Introduction

Video EEG (vEEG) is an advanced diagnostic tool that combines continuous EEG monitoring with simultaneous video recording. This integration allows clinicians to correlate brain activity with observable physical behavior, making it invaluable in diagnosing complex neurological conditions. This guide provides a detailed, step-by-step explanation of when to perform a video EEG, progressing from basic concepts to expert-level insights.

1. Basic Indications for Video EEG

Video EEG is recommended when routine EEG fails to provide sufficient information or when clinical observation is critical for diagnosis. Common scenarios include:

  • Unexplained Seizures: To confirm the presence of epileptic seizures and differentiate them from other events like syncope or movement disorders.
  • Suspected Epilepsy: To establish a definitive diagnosis in cases of suspected epilepsy, especially when initial EEG results are inconclusive.
  • Seizure Classification: To classify seizure types accurately, which is crucial for selecting appropriate treatment options.

2. Intermediate Applications

In more complex clinical situations, video EEG plays a vital role. Intermediate-level indications include:

  • Non-Epileptic Events: To differentiate epileptic seizures from psychogenic non-epileptic seizures (PNES), fainting, or other episodic conditions.
  • Refractory Epilepsy: To evaluate patients with drug-resistant epilepsy and optimize their treatment regimens.
  • Sleep Disorders: To diagnose parasomnias or nocturnal seizures that are difficult to distinguish based on history alone.

3. Advanced Indications

For specialized and expert-level applications, video EEG is indispensable in the following scenarios:

  • Pre-Surgical Evaluation: In patients being considered for epilepsy surgery, video EEG is used to localize the seizure focus and assess its suitability for surgical intervention.
  • Infants and Children: To monitor pediatric patients with developmental delays or suspected seizure disorders, where clinical signs are subtle or atypical.
  • Assessing Therapy Response: To determine the effectiveness of new treatments, such as antiepileptic drugs or neuromodulation therapies, by documenting changes in seizure frequency or behavior.

4. Key Criteria for Video EEG Referral

Video EEG should be considered when the following criteria are met:

  • Frequency of Events: Clinical episodes occur frequently enough to be captured during the monitoring period.
  • Diagnostic Uncertainty: Initial investigations, such as routine EEG or neuroimaging, have not provided definitive answers.
  • Impact on Management: The findings from video EEG are expected to influence treatment decisions significantly.

5. Limitations and Considerations

While video EEG is a powerful diagnostic tool, it has limitations that must be considered:

  • Accessibility: Requires specialized facilities, which may not be available in all healthcare settings.
  • Cost: Video EEG is more expensive than routine EEG, which can limit its use in resource-constrained environments.
  • Patient Cooperation: Prolonged monitoring can be uncomfortable and may require sedation in some cases, particularly in pediatric patients.

6. Conclusion

Video EEG is a critical diagnostic modality in modern neurology, offering unparalleled insights into the relationship between brain activity and clinical events. It is particularly valuable in diagnosing and managing epilepsy, differentiating seizure types, and guiding therapeutic decisions. While its use is primarily indicated in complex or refractory cases, video EEG should be considered whenever a detailed correlation between brain activity and physical behavior is necessary to optimize patient care.