Diagnostic value of stand‐alone videos after inconclusive inpatient EEG–video monitoring

Inpatient electroencephalographic (EEG)-video monitoring occasionally fails to capture the events in question, leaving patients without a definitive diagnosis. Management after an inconclusive admission is generally limited to repeating monitoring or empirical adjustment of antiseizure medications. Although stand-alone videos are increasingly used in clinical practice, their diagnostic value in this setting has not been well established. We aimed to assess the diagnostic contribution, submission rate, and interrater reliability of stand-alone videos obtained after inconclusive inpatient EEG-video monitoring. Over a 26-month period, we prospectively identified patients with inconclusive epilepsy monitoring unit (EMU) admissions who were instructed to submit videos of typical events not captured during their stay. Submitted videos were independently reviewed by two epileptologists, with adjudication by a third reviewer when consensus was not achieved. Among 619 EMU admissions, 165 (27%) were inconclusive. Twenty-seven (16%) patients submitted a stand-alone video. A definitive conclusion was reached in 23 (85%) patients, and in 20 (74%) patients, videos either established, confirmed, or revealed an additional diagnosis. Substantial interrater reliability was observed (κ = .690, 95% confidence interval = .456-.893), with perfect agreement for nonepileptic and physiologic events. This study provides preliminary evidence that stand-alone videos have the potential to be a valuable adjunct in the evaluation of seizures and seizurelike events after inconclusive EMU admissions. Early and systematic reinforcement of video collection may improve diagnostic yield and reduce health care utilization when inpatient studies are unrevealing.