SEIZURES AND EPILEPSY IN CHILDHOOD: UNDERSTANDING YOUR CHILD’S TESTS – AMBULATORY EEG MONITORING

Ambulatory monitoring is usually performed with a small tape cassette worn on the belt and attached by small wires to EEG electrodes pasted to the scalp. These cassettes can record EEG for twenty-four hours without a change in the tape. When the person wearing the monitor has an “episode,” or feels the warning of an episode, he can push a button; a mark will then be made on the cassette tape. For children it is important to have an observer record the time on the machine and also any suspected or unusual behaviors, data to be correlated later with any abnormalities appearing on the recorded EEG.Reading twenty-four hours worth of EEG paper would be cumbersome and time-consuming, but the tapes can be played at sixty times the normal speed with the technician or doctor listening for the characteristic sounds of seizures. If such abnormalities are heard, the tape is slowed down and the EEG tracings displayed on a videoscreen for further analysis. This then becomes an efficient method of screening for EEG abnormalities and seizures.While ambulatory monitoring permits recognition of major brain wave abnormalities, such as generalized spike-wave seizures, it is not, however, precise enough for pre-surgical evaluations. There are also a few additional drawbacks and limitations to the ambulatory monitoring test. Because the child being monitored is usually at home, and because it is not uncommon for one or more of the electrodes to become loose or unglued without anyone knowing, the monitoring may yield less than accurate reports. It may be impossible to interpret any episodes that occur if not all of the electrodes are working. True to Murphy’s Law, it is invariably the critical electrode that malfunctions.It may be difficult to tell what is a seizure and what isn’t. If the tape is scanned rapidly, brief events may be missed unless they have been identified earlier by the child or the observer. That is why it is so important for an accurate diary to be maintained during the recording. Also, if events are occurring infrequently, they may not occur at all while the child is being monitored. Thus, ambulatory monitoring is impractical for assessing rare events. Ambulatory monitoring is not for everyone; in selected cases, however, it can be useful.*86\208\8*

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