Video-electroencephalography (video-EEG) remains the gold standard for diagnosing paroxysmal events, enabling the simultaneous recording of clinical manifestations with corresponding EEG correlates. Its development has required several decades of technological innovation, progressing from early photography and film techniques to modern digital tools. Initially confined to specialized epilepsy surgery centers, advancements in digital technology and growing diagnostic demands have made video-EEG widely accessible across clinical settings. Currently, video-EEG is primarily used to differentiate paroxysmal events, classify seizure types, define electroclinical syndromes, quantify epileptiform discharges, and perform presurgical evaluation. Polygraphy, incorporating additional measures like electrocardiogram (EKG), blood pressure, and respiratory monitoring, enhances its diagnostic value. Even if the safety data are heterogeneous, video-EEG is considered a safe procedure with a low rate of adverse events. Future advancements promise significant improvements in video-EEG technology, offering enhanced diagnostic accuracy, patient comfort, and personalized treatment. These innovations aim to refine data quality, accessibility, and usability. Beyond diagnostics, video-EEG serves as a crucial educational tool for healthcare providers and students, aiding in the recognition of seizures and understanding key symptoms and signs of epilepsy. As technology advances, video-EEG will play an even greater role in improving epilepsy care.