Video-EEG and Advanced Evaluation

In some situations, standard tests are not enough to clarify the diagnosis, and a more advanced evaluation is needed. This chapter introduces the methods used especially when the diagnosis is uncertain or when a surgical option comes onto the table.

Video-EEG Monitoring

Video-EEG monitoring is the EEG recording done together with simultaneous video recording, over a long period (usually a few days in the hospital). The aim is to “catch” the child's actual seizures and see what is happening in the brain at that moment. The main uses of this method are:

• Confirming the diagnosis: Establishing for certain whether the events that occur are truly epileptic seizures. Some events resemble epilepsy but are not epileptic (see below).
• Determining the seizure type and focus: Identifying which part of the brain the seizure starts from is critically important, especially if surgery is being considered.
• Reviewing the medication treatment: Re-evaluating the picture in situations that appear resistant to treatment.

Conditions That Look Like Epilepsy but Are Not

Not every event that “looks like a seizure” is an epileptic seizure. There are many conditions in children that can be mistaken for epilepsy: breath-holding spells, fainting (syncope), certain sleep-related events, night terrors, tics, stiffening spells, and psychogenic (psychological in origin) events. Making this distinction is very important, because the treatment of these conditions is completely different from that of epilepsy, and starting epilepsy medication unnecessarily is harmful. Video-EEG is precisely where it is most valuable for making this distinction.

Advanced Pre-Surgical Evaluation

In children with drug-resistant epilepsy who may be candidates for surgery, more advanced methods may be used to pinpoint the source of the seizure: special MRI techniques, functional imaging of the brain (PET, SPECT), mapping of specific brain functions (functional MRI), and, when needed, recordings made with electrodes placed on or inside the brain surface. These advanced evaluations are carried out only in experienced epilepsy surgery centers, by a multidisciplinary team. We'll cover the topic of surgery in detail in Chapter 25.

Diagnosis Is a Journey, Not a Single Stop

Sometimes all the tests do not give a clear answer on the first try, and the process requires patience. This is not a failure.

The diagnosis sometimes becomes clear over time, as the child's development and the course of the seizures are followed. Along this path, keeping open communication with your doctor and saving up your questions to ask is your best companion.