Abstracts

Rationale: Video-electroencephalographic monitoring (VEM) is critical for distinguishing epileptic from non-epileptic events (NEEs), epileptic seizure type classification, and epilepsy pre-surgical evaluation. In managing patients admitted for VEM, there is no accepted practice guideline. Three important questions about the management of VEM patients are (1) whether it is productive to perform VEM on patients with low outpatient seizure frequency, (2) whether rapid down-titration of antiepileptic drugs (AEDs) during EMU admission helps generate more recorded seizures, and (3) how long a patient who has not yet had a seizure should be monitored in the EMU. This study aimed to answer these three questions Methods: Pre-admission seizure frequency, times and doses of AED administration and times of seizure occurrence were collected on all adult patients admitted to EMU at the Medical University of South Carolina (MUSC) between 2012 and 2014 -- a total of 439 patients. The correlations between EMU seizure frequency and both (1) pre-admission seizure frequency and (2) rate of antiepileptic drug (AED) down-titration were evaluated. The time of occurrence of seizures was evaluated. Estimated AED blood levels were calculated based on the amount and time of AED dose and normalized based on mean AED daily dose. Rate of estimated AED blood level was calculated. Results: There was no correlation between patient-reported outpatient seizure frequency and EMU seizure frequency. In patients who were tapered off AEDs during monitoring, the rate of AED taper correlated with the EMU seizure frequency. Neurologists who tapered patients from AEDs faster generated higher EMU seizure frequencies. In order to record a first event in patients of unknown seizure type, approximately 3.5 days of EMU monitoring was required. Conclusions: Clinicians should not hesitate to admit patients with low pre-admission seizure frequency to the EMU since many of these patients will have a seizure during monitoring. Faster AED down-titration in the EMU increases EMU seizure frequency. In patients who have not yet had a seizure in the EMU, monitoring should continue for at least four days. Funding: NA