From clinical observation to long-term monitoring: Diagnostic developmentsin conservative epileptology

The diagnostic goals in nonsurgical (conservative) epileptology differ from presurgical diagnostic aims. The resulting development of diagnostic metho ds in a tertiary-level epilepsy center is shown and the major technical and organizational consequences of this difference for diagnostic longterm mon itoring (LTM) as opposed to presurgical LTM are investigated. A total of 13 3 consecutive daytime LTM investigations using radio telemetry were reviewe d and seizure parameters such as type, duration, method of seizure detectio n, and need of mobility were evaluated and compared to presurgical LTM. Com pared to presurgical LTM, partial seizures were relatively rare (17.8%) and shea epileptic or nonepileptic motor events lasting <1 s, such as myocloni c, atonic, short tonic seizures, spasms, ties, or startle reactions, are fr equent (34.9%). Of all seizures, 23% had no or minor ictal EEG changes, sub tle symptomatology without signaling by a patient or accompanying person, a nd could be detected only by continuous online surveillance by an experienc ed EEG technician. Due to the nature of the patient population in diagnosti c LTM, there is an increased need for ictal and interictal mobility (radio telemetry). LTM in conservative epileptology requires more intense human su rveillance for seizure detection and increased patient mobility compared to presurgical LTM.