Abstracts

Rationale: Video-EEG monitoring (VEEG) is the gold-standard for diagnosing events concerning for epileptic seizures. VEEGs are usually recorded continuously over several days with electrodes glued to the head. Electrode-related skin breakdown is not uncommon, and scarring has been described, but actual numbers are not known. The objective of this study was to determine the incidence of electrode-related skin irritation during VEEG in our epilepsy monitoring unit (EMU) and to identify potential risk factors for it, as a foundation for an institutional quality improvement initiative.Methods: All patients admitted to our EMU between May 2012 and March 2013 were assessed for skin lesions before electrodes were applied and at the time of discharge. Data were captured prospectively and included: age, gender, race/ethnicity, length of monitoring (LOM), skin prep medium (SPM) used, self-reported skin sensitivity, history of skin diseases and skin products used the day of admission. We initially recorded data for patients ( baseline group (B-Group)) while using our usual practice of electrode placement (adhering to technician training). We then standardized our electrode placement by selecting a single SPM to be used, raising awareness and regularly monitoring for electrode-related patient discomfort. Patients monitored after standardization formed the standardized group (S-group). Electrode-related skin irritation was graded by trained EEG technologists as mild, moderate, or severe depending on the size of the irritated area. The presence of bleeding and discharge (B/D) was also noted and was used as a marker of deeper lesions. Inter-rater reliability was assessed. Chi-square test was used for statistical analysis.Results: Data on a total of 234 patients were evaluated (B-Group: n=121; S-Group: n=113). Age, gender and race composition were comparable in both groups. About two-thirds of patients were women and over 80% were white. Median LOM was 3 days. Skin lesions were common in the B-Group, affecting 33 of 121 patients (28%). Electrode placement on facial skin, as opposed to scalp skin (p<0.0001), and LOM >3 days (p<0.0001) were significantly associated with the occurrence of electrode-related skin irritation. Male gender was significantly associated with electrode-related bleeding or discharge (p=0.012). Other variables were not predictive of skin irritation. Standardization of electrode placement and monitoring led to a significant reduction in the occurrence of electrode-related bleeding or discharge.Conclusions: Electrode-related skin irritation is a common problem for patients undergoing VEEG monitoring and may have long-term cosmetic effects. Electrode site on facial skin and LOM were significantly associated with the occurrence of skin irritation in our baseline group. A standardized protocol that used a single SPM, and helped detect problems before damage had occurred, was associated with a decreased chance of deeper skin lesions. Studies of additional interventions that may prevent skin breakdown are planned.