Comparison of Video-Electroencephalography and Routine Electroencephalography for Diagnosing Seizures Within 14 days of Ischemic Stroke: A Retrospective Study.

Abstract

To compare the clinical value of video electroencephalography (VEEG) and routine electroencephalography (EEG) in diagnosing seizures that occur within 14 days of ischemic stroke onset. A retrospective analysis of 140 ischemic stroke patients suspected of having epileptic seizures was conducted between April 2022 and April 2024. Seventy patients underwent EEG, while 70 underwent VEEG. Diagnostic performance within 24 hours was compared. VEEG had a higher seizure detection rate (74.29% vs. 44.29%) and epileptiform discharge detection rate (90.00% vs. 50.00%), with a shorter time from stroke onset to the first seizure diagnosis (21.15 hours vs. 25.24 hours), as determined on the basis of either recorded EEG/VEEG events or confirmed clinical documentation. VEEG also revealed superior accuracy in distinguishing nonepileptic seizures (95.71% vs. 68.57%) and a higher success rate in localizing epileptic foci (80.00% vs. 40.00%). The detection rate of VEEG for localized epilepsy was greater (90.00% vs. 71.42%), and that of EEG for generalized epilepsy was greater (4.29% vs. 25.71%). The treatment adjustment rates were significantly higher in the VEEG group (57.14% vs. 30.00%). The monitoring duration for VEEG was longer (24 hours vs. 20-30 minutes for EEG), but the compliance rates were similar (98.57% vs. 92.68%). VEEG offers superior diagnostic value over EEG in detecting seizures within 14 days of ischemic stroke onset, providing higher diagnostic accuracy, better differentiation between seizure types, and greater influence on treatment decisions.