The electroencephalogram (EEG) is a key component of the standard workup of patients with epilepsy and paroxysmal events concerning for seizures. The available options for EEG testing have expanded over time since the analog paper EEG. While initially only available within hospital or clinical neurophysiology lab settings, EEG has more recently became available for testing at home via modern ambulatory video EEG equipment. This allows for a lower cost of service and increased convenience, when compared to epilepsy monitoring unit (EMU) admission. The epilepsy team at Ann & Robert H. Lurie Children's Hospital of Chicago successfully initiated an ambulatory video EEG program, and this study reviews one year of data on 77 patients (aged from 19 month to 17 years). Patients were connected to ambulatory video EEG using the International 10-20 System of Electrode Placement with collodion and sent home with video recording equipment for 48 or 72 hours of monitoring. The studies were reviewed by a technologist and an epileptologist for both technical quality and clinical information. Video quality outcomes were grouped into three categories (good video quality, technical issues, and user issues). Events captured were correlated with the EEG recording, video, and patient event log. The overarching response to the program was positive from both patients and providers requesting this modality. Despite ~85% success rate for technical quality of the studies completed, challenges with the service were discovered in the early months of launching the program. Primary issues included technological errors from either the user or equipment failure, as well as issues due to lack of patient compliance with recommended instructions. Patient predictors for an unsuccessful study included young age and developmental status. With refinement of patient selection through provider education and simplified patient instruction, we hope to continue to learn and improve on this useful diagnostic tool.
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