Withdrawal of antiepileptic drugs during presurgical video-EEG monitoring: an observational study for evaluation of current practice at a referral center for epilepsy

Henning, Oliver; Baftiu, Arton; Johannessen, Svein I.; Landmark, Cecilie Johannessen

doi:10.1111/ane.12179

Cited by 33 publications

(44 citation statements)

References 19 publications

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“…FBTCS are, however, far more frequent than status epilepticus during VEM and are significantly related to physical injuries and sudden unexpected death in epilepsy (or SUDEP). Previous studies dealing with FBTCS during VEM included between 54 and 151 patients, with 18% to 57% of them having FBTCS during VEM . The proportion of people with FBTCS in our study (2014/15: 28%; 2004/05: 29%) was largely within the range reported by other studies.…”

Section: Discussionsupporting

confidence: 78%

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

et al. 2020

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Objective To determine predictors of focal to bilateral tonic‐clonic seizures (FBTCS) during video–electroencephalography (EEG) monitoring (VEM). Methods All adult patients undergoing presurgical VEM from 2014 to 2015 in the department of epileptology were eligible (N = 229). Those with refractory focal epilepsy and epileptic seizures recorded during VEM were analyzed (N = 188, Group 1). To assess the effects of antiepileptic drug (AED) taper, the total AED load was calculated as the sum of the ratios of prescribed daily dose and defined daily dose of all AEDs per VEM day and was correlated with the occurrence of focal seizures without bilateral tonic‐clonic seizures (FwoBTCS) and FBTCS. To validate the findings, data of patients undergoing VEM in 2004 and 2005 (Group 2, eligible N = 243, analyzed N = 203) were also investigated. Results In Group 1, 53 patients had FBTCS and 135 patients had exclusively FwoBTCS during VEM. Reduced AED load at seizure onset was the most important modifiable risk factor for FBTCS (receiver‐operating characteristic [ROC]: area under the curve [AUC] = 0.78). Furthermore, the risk of FBTCS varied with the history and frequency of FBTCS prior to VEM. For instance, patients had a 50% risk of FBTCS by reducing the AED load to ~20% when no information about history of FBTCS was taken into account, to ~30% when a positive history of FBTCS was taken into account, and to ~50% when a high frequency of FBTCS prior to VEM was taken into account. These findings were largely replicated in Group 2 (59 patients with FBTCS and 144 exclusively with FwoBTCS). Significance The risk of FTBCS during VEM depends on the history and frequency of FTBCS prior to VEM and is particularly associated with the extent of AED reduction. Our data underscore the need for appropriate tapering regimens in VEM units.

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Section: Discussionsupporting

confidence: 78%

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

et al. 2020

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“…Capturing one seizure may be enough to rule out non-epileptic seizures or to make a diagnosis of epilepsy, but is not regarded sufficient for presurgical evaluation. Many researchers have recommended that at least three seizures are required to properly locate the epileptic region [8,9,14,17,18]. Therefore, we investigated the times of occurrence of the first seizure and third seizure.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal protocol for VEEG monitoring, including the duration of monitoring and time of discontinuation of anti-epileptic drugs (AEDs), also has not been determined. Furthermore, occurrence of seizures, particularly generalized seizures, during VEEG monitoring may cause major adverse events including physical injuries and even death from seizures [3,7,9,[11][12][13][14][15]. Medical staff plays important roles in preventing these events during VEEG monitoring [11].…”

Section: Introductionmentioning

confidence: 99%

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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“…Ayrıca, örneğin video EEG monitorizasyonu esnasında dirençli epilepsi hastalarının ilaçları azaltıldığı halde bazen nöbetleri geçici olarak azalmakta ve hatta durabilmektedir. [16] Bu nedenle tedavisi devam eden hastaların 15 günlük istirahat döneminde nöbetleri olmayabilir, eğer hastanede yattıkları oda sürekli video ile izlenmiyorsa rastgele bir zamanda gelişen nöbet, sağlık personeli tarafından görülemeyebilir (sekiz hastada nöbete tanık olunamamıştır). Sonuç olarak, hastaların %13.7'si NEPN olarak tanı almıştır.…”

