Abstracts

Patients with reports of ongoing seizures are often recommended for admission to an Epilepsy Monitoring Unit for Phase I evaluation to determine next most appropriate care, including possible surgical candidacy. Pressures exist from both patients and third party payers for this assessment to be carried out in the most efficient manner. Antiseizure medications are frequently withdrawn to increase the chance that sufficient events will be captured in a timely fashion. Data is limited regarding safety of this practice. All patients 18 years and older referred for seizures and seizure-like events admitted from 1/1/2000 through 12/31/2004 were reviewed. Data obtained included age, gender, admission seizure type, captured seizure type(s), including non-epileptic events, duration of admission, baseline antiseizure medications and additional medications administered (including rescue medications for acute seizures, staus epilepticus and impending status epilepticus). Patients with intracranial monitoring or history of status epilepticus were excluded from evaluation. A total of 532 patients who were monitored (180 male, 352 female) had medications withdrawn or reduced. 316 patients experienced target events. 191 patients experienced seizures. A total of 29 patients received rescue therapy - 23 received lorazepam, 2 received diazepam, 2 received clonazepam, 2 received fosphenytoin. Almost all received therapy because the study was completed as an added measure was provided for safety while medications were reinstated or because, patient completed the study and was experiencing seizures above baseline frequency in a crescendo fashion. Only one patient required therapy for impending status. No one was treated for status epilepticus. One patient developed spike wave stupor which resolved spontaneously without treatment. This occurred overnight with no technologist present. Drug withdrawal for Phase I long term video eeg monitoring is safe. Impending status epilepticus or status epilepticus is a rare event that may be aborted with appropriate therapy. However, appropriate safeguards must be in place including intravenous access when withdrawing medication, and an ability to assess and treat rapidly. In addition, as it becomes increasingly difficult to have qualified technologists present 24 hours/ day, there is a risk of nonconvulsive seizures occurring with a delay in diagnosis and hence treatment.