Analysis of video electroencephalography and imaging characteristics in children with drug-refractory epilepsy

Objective To compare the detection rates of epileptogenic foci in drug - refractory epilepsy children using video electroencephalography (VEEG), MRI and PET. Methods The 24 h and 2 h VEEG, MRI and PET/CT or PET/MRI were conducted for 70 children with drug - refractory epilepsy in Children's Hospital of Nanjing Medical University from January 2020 to April 2022, and Raven's Standard Progressive Matrices (SPM) or Developmental Screening Test for Child under six (DST) based on their age (< 5 or ≥ 5 years old) were assessed for intelligence. Results Among 70 children, 44 seizures were detected during 24 h VEEG, while 31 seizures were detected during 2 h VEEG, and there was statistically significant difference between the two methods (χ2 = 5.760, P = 0.015). The consistency of diagnosing single location/ unilateral abnormalities, bilateral abnormalities, or normal results was poor among VEEG, MRI and PET/CT or PET/MRI (κ = 0.194, P = 0.000), and the difference among the three methods was statistically significant (χ2 = 33.068, P = 0.001). The VEEG (χ2 = 25.000, P = 0.000) and PET/CT or PET/MRI (χ2 = 11.764, P = 0.002) had higher diagnostic capabilities than MRI, and PET/CT or PET/MRI had higher diagnostic capability than VEEG (χ2 = 8.048, P = 0.014). There were 41 children (58.57%) showed mental retardation, among them children with onset age ≤ 2 years had a higher rate compared to those with onset age > 2 years (χ2 = 6.193, P = 0.013), and children with abnormal VEEG background had a higher rate compared to those with normal VEEG background (χ2 = 4.868, P = 0.027). Conclusions The detection rate of epileptiform discharges and clinical seizures can be increased by lengthening VEEG time at each time and increasing the number of times of VEEG. PET/CT or PET/MRI and VEEG can provide localization information of epileptic foci of children whose MRI results are negative. The mental retardation rate of children who have onset age ≤ 2 years and of abnormal VEEG background is higher.