- •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.
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.
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Epilepsy & Behavior
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Reasons for prolonged length of stay in the epilepsy monitoring unit.Epilepsy Res. 2016; 127: 175-178https://doi.org/10.1016/j.eplepsyres.2016.08.030
- Correlation of seizure frequency and medication down-titration rate during video-EEG monitoring.Epilepsy Behav. 2016; 64: 51-56https://doi.org/10.1016/j.yebeh.2016.08.026
- Diagnostic utility of video EEG monitoring in paroxysmal events.Acta Neurol Scand. 1996; 94: 320-325https://doi.org/10.1111/j.1600-0404.1996.tb07073.x
- Instruction manual for the <scp>ILAE</scp> 2017 operational classification of seizure types.Epilepsia. 2017; 58: 531-542https://doi.org/10.1111/epi.13671
- The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic.Epilepsy Behav. 2021; 122108229https://doi.org/10.1016/j.yebeh.2021.108229
- Seizure Frequency Process and Outcome Quality Measures.Neurology. 2022; 98: 583-590https://doi.org/10.1212/WNL.0000000000200239
- Seizure clusters and adverse events during pre-surgical video-EEG monitoring with a slow anti-epileptic drug (AED) taper.Clin Neurophysiol. 2012; 123: 486-488https://doi.org/10.1016/j.clinph.2011.08.011
- How should cost data in pragmatic randomised trials be analysed?.BMJ. 2000; 320: 1197-1200https://doi.org/10.1136/bmj.320.7243.1197
- A Study of the Statistical Inference Criteria: Can We Agree on When to use Z Versus t?.Decis Sci J Innov Educ. 2004; 2: 177-192https://doi.org/10.1111/j.1540-4609.2004.00043.x
- The ASA Statement on p -Values: Context, Process, and Purpose.Am Stat. 2016; 70: 129-133https://doi.org/10.1080/00031305.2016.1154108
- Evaluating the Utility of Inpatient Video-EEG Monitoring.Epilepsia. 2004; 45: 928-932https://doi.org/10.1111/j.0013-9580.2004.51003.x
- A Prospective Study on the Cost-Effective Utilization of Long-Term Inpatient Video-EEG Monitoring in a Developing Country.J Clin Neurophysiol. 2009; 26: 123-128https://doi.org/10.1097/WNP.0b013e31819d8030
- Recommendations Regarding the Requirements and Applications for Long-term Recordings in Epilepsy.Epilepsia. 2007; 48: 379-384https://doi.org/10.1111/j.1528-1167.2007.00920.x
- Quality and safety in adult epilepsy monitoring units: A systematic review and meta-analysis.Epilepsia. 2016; 57: 1754-1770https://doi.org/10.1111/epi.13564
- Epilepsy monitoring units in Saudi Arabia: Where do we stand compared to developed countries?.Neurosciences. 2018; 23: 244-249https://doi.org/10.17712/nsj.2018.3.20170412
- Patients’ safety in the epilepsy monitoring unit.Curr Opin Neurol. 2014; 27: 213-218https://doi.org/10.1097/WCO.0000000000000076
- Video-EEG monitoring: Safety and adverse events in 507 consecutive patients.Epilepsia. 2011; 52: 443-452https://doi.org/10.1111/j.1528-1167.2010.02782.x
- Decrease in mortality of adult epilepsy patients since 1980: lessons learned from a hospital-based cohort.Eur J Neurol. 2017; 24: 667-672https://doi.org/10.1111/ene.13267
- Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study.Lancet Child Adolesc Health. 2019; 3: 627-635https://doi.org/10.1016/S2352-4642(19)30201-9
- Association of Levels of Specialized Care With Risk of Premature Mortality in Patients With Epilepsy.JAMA Neurol. 2019; 76: 1352https://doi.org/10.1001/jamaneurol.2019.2268
- Epilepsy monitoring units can be safe places; a prospective study in a large cohort.Epilepsy Behav. 2020; 102106718https://doi.org/10.1016/j.yebeh.2019.106718
- Guideline Twelve: Guidelines for Long-Term Monitoring for Epilepsy.J Clin Neurophysiol. 2008; 25: 170-180https://doi.org/10.1097/WNP.0b013e318175d472
- Essential services, personnel, and facilities in specialized epilepsy centers-Revised 2010 guidelines.Epilepsia. 2010; 51: 2322-2333https://doi.org/10.1111/j.1528-1167.2010.02648.x
- Indications and methodology for video-electroencephalographic studies in the epilepsy monitoring unit.Epilepsia. 2018; 59: 27-36https://doi.org/10.1111/epi.13938
- Current practice and recommendations in UK epilepsy monitoring units. Report of a national survey and workshop.Seizure. 2017; 50: 92-98https://doi.org/10.1016/j.seizure.2017.06.015
- Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery.Seizure. 2016; 38: 38-45https://doi.org/10.1016/j.seizure.2016.03.009
- How Long Does It Take to Make an Accurate Diagnosis in an Epilepsy Monitoring Unit?.J Clin Neurophysiol. 2009; 26: 213-217https://doi.org/10.1097/WNP.0b013e3181b2f2da
- Optimal duration of video-electroencephalographic monitoring to capture seizures.J Clin Neurosci. 2016; 28: 55-60https://doi.org/10.1016/j.jocn.2015.10.032
- Minimum standards for inpatient long-term video-EEG monitoring: A clinical practice guideline of the international league against epilepsy and international federation of clinical neurophysiology.Clin Neurophysiol. 2022; 134: 111-128https://doi.org/10.1016/j.clinph.2021.07.016
- Clinical characteristics of video-EEG patients: Limited utility of prolonging VEEG study duration beyond 5 days for spell classification.Epilepsy Behav. 2020; 103106827https://doi.org/10.1016/j.yebeh.2019.106827
- Epilepsy monitoring unit length of stay.Epilepsy Behav. 2016; 58: 102-105https://doi.org/10.1016/j.yebeh.2016.02.031
- The number of seizures needed in the EMU.Epilepsia. 2015; 56: 1753-1759https://doi.org/10.1111/epi.13090
Published online: May 17, 2023
Accepted: April 28, 2023
Received in revised form: April 27, 2023
Received: January 7, 2023
© 2023 Elsevier Inc. All rights reserved.