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Types

Long-term or “continuous” electroencephalography (EEG) video monitoring or video telemetry is a diagnostic technique used in certain patients with epilepsy or seizures which involves the hospitalization of the patient for a period of time, typically days to several weeks, during which their brain waves and physical actions are continuously monitored and recorded with a video camera and an electroencephalograph.[1] [ Long-term EEG video monitoring is utilized in the localization of epileptogenic zones (or the areas of the cortex of the brain responsible for epileptic seizures) of the brain [7]. Utilized commonly in many neuroscience or epilepsy monitoring units (EMUs), and at-home video telemetry units are also being introduced to market for more continuous care.

Medical Uses

Long-term EEG monitoring is very similar to EEG in that the brain waves are periodically monitored and analyzed by a neurologist. Typically one trained in clinical neurophysiology, the neurologist determines when the monitoring is finished and issues the final report after they interpret the compiled data.

The results from the EEG and video monitoring are used to characterize episodic disruptions in brain-function and its physical manifestations; many recordings show symptoms of epileptic seizures over time and how severe and frequent they become over a given period.[1]

The purposes of long-term video-EEG monitoring include:

• Discovering where in the brain a given person's seizures begin
• The severity of the seizures (Different Scales)
• Determining frequency of seizures
• Audio recordings of patients (Verbal and nonverbal)
• Duration and prominence of physical activity (May be indicator of status epilepticus)
• Distinguishing epileptic seizures from psychogenic non-epileptic seizures
• Evaluating a person who is a candidate for surgery to treat epilepsy

In adults, long-term EEG monitoring typically includes three options which are long-term video monitoring, sleep-deprived EEG monitoring, and 24-hour ambulatory monitoring. Video monitoring typically lasts from a few hours to several days, depending on the needs of the patient. Sleep-deprived and ambulatory EEG monitoring are often used to further investigate symptoms of epilepsy when a standard EEG reading returns negative results. In contrast, long-term video monitoring is typically used in cases of drug-resistant epilepsy to examine symptoms before surgery. Video monitoring is also used to more precisely diagnose a patient when episodes become more frequent and if the patient displays physical characteristics.[2]

Interpretation of Results

The recording is periodically monitored and analyzed by a neurologist. Typically one trained in clinical neurophysiology, the neurologist determines when the monitoring is finished and issues the final report.

The purposes of long-term video-EEG monitoring include:

• Discovering where in the brain a given person's seizures begin
• Distinguishing epileptic seizures from psychogenic non-epileptic seizures
• Evaluating a person who is a candidate for surgery to treat epilepsy

Risks/Complications

In order to perform long-term EEG video monitoring appropriately, a patient is admitted into a hospital or clinic, where epileptic seizures may be induced using sleep deprivation techniques or temporarily ceasing the consumption of antiepileptic drugs [5]. With these techniques, the patient under observation is susceptible to not only experiencing a higher frequency of seizures, but to a change in seizure type or seizure intensity [5]. These changes in seizure behavior can in turn lead to the patient experiencing a higher risk of injuries due to uncontrolled mental behavior such as aggression, psychosis, self-inflicted injury, as well as seizure related injuries including falls and status epilepticus (prolonged seizures or increased frequency of seizures without a return to an otherwise normal state) [5]. Finally, other safety concerns of patients under observation using long-term EEG video monitoring include technical problems with the equipment used such as electrode degradation and restraints [5]. Each of these safety concerns are negated with staff training and education [5].

Procedure/Technique

Long-term EEG Video Monitoring utilizes a series of instruments to test on epileptic patients. The goal of long-term EEG video monitoring is to have a continuous EEG recording for a prolonged period in a clinical setting where recordings of both the patient’s recorded behavior in video form and EEG activity during epileptic attacks. One of the most important dynamics of long-term EEG video monitoring is that the patient remains in a clinical setting for a prolonged period of time so that observers can recognize trends and particular moments when these seizures occur to better understand the condition of the patient.

