Todorov et al.(1) examined the necessary length of study to record a sufficient number of seizures for patients undergoing pre-surgical evaluation at Johns Hopkins Hospital. In determining a lower boundary, research from inpatient epilepsy monitoring units (EMU) can provide a sufficient starting point. The following studies provide evidence concerning the effectiveness of recording times between these upper and lower boundaries. Additionally, a minimum boundary of 24 hours is determined by the desire to record a period of nocturnal sleep and sleep-wake transitions that correlate with increased interictal abnormalities and some ictal events. Practical limits govern the upper boundary of recording time, namely an increasing risk of scalp skin breakdown beginning at roughly 7 days. A longstanding question within the epilepsy community is: How much recording time is enough? Although recording for longer periods of time increases the likelihood of detecting interictal epileptiform abnormalities, most prolonged video EEG monitoring studies are ordered in the hopes of recording at least one of the patient’s typical clinical events. The gold standard of epilepsy diagnosis is the time-locked video EEG recording of the clinical event, with prolonged monitoring providing the greatest advantage over routine studies of 20-30 minutes in duration. Impact of the Length of Study on Event Detection with Video EEG Monitoring Introduction
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