Differential diagnosis in epilepsy is sometimes challenging. Video-electroencephalography (V-EEG) is an essential tool in the diagnosis and management of epilepsy. The prolonged duration of V-EEG recording increases the diagnostic yield of a conventional V-EEG. The right length of monitoring for different indications is still to be established. We present a retrospective descriptive study with a sample of 50 patients with long-term V-EEG monitoring, with a mean age of 36.1 years, monitored from 2013 to 2019 at the Burgos University Hospital. The mean monitoring time was 3.6 days. Events were obtained in 76% of the patients, corresponding to epileptic seizures (ES) in 57.9% of them, with psychogenic non-epileptic seizures (PNES) in 39.5%, and with episodes of both pathologies in 2.6% of the patients. We found that the first event was highly representative, and it correlated with the rest of the events that would be recorded. Moreover, 92% of the first PNES had been captured at the end of the second day, and 89% of the first ES by the end of the third day. V-EEG for differential diagnosis between ES and PNES can be performed in hospitals without specialized epilepsy surgery units. For this indication, the duration of long-term V-EEG can be adjusted individually depending on the nature of the first event.