A general overview of long-term EEG video monitoring composes of three important components:

1. Retrieval of Information
   1. Electrodes: A series of electrodes will be placed both extra and intracranially to retrieve electrical currents that travel throughout the brain during the long-term EEG video monitoring. Electrodes are used to retrieve information for EEG monitoring.
   2. Video Cameras: Series of fixed positioned cameras to have a visual representation of epileptic behavior in comparison to EEG data. Traditionally, a monitoring unit will be accessible to nursing stations so that the patient can be monitored always.
   3. Audio: Microphones. This retrieval of information is important so that professionals can monitor verbalizations and descriptions of epileptic events from the patient.
2. Data Storage:
   1. Digital Storage: Storing video and EEG data digitally is the most reliable and effective way to allow for 24+ hours of continuous video EEG feed.
      1. Digital storage also allows for data to be shared amongst professionals to evaluate data.
3. Review:
   1. Event Analysis: After data has been retrieved, professionals and researchers can study and analyze temporal sequence of the patient’s readings during the length of the procedure.
   2. Correlation of Behavior and EEG: EEG and epileptic activity will be temporally concurrent within the procedure to identify patterns and other such trends.[4]

Preparation

During monitoring period: Doctors will traditionally lower dosage of epilepsy medication to make seizures more likely to occur. In addition, during long-term EEG video monitoring, other methods of triggering seizures will be introduced such as deprivation of sleep, flashing lights, or exercise. Prior to the procedure, it is recommended by healthcare professions that one must avoid eating or drinking caffeinated beverages for at least eight hours prior to the procedure.

Some patient opinions describe the procedure as mundane or tedious and recommend bringing an activity such as crossword puzzle books or other reading materials to keep oneself entertained during the process. Activities involving electronic devices are disallowed as the electromagnetic radiation or radio frequencies given off from the devices may interfere with the EEG recordings and equipment.

Risk and Recovery

Depth electrodes have a relatively low risk for complications. Smaller holes are made in the skull so patients may recover more quickly and experience less pain and discomfort than after EEG recordings which utilize grids or strips. Bleeding in the brain and infection are possible but complications happen infrequently. Since surgery to place strips and grids need a larger opening in the brain, the potential for complications and headaches after surgery is slightly greater.

Legal Issues

For ethical purposes, the mice and other animals utilized in long-term EEG video monitoring research are raised and cared for under conditions regulated by The Institutional Animal Care and Use Committee (IACUC) and are euthanized once the experiment has been completed. Regulations enforced by the IACUC explain that the use of animal models be reduced whenever possible, distress of the animals must be minimized, and that the use of these animals coincides with the goals of the experiment.

Long-term video-EEG monitoring is a relatively safe procedure when compared to other invasive techniques. Like any other invasive procedure, there is a chance for adverse events to occur, but with the right precautions, they can be mostly prevented. Should an adverse event occur, death and increased time of hospitalization are not likely.[8]

History

Long-term EEG video monitoring techniques developed from commonly used techniques involved in EEG monitoring in other applications. Thus, the history of long-term EEG video monitoring is an extension of the history of standard EEG monitoring techniques.

Society and Culture

As seizures become monitored more closely by doctors and their patients, EEGs and Long term EEGs have become the standard for both hospital and home care [6]. The use of such devices at home allows for more a more regular monitoring of the patients symptoms for optimized care by the neurologist while also signifying to caregivers if a problem arises. These logs provide information that may be otherwise improperly described and can allow for a sense of security and control for the patient/ caregiver as they can now see how frequent and severe these seizures are. At-home long-term EEG monitoring also reduces the financial burden since the patient is no longer at the hospital for long periods of time [6]. In contrast, EEG also record non-cerebral signals from throughout the body and thus make the logs have a noticeable false alarm rate due to factors such as biological and extra-physiological artifacts[6]. Because a device can only be successful if it is used and is accessible, the desires of the patient have become one of the driving forces for society's acceptance and use of these EEG systems.

Research

The use of long-term EEG video monitoring on model animals allows for neuronal activity to be better understood by inducing states that would not be ethical to induce in humans experimentally [7]. Also, the use of animal models provide differing features such as life span, easy to study lineages, and age to maturation while also allowing researchers to seizures mimicking those found in humans. Current research being performed using long term EEG also coincides with animal testing by using models such as the C57BL/6J mice.This type of mouse is specifically used for research into the induction of behavioral convulsive (CS) and electrographic nonconvulsive (NCS) seizures and then monitoring their states over 4-18 weeks using long term EEG recordings [7]. By using long term EEG, the length of the episode, spike amplitude, interspike interval, and spike frequency can all be closely monitored and compared over several weeks[7]. Different stages of SEs can also be distinguished by using scales, such as the Racine Stages and CSS indices, that can determine the severity of the episode.