects were categorized into five diagnostic groups: epileptic seizures (Epi), nonepileptic events (NEE), mixed epileptic and nonepileptic events (Mixed), nonepileptic events from a physiologic cause (NEEP), and nondiagnostic study without results recorded (ND). The most diagnoses were made during the first day of admission (45%), and by day 3, 82 patients remained without a diagnosis. On day 3, 25 of these patients (33%) received a diagnosis, on day 4, seven (22%) additional patients received a diagnosis, on day 5, 5 patients (35%) received a diagnosis, and by day 6, only one additional patient (11%) was given a diagnosis. Significant differences were found between diagnostic groups for admission reason, duration of EMU stay, age at seizure onset, duration of epilepsy, seizure frequency, and number of current and previously tried AEDs. Our findings show that the majority of patients are diagnosed in the first 2 days of admission, and we found a limited benefit of prolonging nonsurgical inpatient VEEG studies beyond 5 days for spell/seizure classification. Additionally, patient demographics were significantly different for patients depending on VEEG diagnosis, which can help predict the utility of completing VEEG studies in individual patients. •The optimal duration for video-EEG evaluation is not well described.•The majority of patients monitored in our analysis are diagnosed in the first two days of admission.•We found a limited benefit of prolonging nonsurgical video-EEG studies beyond five days.•There are differences in patient demographics between VEEG diagnostic groups.