Safety in the epilepsy monitoring unit: A retrospective study of 524 consecutive admissions

Fahoum, Firas; Omer, Nurit; Kipervasser, Svetlana; Bar-Adon, Tal; Neufeld, Miri Y.

doi:10.1016/j.yebeh.2016.06.002

Cited by 26 publications

(26 citation statements)

References 19 publications

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“…There were no previous studies in which all AEDs were discontinued before the VEEG admission. Interestingly, we and a number of other authors observed no complications related to discontinuation or dose reduction of AEDs [2,9,10,18,19,[21][22][23][24][25]. However, it is too early to conclude that we can discontinue all AEDs from our single series of VEEG monitoring.…”

Section: Discussionmentioning

confidence: 48%

Timing of seizure occurrence and response of medical staff in video-EEG monitoring for drug-resistant epilepsy

Dhuha

Konno

Yokota

et al. 2017

E&S

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Purpose:The pur pose of this study was to deter mine the optimal dur ation of long-term video-EEG monitoring (VEEG) in patients with epilepsy. The response time of medical staff to seizures was also evaluated from the viewpoint of safety of the monitoring. Methods: We estimated the optimal duration of VEEG from the seizure onset pattern. We retrospectively investigated all VEEG sessions performed in our department during the period between June 2005 and July 2016. Sessions with no seizures and with only non-epileptic seizures were excluded. Using 91 sessions from 69 patients, information on the onset time and response time of medical staff to seizures was collected. Results: The median duration from the start of VEEG to the first seizure was 2 days. Seventy-seven percent of first seizures occurred within 3 days of VEEG. The median duration from the first seizure to the third seizure was 2 days. Eighty percent of third seizures occurred within 3 days of the first seizure. There was no significant diurnal distribution of seizure occurrence. Medical staff did not respond to 20% of generalized seizures and 69% of focal seizures. The overlooking of generalized seizures occurred mainly during the hours of 1-2 pm and 8-9 pm but there was no significant diurnal pattern in overlooking generalized and focal seizures.Conclusion：Based on these findings, we suggest that VEEG can be terminated when no seizure occurs within 4 days after onset. In our VEEG protocol, in which all antiepileptic drugs were discontinued before the start of a session, there was no diurnal pattern of seizure occurrence. This is the first study investigating the diurnal pattern of overlooking seizures by medical staff during VEEG. Since there was no diurnal pattern to the overlooking, medical staff should pay equal, 24-hour attention to patients on VEEG.

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Section: Discussionmentioning

confidence: 48%

Timing of seizure occurrence and response of medical staff in video-EEG monitoring for drug-resistant epilepsy

Dhuha

Konno

Yokota

et al. 2017

E&S

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“…Previous work concerning patient safety mainly focused on reporting occurrence of adverse events in the EMU in selected patient groups or in consecutive patients . There is a need to establish standardized safety protocols to minimize adverse events and improve patients’ safety outcomes . This was also emphasized by the NAEC in its revised guidelines for specialized epilepsy centers in 2010 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients’ safety has become a major concern in the organization of epilepsy monitoring units (EMUs) because it is an iatrogenic exposure of patients to seizures and their potentially harmful consequences . Despite growing awareness for safety issues in the EMU, many aspects remain to be addressed.…”

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confidence: 99%

Personalized safety measures reduce the adverse event rate of long‐term video EEG

et al. 2017

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SummaryObjectiveSafety in epilepsy monitoring units (EMUs) has become an increasing concern because adverse events occur in up to 10% of patients undergoing long‐term video EEG in EMUs. The aim of this study was to assess the effectiveness of a specific safety protocol in an EMU.MethodsWe retrospectively assessed the adverse event rates in a group without (group 1, 84‐month period, Innsbruck, Austria) and a group with (group 2, 33‐month period, Salzburg, Austria) personalized safety measures utilizing a standardized protocol for long‐term epilepsy monitoring in high‐risk patients. Differences in adverse event rates during and after long‐term video EEG between the two groups were calculated and compared.ResultsIn group 1, 44/507 (9%, 95% confidence interval [CI] 6.5–11.5%) patients experienced 53 adverse events: 20/507 (4%, 95% CI 2.6–6.0%) patients had psychiatric events, 15/507 (3%, 95% CI 1.8–4.8%) patients sustained a total of 19 injuries during seizures, and 10/507 (2%, 95% CI 1.1–3.6%) patients had 13 episodes of status epilepticus; one adverse event was treatment‐related (valproic acid–induced encephalopathy; 1/507, 0.2%, 95% CI 0.0–1.1%). By using the new safety protocol in group 2, the adverse event rate was only 5% (95% CI 3.4–7.6%; 30 adverse events in 26/491; 45% reduction; p = 0.036), in contrast. These events included 13 psychiatric complications in 13/491 (2%, 95% CI 1.6–4.5%, p = 0.252) patients, 12 seizure‐related injuries in 9/491 (2%, 95% CI 1.0–3.4%, p = 0.250) patients, and 5 episodes of status epilepticus in 4/491 (1%, 95% CI 0.3–2.1%, p = 0.120) patients.SignificanceImplementation of personalized safety measures in high‐risk patients resulted in a clinically relevant reduction of adverse events in the EMU. Safety protocols are a valid tool to reduce the occurrence of adverse events in EMUs.

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“…The term ADEs used in this study includes unintended injuries resulting from medication use at usual therapeutic doses (Nebeker et al 2004), excluding those due to overdose and medication errors. Previous studies reported higher incidence of ADEs in PwNDD compared with those without (McCracken 2005;Mahan et al 2010;Aagaard & Hansen 2011;Fahoum et al 2016;Scheifes et al 2016b;Sheehan et al 2017), with a variety of ADEs being reported during the use of psychotropic medications, e.g., cardiovascular complications (Vigod et al 2016), cognitive and emotional disorders (Kovshoff et al 2016) and metabolic disorders (Aagaard & Hansen 2011;Vigod et al 2016). Despite this, epidemiological profile analysis regarding ADEs serious enough to warrant hospital acute care is scarce in the extended group of NDD.…”

Section: Introductionmentioning

confidence: 99%

Adverse drug event‐related hospitalisation in persons with neurodevelopmental disorders: a state‐wide retrospective cohort study

Zhou

Salvador‐Carulla

et al. 2019

J intellect Disabil Res

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Background Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). Objective The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. Methods The all‐inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE‐related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. Results A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE‐related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14‐year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE‐related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio‐economic disadvantage and less private insurance coverage, suffered with less severe but different co‐morbid clinical conditions and incurred more challenges in the acute hospital care setting. Conclusion Although the pattern of ADE‐related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group.

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Safety in the epilepsy monitoring unit: A retrospective study of 524 consecutive admissions

Cited by 26 publications

References 19 publications

Timing of seizure occurrence and response of medical staff in video-EEG monitoring for drug-resistant epilepsy

Timing of seizure occurrence and response of medical staff in video-EEG monitoring for drug-resistant epilepsy

Personalized safety measures reduce the adverse event rate of long‐term video EEG

Adverse drug event‐related hospitalisation in persons with neurodevelopmental disorders: a state‐wide retrospective cohort study

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