Video-EEG monitoring was used to distinguish epileptic and non-epileptic events in 193 children, mean age 9.6 years, who presented with paroxysmal symptoms of uncertain etiology at Children’s Hospital, Los Angeles, CA. Diagnosis was established in 130 (67%). Seventy (36%) were mentally retarded (MR). Epileptic seizures were identified in 67 (51%), non-epileptic events in 54 (41%), and both epileptic and non-epileptic events in 9 (7%) children. Children with MR had predominantly epileptic seizures on long studies and non-epileptic events on short studies. A diagnosis was established in 82% following long studies and in 62% with short studies. The most common seizure type was complex partial, and non-epileptic symptoms were behavioral, psychogenic, and physiological events. Children with MR were more likely than children without MR to have events during the studies, but the frequencies of epileptic and non-epileptic events were similar in the two groups. Management was modified following diagnostic studies. [1]

COMMENT. Improved diagnosis and more appropriate management following video-EEG in children with paroxysmal events should prompt more general use of this test, especially in children with mental retardation.

Eight infants with early-infantile epileptic encephalopathy (Ohtahara syndrome) had seizures that correlated with the ictal burst of the suppression-burst pattern recorded by video-EEG, in a report from the Bambino Gesu’ Children’s Hospital, Rome, Italy [2]