Highlights
- •Time to last seizure may influence the time to record earlier seizures during the admission to epilepsy monitoring unit (EMU).
- •Time to last seizure prior to EMU admission appeared to have an impact on epilepsy classifications and length of hospital stay (LOHS).
- •The utilization of EMU might be enhanced by considering the time to last seizure before admission to EMU.
Abstract
Introduction and background
The impact of the timing of the last seizure (TTLS) prior to admission to the epilepsy
monitoring unit (EMU) on epilepsy classification is unclear for which we conducted
this study.
Methods
We reviewed patients with epilepsy admitted to EMU between January 2021 and April
2022 and identified TTLS before EMU admission. We considered EMU yield as whether;
it confirmed epilepsy classification, added new knowledge to the classification, or
failed to classify epilepsy.
Results
We studied 156 patients. There were 72 (46%) men, with a mean age of 30. TTLS was
divided according to a one- or three-month cutoff. We confirmed the pre-EMU epilepsy
classification in 52 (33%) patients, learned new findings on epilepsy classification
in 80 (51%) patients, and failed to classify epilepsy in 24 (15%) patients. Patients
with “confirmed epilepsy classifications” reported seizures sooner to EMU admission
than other groups (0.7 vs. 2.3 months, p-value = 0.02, 95% CI; −1.8, −1.3). Also,
the odds of confirming epilepsy classification were more than two times in patients
with TTLS within a month compared to those with TTLS of more than a month (OR = 2.4,
p-value = 0.04, 95% CI; 1.1, 5.9). The odds were also higher when the 3-month TTLS
cutoff was considered (OR = 6.2, p-value = 0.002, 95% CI; 1.6, 40.2). Confirming epilepsy
classification was also associated with earlier seizures recorded at one- or three-month
cutoff (OR = 2.1 and OR = 2.3, respectively, p-value = 0.05). We did not observe similar
findings when we modified the classification or failed to reach a classification.
Conclusions
The timing of the last seizure before EMU admission appeared to influence the yield
of EMU and enhanced the confirmation of epilepsy classifications. Such findings can
improve the utilization of EMU in the presurgical evaluation of patients with epilepsy.
Keywords
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Article info
Publication history
Published online: May 17, 2023
Accepted:
April 28,
2023
Received in revised form:
April 27,
2023
Received:
January 7,
2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
