Diagnostic Utility of an Epilepsy Monitoring Unit

Abstract

Guidelines recommend that patients with persist- ent seizures not responsive to standard antiepileptic drugs after 1 year be referred to specialized epilepsy centers for evaluation, which may include inpatient video-electroencephalographic monitoring. This 1-year retrospective, limited-focus review of 213 admissions and 3-year postdischarge review of epilepsy surgery referrals sought to determine if admission to an inpatient adult epilepsy monitoring unit resulted in a definitive diagnosis, a change in diagnosis or treatment, and whether referral patterns were consistent with guidelines. The median duration of time since symptom onset prior to admission was 15 years. At discharge, 87.8% of admissions received a definitive diagnosis. Epilepsy was diagnosed in 73.3% and excluded in 21.6%. Admissions without epilepsy had been treated with antiepileptic drugs for a median of 9 years. Admission resulted in change in treatment in 79%. This review documents the diagnostic utility of an epilepsy monitoring unit while highlighting that time since symptom onset to admission exceeded established guidelines.

A consensus-based approach to patient safety in epilepsy monitoring units: Recommendations for preferred practices

“…Treatment for epilepsy and its co-morbidities may pose safety risks as well. Video-EEG telemetry is a valuable diagnostic tool used to confirm the diagnosis of epilepsy, classify seizure types, and guide epilepsy treatment including epilepsy surgical evaluations [1][2][3][4]. In order to achieve the goals of an epilepsy monitoring unit (EMU) admission, it is often necessary to record the events in question, potentially placing patients at risk of harm from seizures or changes in medication.…”

Identification of Pharmacoresistant Epilepsy

“…Part of the reason to recommend a comprehensive center is so that patients who might benefit from surgical procedures can be identified and properly evaluated. Other considerations however are accuracy in diagnosis starting with whether the patient in fact has epilepsy or some other disorder whose symptoms are mistaken for seizures 32,42,52,56. In addition especially in the case of childhood epilepsy, accurate diagnosis of the specific type of epilepsy is key, to the extent that may influence treatment and management decisions and provide information about likely prognosis.…”

The influence of staffing on diagnostic yield of EMU admissions: A comparison study between two institutions

“…Previously published retrospective series from tertiary epilepsy centers have found an average duration of EMU admission for event classification ranging from 3 to 6 days, but the range is broad [3,4,8]. Friedman …”