Computer-Assisted Ambulatory Electroencephalography

Abstract

AbstractThe usage of ambulatory electroencepholographic (EEG) monitoring has grown in popularity due to technological advances, including miniaturization and portability of smaller devices, accessibility and affordability, and similarities to inpatient video-EEG results. Ambulatory EEG is recorded in the patient’s environment and natural surroundings, which may serve as event triggers. Ambulatory EEG may be interpreted through secure wireless connections at sites distant from the hospital to enhance accessibility for interpretation. Prolonged recording increases the yield of capturing interictal epileptiform discharges or an event. Practical benefits include providing a definitive diagnosis, classification of seizure types or epilepsy syndromes, quantification of spike and seizure burdens including those experiencing seizures without self-awareness, and rarely to augment a presurgical evaluation in patients with drug-resistant focal epilepsy. Recording EEG through normal ultradian and circadian rhythms makes ambulatory EEG a logical choice compared with standard EEG; its prolonged recording may identify patient-specific patterns associated with sleep, menses, or other triggers. Ambulatory EEG may be used to evaluate response to antiseizure drug or assessing risk associated with a trial of medication withdrawal. Compared with inpatient video-EEG, ambulatory EEG is cost effective and easier to arrange with busy schedules. Currently ambulatory EEG is coupled with seizure and spike detection algorithms for assessment of prolonged time. Chronic intracranial ambulatory EEG is being evaluated coupled with responsive neuromodulation. Future attempts to provide diagnostic ambulatory EEG monitoring with therapy is emerging; efforts to move toward mobile health are ongoing. This chapter focuses on diagnostic applications of ambulatory EEG in patients suspected of epilepsy.