Video Electroencephalography (VEEG) is a specialized medical procedure that combines the brain wave recording of an electroencephalogram (EEG) with simultaneous video monitoring. This synchronized approach creates a comprehensive record of a person’s brain activity and physical behavior during an event. VEEG is considered the gold standard in neurology for accurately diagnosing and characterizing paroxysmal events, such as sudden, recurrent episodes like seizures.
Why Doctors Order VEEG Monitoring
Doctors use VEEG monitoring when a standard, short-duration EEG is not sufficient to capture or clarify a patient’s episodic events. The primary goal is to differentiate between epileptic seizures, which result from abnormal brain electrical activity, and non-epileptic events that may mimic seizures, such as psychogenic non-epileptic seizures or syncope. This distinction is important because the treatments for these conditions are vastly different. The test is also used to classify the specific type of seizure a patient is experiencing, which directly influences medication selection and long-term treatment planning. For patients with epilepsy that does not respond to medication, VEEG is an important step in a pre-surgical evaluation. It helps neurologists precisely pinpoint the area of the brain where the seizures originate. Monitoring duration typically ranges from 24 to 72 hours for diagnosis, but may extend up to seven days for complex pre-surgical evaluations.
How Patients Prepare for the Test
Preparation for VEEG monitoring begins with managing current medications, a process guided strictly by the treating physician. Anti-seizure medications may be gradually reduced or temporarily stopped before or during monitoring to increase the likelihood of provoking a typical event. This intentional withdrawal is done under close medical supervision in a safe, controlled environment to ensure patient safety. Patients must wash their hair thoroughly the night before the procedure, using only shampoo and avoiding all styling products. Clean hair is necessary because residue interferes with the adherence of the electrodes to the scalp. In some instances, a period of sleep deprivation may be requested prior to the test, as this physiological stressor can sometimes trigger epileptiform activity. Patients are advised to wear comfortable, loose-fitting clothing, particularly shirts that button or zip up the front, since pullover shirts cannot be removed easily after the electrodes are placed.
The Video EEG Monitoring Experience
The VEEG procedure usually takes place in a specialized hospital setting known as an Epilepsy Monitoring Unit (EMU), where the patient stays for several days. Monitoring begins with a technologist applying numerous small metal discs, or electrodes, to the scalp using a conductive paste or glue. This setup process can take one to two hours, and the electrodes are secured with a gauze wrap to keep them firmly in place. Once connected to the recording equipment, continuous, synchronized monitoring of both brain activity and physical behavior begins. The patient is recorded 24 hours a day by a video camera, capturing any movements, sounds, or behaviors that coincide with changes in the brain’s electrical signals. When the patient or a loved one observes an event, they press an event button to mark the precise time on the recording, helping the clinical team correlate the data. Safety is maintained through the continuous presence of nursing staff, padded bed rails, and emergency protocols, which are important since the goal is to record a seizure.
Understanding the VEEG Results
After the monitoring period is complete, a neurologist specializing in EEG interpretation reviews the extensive data collected. The analysis involves meticulously correlating the video footage of the patient’s physical events with the corresponding electrical patterns recorded on the EEG. The physician looks for characteristic waveforms, such as spikes or sharp waves, that indicate abnormal electrical discharges consistent with epileptic seizures. A positive result confirms that the patient’s episodes are epileptic events, and the location of the abnormal brain activity helps determine the seizure type and its origin. If the patient’s physical events do not correspond with any electrical abnormality on the EEG, it suggests a diagnosis of a non-epileptic event. The VEEG findings are used to make informed decisions about the next steps, which may include adjusting anti-seizure medication, recommending further diagnostic imaging, or proceeding with a consultation for epilepsy surgery.