videoEEGmonitoring

Video EEG Monitoring (VEM) is the prolonged synchronized recording of brain electrical activity with continuous video surveillance to document and analyze seizures and related behaviors. It combines electroencephalography (EEG) with real-time observation of the patient, enabling correlation between electrographic changes and clinical events.

Typically performed in an epilepsy monitoring unit (EMU) or intensive care setting, VEM sessions last from 24 to 72 hours and can be longer if needed. The procedure uses scalp electrodes arranged according to the international 10-20 system, with impedance checks and skin care to minimize discomfort. A video camera records the patient throughout, often with infrared capability for nighttime monitoring. Data are synchronized and reviewed by epileptologists and neurophysiology technicians, sometimes with advanced software to detect events.

Applications include distinguishing epileptic from non-epileptic events, characterizing seizure types and frequency, localizing seizure onset zones, and informing presurgical planning. VEM is also used to monitor treatment response, assess prognosis in coma or impaired consciousness, and evaluate patients with refractory seizures in outpatient settings (ambulatory VEM) when feasible.

Benefits include increased diagnostic yield, objective documentation of events, and improved accuracy in classifying seizures and guiding therapy. Limitations involve artifacts from movement or poor contact, incomplete capture of events, and resource requirements in terms of equipment, space, and specialized staff. Risks are generally minimal but can include skin irritation from electrodes, infection risk at sites of electrode contact, and privacy considerations related to video recording. Standards and guidelines from professional bodies advocate standardized montages, duration, and reporting to maximize diagnostic value.