Epilepsy and paroxysmal conditions

Advanced search

Video-EEG monitoring in diagnostics and treatment efficacy evaluation in newly-diagnosed generalized epilepsy in adults

Full Text:


Introduction. Video-electroencephalography (EEG) monitoring (VEEGM) is an indispensable functional method in epileptology. However, virtually no trials on assessing efficacy of antiepileptic drugs (AED) by using VEEGM are available.
Objective: to improve efficacy of EEG-diagnostics and evaluate the epileptiform activity index (EAI) in newly-diagnosed idiopathic generalized epilepsy in adult patients receiving  alproic acid and levetiracetam.
Material and methods. T here w ere e nrolled 130 p atients: 6 0 (46.2%) m ales a nd 7 0 (53.8%) f emales w ith n ewlydiagnosed
idiopathic generalized epilepsy (IGE), aged 22.51±8.9 years. All patients underwent VEEGM with quantitative EAI analysis at baseline visit and 1 3, 6 and 12 months later after treatment. Each seizure episode developed during the VEEGM study were assessed for type, time of seizure onset, relation to wake-sleep cycle, duration, ictal EEG pattern followed by diagnosing epileptic syndrome. Valproic acid and levetiracetam were used for initial therapy in groups per 65 patients in each. Treatment efficacy was assessed using parameters such as retention on therapy, absence of seizures, decrease of seizure frequency by >50%, decrease of seizure frequency by <50% – insufficient efficacy.
Results. It was found that seizures during baseline VEEGM were recorded in 43.1% (n=56) patients, who were assigned to group 1, whereas remaining 74 (56.9%) patients were assigned to group 2. EAI was significantly higher in patients with seizures recoded at baseline VEEGM, compared to those lacking seizure episodes during initial VEEGM (p<0,001), mean EAI was also higher in group I at second (p<0.001) and third (p<0.001) visits. EAI magnitude at 6 and 12 months of study became virtually comparable in all groups and did not depend on AED prescribed. Treatment efficacy was higher in patients with IGE, with no  eizures recorded during the initial VEEGM.

Conclusion. Long-term VEEGM allows unbiased assessment of treatment dynamics based on EAI analysis. The first 6 months of initial treatment titration in represent most crucial period for patients with newly-diagnosed IGE.

About the Authors

A. B. Kozhokaru
Russian State Research Center − Burnasyan Federal Medical Biophysical Center, Federal Medical Biological Agency; Central State Medical Academy of the Presidential Administration of the Russian Federation
Russian Federation

Anzhela B. Kozhokaru – MD, PhD, Head of the Laboratory of Clinical Neurophysiology; Associate Professor, Chair of Neurology

RSCI SPIN-code: 9567-7212

23 Marshal Novikov Str., Moscow 123098

19bld1A Marshal Timoshenko Str., Moscow 121359

V. A. Karlov
Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Vladimir А. Karlov – Dr. Med. Sc., Corresponding Member of Russian Academy of Sciences, Professor, Department of Nervous Diseases, Medical Faculty

Scopus Author ID: 7103065003; RSCI SPIN-code: 2726-9790.

10bld2 Vuchetich Str., Moscow 127206

P. N. Vlasov
Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Pavel N. Vlasov – Dr. Med. Sc., Professor, Chair of Nervous Diseases, Medical Department

Scopus Author ID: 7101688064; RSCI SPIN-code: 9357-2284.

10bld2 Vuchetich Str., Moscow 127206

A. S. Orlova
Sechenov University
Russian Federation

Aleksandra S. Orlova – MD, PhD, Associate Professor, Chair of Human Pathology, Sklifosovsky Institute of Clinical Medicine

WoS ResearcherID: F-6886-2016; Scopus Author ID: 57191331064; RSCI SPIN-code: 6468-5100

8/2 Trubetskaya Str., Moscow 119991


1. Karlov V.А. Epilepsy in children and adults, women and men. A guide for doctors. 2nd ed. Мoscow: BINOM; 2019 (in Russ.).