Section: Discussionunclassified

An approach to epilepsy patients admitted to hospitalization for the purpose of disability determination

Buluş¹

2015

Epilepsi

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SummaryObjectives: In this retrospective study, it was aimed to share the experience gained in Cerrahpaşa Medical Faculty, Department of Neurology regarding a 15 (or 21)-day of observation of epilepsy patients referred by the Social Security Institution (SSI) in an attempt to identify their rate of disability and question the practicality and validity of this practice. Methods: Fifty-eight patients, referred to our clinic and hospitalized for the purpose of determining the disability rate between 2007 and 2014, were retrospectively analyzed. Results: Fifty-eight patients (10 female, 48 male) were included into our study. The number of patients with refractory epilepsy was 18 (33.3%). Twenty-seven cases had witnessed seizures during hospitalization and 11 of these patients were evaluated with psychogenic seizures. We were unable to witness seizures in eight cases. Of the fifty-eight patients, 65.5% of them (n=38) were diagnosed with epilepsy, 20.6% of them (n=12) were psychogenic non-epileptic seizures (PNES) and epilepsy association, 13.7% (n=8) of them were PNES with history, clinical, imaging and interictal EEG assessment. Eighteen of the patients (33.3%) who were known as mentally retarded acquired the right to disability. Eighteen of the 36 patients (33.3% of whose mental state was known) who were known not to be mentally retarded obtained the right to pension because they were diagnosed with drug-resistant epilepsy and were using adequate and regular AEDs. Conclusion: Most of the patients referred for hospitalization for the purpose of determining the disability may be given the disability report only with a good history and short-term video EEG monitoring, without hospitalization. In our opinion, this type of practice might be a more economical, practical and valid behavior in terms of time and place. Key words: Epilepsy; disability. ÖzetAmaç: Bu geriye dönük çalışmada, Sosyal Güvenlik Kurumu (SGK) tarafından, kliniğimize sevk edilen epilepsi hastalarının, özürlülük oranlarının saptanması amacıyla en az 15 (ya da 21) gün yatırılarak gözlenmesi ile ilgili Cerrahpaşa Tıp Fakültesi Nöroloji Kliniği'ndeki deneyimi paylaşmak, bu uygulamanın pratikliğini ve geçerliliğini sorgulamayı amaçladık. Gereç ve Yöntem:Çalışmada 2007-2014 yılları arasında İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Nöroloji Kliniği'ne SGK tarafından maluliyet durumunun belirlenmesi amacıyla yatırılmak üzere sevk edilen ve servisimizde yatırılarak izlenen 58 hastanın kayıtları geriye dönük olarak araştırılmıştır. Bulgular: Çalışmaya 58 hasta (10 kadın, 48 erkek) alındı. Dirençli epilepsisi olan hasta sayısı 18 (%33.3) idi. Yatış sırasında 27 olgu tanıklı nöbet geçirdi. Bu hastalardan 11 'inin nöbeti psikojen olarak değerlendirildi. Sekiz olgunun nöbetine tanık olunamadı. Öykü, klinik, görüntüleme ve interiktal EEG değerlendirmeleri ile birlikte hastaların %65.5'i (n=38) epilepsi, %20.6'sı (n=12) nonepileptik psikojen nöbet (NEPN) ve epilepsi birlikteliği, %13.7'si (n=8) ise NEPN tanılarını aldı. Mental retarde olduğu bilinen 18 (%33.3)...

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Withdrawal of antiepileptic drugs during presurgical video-EEG monitoring: an observational study for evaluation of current practice at a referral center for epilepsy

Abstract: Less than 50% of the patients got a sufficient number of seizures for a conclusive result within 3 days. An increase in the registration period could increase the number of successful registrations.

Cited by 33 publications

References 19 publications

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

Predictors of focal to bilateral tonic‐clonic seizures during long‐term video‐EEG monitoring

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

An approach to epilepsy patients admitted to hospitalization for the purpose of disability determination

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