How much time is enough? Establishing an optimal duration of recording for ambulatory video EEG

OBJECTIVE: Ambulatory video EEG allows for extended recording of EEG in the comfort of a patient's home. However, the optimal duration of recording to capture clinical events is yet to be established. The current study uses retrospective analyses to identify an optimal recording duration for at‐home video EEG. METHODS: A retrospective review was performed utilizing an anonymized database of ambulatory video EEG recordings performed between March and September 2020 with a national in‐home EEG provider. Only completed assessments with neurologists' reads of raw data were reviewed, resulting in 3644 unique studies divided into three age cohorts: pediatrics (n = 941), adult (n = 2020), and geriatric (n = 683). Cohorts were characterized by assessment yield and time to first typical clinical event, as well as subsequent typical events over duration of recording. RESULTS: Frequency distributions reveal over half of first events are captured within 12 hours, but longer recording durations capture a much wider majority of both first typical events, as well as the mean number of subsequent events (5 clinical events). In 72 hours, over 97% of first events were observed in adult and geriatric patients, as well as over 95% of the mean number of subsequent events. In children, time to first event was significantly earlier than either adult or geriatric samples, with 98% of first events, and 92.8% of the mean number of subsequent events being observed in 48 hours. SIGNIFICANCE: These results from a large‐scale, national dataset of patients using in‐home EEG monitoring suggests recording at least 48 hours in duration for children, and at least 72 hours in duration for adult and geriatric samples, is optimal to maximize the likelihood of observing typical clinical events to facilitate diagnosis.