Clinical utility of video-EEG telemetry: optimum use of resources

We examined seizure outcome Cfree ,from seizures however minor vs. continuing seizures however infrequent) 5 years post-TLES for mesial temporal sclerosis in 82 consecutive patients, aged 8-43 years, who underwent pharmacologically activated sphenoidal EEG pre-operatively (12 with extracranial ictal monitoring (VT), 70 without). Fifty-six had suffered an early-childhood complicated convulsion (ECC+); 56 had strictly unilateral sphenoidal spikes (SphU). The 70 non-monitored patients were divided according to the presence/absence of ECCf and of SphU. Those seizure free were: 78%. ECCf, SphU (N = 37) + 14% Engel other 1-t 11; 60%, ECC+, not SphU (N = 10) + 30% Engel other I + 11; 47%, not ECC+, SphU (N = 15); 25%, not ECC+, not SphU (N = 8). VT patients had no better outcome in any group. Therefore, excellent outcome is achieved for most with both ECC+ and SphU making routine VT unnecessary. Videotelemetry may be indicated (often intracranially) for all without ECC+, and for some (usually only extracranially) with ECC+ but not SphU.