2. Karlov V.А., Ayvazyan S.О. Epilepsy in terms, visual and EEG patterns. Мoscow: Nevromed-klinika; 2020 (in Russ.).

3. Mukhin К.Yu., Petrukhin А.S., Glukhova L.Yu. Epilepsy. Atlas of electro-clinical diagnostics. Мoscow: Alvares Publishing; 2004 (in Russ.).

4. Gnezditskiy V.V. Inverse EEG problem and clinical electroencephalography. Мoscow: MEDpress-inform; 2004 (in Russ.).

5. Tufenkjian K., Lüders H.O. Seizure semiology: its value and limitations in localizing the epileptogenic zone. J Clin Neurol. 2012; 8 (4): 243–50.

6. Zenkov L.R. Clinical significance of changes in the electroencephalogram in the treatment of epilepsy with valproate (Depakin Chrono). Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2002; 102: 20 (in Russ.).

7. Sharmila A. Epilepsy detection from EEG signals: a review. J Med Eng Technol. 2018; 42 (5): 368–80.

8. Akman C.I., Montenegro M.A., Jacob S., et al. Seizure frequency in children with epilepsy: factors influencing accuracy and parental awareness. Seizure. 2009; 18 (7): 524–9.

9. Villanueva V., Gutiérrez A., García M., et al. Usefulness of video-EEG monitoring in patients with drug-resistant epilepsy. Neurologia. 2011; 26 (1): 6–12.

10. Tatum W.O., Rubboli G., Kaplan P.W., et al. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. Clin Neurophysiol. 2018; 129 (5): 1056–82.

11. Kobulashvili T., Hofler J., Dobesberger J., et al. Current practices in long-term video-EEG monitoring services: a survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery. Seizure. 2016; 38: 38–45.

12. Kinney M.O., Kovac S., Diehl B. Structured testing during seizures: a practical guide for assessing and interpreting ictal and postictal signs during video EEG long term monitoring. Seizure. 2019; 72: 13–22.

13. Fisher R.S., Engel J.J. Definition of the postictal state: when does it start and end? Epilepsy Behav. 2010; 19 (2): 100–4.

14. Shih J.J., Fountain N.B., Herman S.T., et al. Indications and methodology for video-electroencephalographic studies in the epilepsy monitoring unit. Epilepsia. 2018; 59 (1): 27–36.

15. Wilby J., Kainth A., Hawkins N., et al. Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation. Health Technol Assess. 2005; 9 (15): 1–157.

16. Karlov V.A., Kozhokaru A.B., Vlasov P.N., et al. Dynamics of epileptiform activity, efficacy and tolerability of valproic acid in adults and adolescents with newly-diagnosed epilepsy. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2020; 120 (7): 35–43 (in Russ.).

17. Beniczky S., Aurlien H., Brøgger J.C., et al. Standardized computerbased organized reporting of EEG: SCORE – Second version. Clin Neurophysiol. 2017; 128 (11): 2334–46.

18. Urigüen J.A., García-Zapirain B., Artieda J., et al. Comparison of background EEG activity of different groups of patients with idiopathic epilepsy using Shannon spectral entropy and cluster-based permutation statistical testing. PLoS One. 2017; 12 (9): e0184044.

19. Siddiqui M.K., Morales-Menendez R., Huang X,. Hussain N. A review of epileptic seizure detection using machine learning classifiers. Brain Inform. 2020; 7 (1): 5.


For citations:

Kozhokaru A.B., Karlov V.A., Vlasov P.N., Orlova A.S. Video-EEG monitoring in diagnostics and treatment efficacy evaluation in newly-diagnosed generalized epilepsy in adults. Epilepsy and paroxysmal conditions. 2021;13(1):21-32. (In Russ.)

Views: 594

ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)