Video-EEG — Why is video used to diagnose seizures?

When it comes to diagnosing seizures or seizure-like events, your doctor may recommend a few types of testing. If you have been referred for a video-EEG test — sometimes written as VEEG or VEM — this article will cover some questions you may have.

What is video-EEG (VEEG) monitoring?

Electroencephalography (EEG) tests come in a variety of forms and you can find out everything you need to know about EEG in our ultimate guide

Video-EEG, or VEEG, is the addition of video recording to an EEG recording. Video is recorded at the same time as EEG data to capture what is happening to the body and in the brain during an event. In most cases, electrocardiography (ECG) is also done — this is referred to as video-EEG-ECG monitoring and is considered the gold standard for diagnosing seizures and seizure-like events. 

The person being monitored is connected to an EEG and ECG recording device and needs to stay in view of the camera as much as possible for the duration of the test.

The camera used to record can be:

  • A basic camcorder that needs to be set up on a tripod,
  • Attached to the ceiling or set up with a machine in a hospital, or 
  • Extended out of a monitoring hub
Person setting up the video camera for at-home video-EEG monitoring
Person watching TV while having video-EEG monitoring

The video recorder is set up in the corner of the room to capture the body and environment.

Why is video recorded with EEG data?

Video provides clarity

Video-EEG-ECG testing can be recommended when the cause of events is not clear, and a doctor needs to determine whether the events are epileptic, non-epileptic, or events that look like seizures but are not. 

Eye-witness accounts of events are extremely important for understanding what is happening. Most of the time there are no witnesses when an event occurs, and even if there are witnesses, the accounts are not always reliable as the viewer doesn’t know what to look for or doesn’t remember accurately. 

The advantage of this type of monitoring comes from recording video simultaneously to EEG data. Having both points of data — what’s happening in your brain and to your body — provides doctors with an understanding of what could be causing the events. 

  • How someone’s body behaves may look like a seizure, but the brain activity may not lead to a diagnosis of epilepsy, or even seizures
  • Seizure activity can be happening in the brain, but the behaviour of the body does not obviously look like a seizure to an observer

Referencing an objective video recording with EEG data can clear up confusion. 

EEG trace with video recording to diagnose seizures

Analysing EEG data with video recording during an event.

Video can change an initial diagnosis

A study on the usefulness of using video recording with EEG recording found that the results from monitoring can have a significant effect on the initial diagnosis (58% changed the diagnosis) or management of their condition (73% adjusted management plan). 

The greatest change was the increase in people who were diagnosed with non-epileptic events after VEEG monitoring (from 7% before testing to 31% after testing). This means that an initial diagnosis of epilepsy may in fact be changed to a diagnosis non-epileptic events after VEEG testing.

An accurate diagnosis means that people can get appropriate care and avoid unnecessary treatments and medications. 

Video catches nocturnal events

Many people who have events in their sleep only have the side effects during the morning after as clues that there may be something happening.

Some people describe:

  • A swollen or bitten tongue
  • Headache
  • Sore limbs
  • Unexplained injury to the body
  • Feeling tired despite a full night’s sleep

If you are experiencing any of the above symptoms, please consult your doctor and seek medical advice. 

Events that occur during sleep are difficult to remember and often go unnoticed if there is no one there to witness them. If someone frequently experiences the above symptoms, a doctor may be able to determine if they are having nocturnal events with VEEG monitoring

Where does video-EEG take place?

Testing can take place either in the hospital (known as in-patient monitoring) or in the home (known as out-patient or ambulatory monitoring). 

Hospital monitoring is commonly chosen when:

  • Daily check-ins by a doctor or medical staff are required
  • Testing the effects of reduced seizure medication is required
  • Sleep-deprived monitoring is required
  • Pre-surgery evaluation is required

For diagnostic testing and most other reasons for testing, home monitoring is a suitable alternative.

With monitoring technology rapidly improving, at-home VEEG opens up accessibility for hard to reach areas where people may not have access to a hospital. 

Testing in the home has been shown to be useful for informing a diagnosis and the data quality is similar to in-hospital recordings. Being in the home provides exposure to a natural environment and sometimes triggers exist within a person’s home even if they are not aware. This is particularly useful for monitoring for children.

Child undergoing at-home video-EEG monitoring playing as normal while being recorded

Children can play as normal during at-home video-EEG monitoring.

How long does a video-EEG test take?

Monitoring can last from as short as three hours to as long as 10 days. The duration of the test depends on the referring doctor’s recommendation. 

Longer monitoring is particularly useful for people who have infrequent and unpredictable events. These types of events would not very likely be captured in a shorter EEG study so by increasing the duration of monitoring, the likelihood of capturing an event greatly increases.

 

Use this checklist to prepare for your at-home video-EEG-ECG monitoring [Printable]

 

What about privacy?

Being recorded in the home can be an unsettling idea for some people, but video plays a necessary role in getting the best results possible from monitoring. At Seer Medical, we take your privacy seriously and want to assure you that your medical data is in safe hands. 

Seer Medical provides at-home video-EEG-ECG. Here are answers to questions that we are commonly asked about video monitoring.

FAQs

Is someone watching the video constantly/regularly?

No. Support staff perform technical checks twice a day to ensure that the camera is on and recording, but they do not watch the footage. Video recordings are only reviewed after the monitoring period by clinical scientists if an event occurs.

Will the camera see me when I am getting changed/going to the toilet/bathing?

No. You don’t need to take the camera into the bathroom or whilst you are changing. We recommend setting the monitoring hub and a camera up in the room which you are likely to spend the majority of the day. If you are out of view of the camera briefly as the day goes on that is fine, just as long as you try to be in view when possible.

Can it hear me as well?

Yes. The monitoring hub will record both video and audio for the duration of the monitoring. Audio may be used to support the diagnosis. It’s important to remember that footage and audio are not being watched or listened to. Video and audio recordings are only reviewed after the monitoring period by clinical scientists and only if an event occurs.

Can I still work from home?

Yes. If you are able to work from home then you certainly can. It is advisable not to use your phone or laptop whilst they are plugged in. Remember to keep your laptop on a desk or table, rather than on your lap, as these devices can cause data interference.

Do I have to leave the light on at night?

No. You do not need to leave a room light on overnight as the camera will still be able to capture you with its inbuilt infrared light.

Do I have to set the camera up on anything (desk/shelf etc).

No. The camera is attached to an extendable pole and connected to the monitoring hub. You just need to set up the hub and camera in the room that you are spending the most time in. The camera has a wide lens, so it can see most of the room, meaning you don’t have to be directly in front of it — just in view

Can I have a break from the camera?

Yes. Being recorded 24/7 may get overwhelming, or sometimes you might need to leave the house. You may leave the view of the camera for up to one (1) hour per day for privacy breaks. You can also leave the house for important appointments that cannot be rescheduled. No matter what, please ensure that the monitoring hub is plugged in at all times.

Can I unplug the monitoring hub if I have sensitive conversations or material that I don’t want to be recorded?

No. The monitoring hub must be plugged in at all times to ensure data does not get lost. You can leave the room the monitoring hub is set up in, or move it to another room if you need to.

 

If you have any other questions, our friendly staff are more than happy to help you. Get in touch with us.

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