The VEEG (Video Electroencephalogram) Test Appears Useful for Identifying Seizures

Past Studies

Past Studies state that individuals can experience a seizure as a result of a traumatic brain injury. A seizure occurs when there is a temporary electrical short circuit in the brain. An individual having a seizure can experience uncontrollable body movements, sensations, and changes in awareness. Some individuals have repeated seizures, a condition called epilepsy. Fifteen to 20% of individuals with moderate to severe traumatic brain injuries have epilepsy. 

There are different types of seizures and can be difficult for physicians to identify. Other conditions may appear to be seizures, but actually are not. Historically, physicians have used clinical examination and electroencephalograms (EEGs) as tools to diagnose seizures. An EEG is a test that detects electrical brain abnormalities and involves placing small metal discs, called electrodes, on a person’s scalp. EEGs are not sensitive enough to identify all seizure activity. It is important for physicians to determine a correct diagnosis in order to provide the best treatment. Some medications can be helpful in select individuals. It is believed that some individuals have been incorrectly medicated because a correct diagnosis was not achieved. Physicians have been challenged to accurately diagnose and treat seizures.

This Study

This study focused on identifying seizures or seizure-like activity in 127 individuals with moderate to severe brain injuries. The researchers monitored the participants with a Video Electroencephalogram Monitoring Test (VEEG) for an average of nearly five days. A VEEG is a more specialized test than an EEG. The VEEG includes the EEG test plus constant video monitoring of the individual. This allows physicians to observe brain wave activity during the time of a seizure. It also enables physicians to diagnose other conditions, such as fainting or confusion, that may appear to be seizures, but actually are not. The VEEG helps physicians to determine the specific nature of a seizure to assist them to identify appropriate treatments.

The researchers found that the VEEG was able to establish a diagnosis in 82% of the participants. The VEEG assisted the researchers to determine the specific type of seizures that the individuals were experiencing. This information enabled the researchers to provide the most appropriate medications possible, including changes to the individual’s current medications. The researchers were also able to determine individuals who would benefit from surgical treatments. Additionally, the researchers were able to detect and recommend treatment for 33% of those diagnosed that had pychogenic non-epileptic seizures, a condition that appears seizure-like, but is not caused by abnormal electrical signals in the brain.

Further, the researchers were able to determine that 53% of those diagnosed had mesial temporal sclerosis, a condition that develops from injury to the hippocampus, amygdala, and parahippocampal gyrus structures of the brain. Individuals with mesial temporal sclerosis may benefit from tailored medications and resective surgery.

Who May Be Affected By These Findings

Individuals with traumatic brain injury and seizures, healthcare professionals, and researchers.

Caveats

While this study shows that potentially treatable conditions can be diagnosed by VEEG monitoring, it is unclear whether those treatments are in fact effective. Video-EEG evaluations are expensive, and require several days of hospitalization. Further, antiepileptic medications are usually held during the admission, which may result in a greater number and more severe seizures than occur at baseline.

Bottom Line

In this study, the video electroencephalogram (VEEG) appears to be a useful tool for identification of seizures for individuals with moderate to severe traumatic brain injuries. Additionally, the VEEG appears to be helpful to determine specific types of seizures and seizure-like conditions.

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