What are the advantages of ambulatory electroencephalography (EEG) with full American Psychological Association (APA) style citations?

From the Guidelines

Ambulatory electroencephalography (EEG) is the preferred method for monitoring patients with suspected seizure disorders due to its ability to capture intermittent epileptiform discharges or seizure events over an extended period, typically 24-72 hours, in a natural setting. The advantages of ambulatory EEG include increased sensitivity to detect seizures and status epilepticus, improved correlation between EEG abnormalities and the patient's typical triggers or activities, and cost-effectiveness compared to inpatient video-EEG monitoring 1.

Key Benefits of Ambulatory EEG

• Extended recording time, typically 24-72 hours, which increases the likelihood of capturing intermittent epileptiform discharges or seizure events
• Allows patients to maintain their normal daily activities and sleep in their home environment, triggering habitual seizures that might not occur in a hospital or clinic setting
• Enables correlation between EEG abnormalities and the patient's typical triggers or activities
• Cost-effective compared to inpatient video-EEG monitoring, reducing healthcare expenses and freeing up hospital beds
• Portable equipment makes it accessible to patients who may have difficulty traveling to specialized epilepsy centers, particularly those in rural areas or with mobility limitations

Clinical Implications

The use of ambulatory EEG can inform neurological prognostication, detect nonconvulsive seizures and status epilepticus, and distinguish among different types of myoclonus in post-cardiac arrest patients 1. Although there is no direct evidence that EEG used to detect nonconvulsive seizures improves outcomes, the high prevalence of nonconvulsive seizures and other epileptiform activity in post-arrest patients supports the use of ambulatory EEG as a valuable diagnostic tool. The TELSTAR trial, a randomized clinical trial of protocolized tiered treatment targeting suppression of EEG rhythmic or periodic patterns, found that patients with unequivocal electrographic seizures or evolving patterns and those with nongeneralized periodic discharges may fare better with protocolized, tiered antiseizure treatment 1.

Recommendations

The use of ambulatory EEG is recommended for patients with suspected seizure disorders, particularly those with infrequent events or those whose seizures occur predominantly during sleep or specific times of day. The American Clinical Neurophysiology Society defines the ictal-interictal continuum as rhythmic or periodic patterns that are considered to be possible seizure or status epilepticus, even without fulfilling strict electrographic criteria 1. Patients with patterns on the ictal-interictal continuum who exhibit clinical correlation with EEG abnormalities may benefit from ambulatory EEG monitoring to guide treatment decisions.

From the Research

Advantages of Ambulatory Electroencephalography (EEG)

The advantages of ambulatory electroencephalography (EEG) can be summarized as follows:

• Cost-effective alternative to inpatient long-term video-EEG monitoring, particularly in resource-limited countries 2, 3
• Allows for prolonged recordings in normal environments, such as patients' homes 2, 3
• High diagnostic yield, with 72% of patients providing useful information for management 3
• Useful for characterizing patients with non-epileptic events, diagnosing epilepsy, and quantifying spikes and seizures to improve medical management 3, 4
• Enables recording of interictal epileptiform discharges to classify the epilepsy syndrome, with superior sampling compared to standard EEG recordings 4
• Convenient and accessible alternative to inpatient video-EEG monitoring, with the ability to capture clinically relevant events and resolve referring clinical questions 5

Clinical Applications

Ambulatory EEG has various clinical applications, including:

• Differentiating between seizures and non-epileptic events 2, 3, 5
• Determining the frequency of seizures and epileptiform discharges 3
• Characterizing seizure type or localization 3
• Diagnosing epilepsy 3, 4
• Quantifying seizure burden and improving medical management 3, 4

Diagnostic Utility

The diagnostic utility of ambulatory EEG is supported by several studies, which have shown that it can:

• Capture diagnostic events and resolve referring questions in a significant proportion of patients 5
• Provide useful information for management in 72% of patients 3
• Be a valuable tool in resource-limited settings for assessing suspected or confirmed epilepsy cases 2