Evaluating the Usefulness of 24-Hour Video EEG Monitoring in Dr. Sa’ad Alwitry’s Hospital, Baghdad, Iraq

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Background: Video electroencephalography (VEEG) monitoring, which combines EEG with synchronized video recording, is a valuable but resource-intensive tool for evaluating seizure disorders. While its role in diagnosis and classification is established, its specific impact on altering provisional diagnoses and guiding treatment remains underexplored.Objective: To assess the diagnostic utility of 24-hour inpatient VEEG monitoring in confirming or modifying provisional diagnoses and reducing misdiagnosis in patients with paroxysmal events.Methods: A retrospective analysis was conducted on 192 patients who underwent VEEG monitoring at Dr. Saad Alwitry Hospital between January and December 2018. Patient records were reviewed to assess the impact of VEEG on diagnostic revision, seizure classification (based on the 2017 ILAE criteria), and event onset timing. Outcomes were categorized as confirmed, changed, or inconclusive diagnoses.Results: Of the 192 patients, 64.1% were male. Epileptic seizures were the provisional diagnosis in 55.7%, and non-epileptic seizures (NES) in 44.3%. VEEG altered the diagnosis in 19% and confirmed it in 42%. In 39% of cases, results were inconclusive. Notably, 28% of patients receiving antiepileptic drugs were ultimately diagnosed with NES, prompting significant clinical reconsideration.Conclusion: VEEG monitoring demonstrated an 86.6% sensitivity and played a pivotal role in confirming or altering diagnoses in 61% of patients. Its balanced predictive values support its use in differentiating epileptic from non-epileptic events, thereby refining management strategies and minimizing unnecessary AED exposure.

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