Preface

Although continuous video–electroencephalographic monitoring (VEM) was first developed in the 1960s, it did not become relatively available in routine neurologic care until the past decade. This progress may be due to both increasing expectations for diagnostic accuracy and advancing monitoring technology. With current technology, VEM is less expensive, is easier to perform, and has changed from a primarily academic university hospital–based test to one that many community hospitals and unaffiliated neurologists can provide. VEM is the fastest-growing aspect of EEG and often is an expected standard of care. However, the increase in use has not been accompanied by reference sources for this diagnostic technology. Current references focus on brief EEG patterns without inclusion of extended recordings, the behaviors that accompany EEG patterns, or aspects of providing this more comprehensive diagnostic service. The purpose of the Atlas of Video-EEG Monitoring is to serve as a reference and essential reading for the large population of clinicians and technologists who provide VEM. The skilled use of VEM requires more than a thorough understanding of EEG, and this reference aims to be authoritative for the essentials of VEM in diverse clinical practices and hospital laboratories.

The essential purpose of VEM is to identify the underlying diagnosis for both acute and chronic episodes that include altered mentation or behavior. Such situations are relatively common because of the variety of clinical situations that present this way. The situations cover epileptic seizures, other paroxysmal neurologic disorders, behavioral (psychiatric and psychological) disorders, and persisting states of cognitive dysfunction. Persisting impaired cognition may be due to continuous or frequently recurring epileptic seizures (status epilepticus), which is one clinical situation where VEM is a critical test for potentially life-saving treatment. It establishes whether the diagnosis is status epilepticus and determines whether the treatment has been successful. VEM also is the pivotal test when assessing chronic and uncontrolled episodic alterations in mentation or behavior. This situation often is considered to be due to epilepsy, but one third of such individuals are found to have another diagnosis when VEM is performed. As such, VEM often is diagnostically essential and leads to more appropriate treatment.

VEM may be a component of neurologic practice and also may be used in practices that may adjoin neurology, including neurosurgery, psychiatry, intensive care medicine, pediatrics, and psychology. Neurologists who perform clinical neurophysiological testing are expected to be the primary readership, and they include a spectrum from epileptologists in university practices to general neurologists in private settings. The Atlas is a resource for the academic epileptologist with discussions of seizure localization and VEM techniques, but it is also useful to the general neurologist who occasionally uses VEM when evaluating acute or paroxysmal abnormal behaviors to determine an underlying diagnosis. The details included in the chapters span the range of needs to also benefit the other allied clinicians who participate in the care of these patients. Because of the diagnostic conundrum of psychogenic nonepileptic episodes, which raises great concern for misdiagnosis, psychiatrists and psychologists are likely to find this reference helpful. The inclusion of multiple forms of nonneurologic episodes, that mimic epilepsy with discussion and videos, makes the book unique. EEG technologists also will find it useful. Many EEG technologists already are specialized in VEM and would benefit from a central reference. Moreover, most technologists are expected to be familiar with VEM because of its increased use and the incorporation of VEM potential within routine EEG equipment.

The design of the Atlas is based on practicality and clinical applicability. The text includes 33 chapters with numerous video-EEG figures and an accompanying DVD that provides an expansion of the material. The book is divided into five broad sections. The first section highlights technical matters and discusses the fundamentals of EEG, video-EEG recording, and clinical practice in a VEM unit. The second section reviews epileptic seizure types, describing their typical manifestations and associated epilepsy syndromes. Individual chapters focus on simple partial seizures, other partial seizures, generalized seizures, and other seizures. The third section pertains to mimickers of seizures, including psychogenic spells, movement disorders, and other paroxysmal events. This section compares the similarities of these disorders with seizures while contrasting differentiating characteristics. The fourth section discusses status epilepticus, including generalized convulsive status epilepticus, end-stage nonconvulsive status epilepticus, and nonepileptic movements in coma. The fifth section covers intracranial VEM, which includes technical and interpretation aspects of both depth electrode and subdural grid and strip electrode recording.

The goal of the Atlas is to offer detailed, comprehensive, and authoritative information on VEM. Through the organization and contents of the text and the accompanying DVD, we hope that the reader will be able to appreciate the range of fascinating and unique behaviors that are captured within a VEM unit. Thus, another goal of the Atlas is to convey the challenges and satisfactions of this clinical practice. The book may also help physicians prepare for certification examinations in epilepsy, neurology, and clinical neurophysiology. Visualizing seizure behaviors and their accompanying EEGs as presented in this text and accompanying DVD brings the examinee closer to the true clinical situation while providing an efficient and enjoyable method of study.