Prolonged video-EEG in identifying paroxysmal nonepileptic events in children with epilepsy: a useful tool.

PURPOSE: Habitual events, behaviors, and nonepileptic events can be easily confused with epileptic seizures in children in the absence of clear description and can be challenging, even for an experienced clinician. The aim was to report on the usefulness of adding video-EEG to routine EEG studies of infants and children with frequent atypical paroxysmal events. METHODS: A retrospective analysis of video-EEG carried over a 2-year period in a tertiary pediatric neurology center. Outcomes were classified as: "conclusive epileptic," "conclusive nonepileptic," "unremarkable," and "inconclusive." RESULTS: Forty-four children (M:F 19:25) with an age range of 1 to 15 years (mean: 7 years, median: 8.5 years) were analyzed. Thirty (68%) children had successful epilepsy classification. A diagnosis of a specific nonepileptic event was reached in 55% of cases. Antiepileptic drugs were discontinued completely in 8 patients (20%), and the total number of antiepileptic drugs was reduced in 13 others (33%). CONCLUSIONS: Paroxysmal nonepileptic events can cause diagnostic confusion, particularly in children with developmental delay, epilepsy (especially refractory epilepsy), or those with previous "abnormal" EEG. Accurate diagnosis can be reached in the majority of cases using prolonged video-EEG monitoring.