Abstracts

Rationale: Video-EEG is a gold standard utilized to record typical clinical events and evaluate seizure classification. In majority of comprehensive epilepsy centers current practice is to minimize or terminate antiepileptic drugs upon patient admission to obtain diagnostically useful information and shorten hospital stay. However, as video-EEG has become a widespread diagnostic tool that is not performed only at specialized epilepsy centers, but also at neurology units, some clinicians are reluctant to change medication due to security risk to the patients. Methods: Time to first, second and third seizures was analyzed in 138 consecutive patients with complex partial seizures during long term video-EEG monitoring. EEG was recorded using the routine 10-20 scalp electrode placement with anterior cheek electrodes and video camera. All seizures were detected by physicians review of the EEG. Results: Mean age of 138 patients was 32 12 years and 66% were females. At least one seizure was recorded in 80 (58%) epilepsy patients during video-EEG monitoring. 70% of these patients had second seizure and 75% of the patients with the second seizure had the third event. Mean time to first seizure was 41h, to the second seizure 57 h and to the third seizure 56 h. Only 24% of patients recognized all their seizures. The average daily dose of medication was carbamazepine 800mg, lamotrigine 200mg, valproic acid 1000mg, oxcarbazepine 1200mg, levetiracetam 2000mg, topiramate 150mg and gabapentin 1200mg. Conclusions: Majority of epilepsy patients had typical seizures during long term monitoring despite no change in their antiepileptic medication. Time to first seizure was similar to previous studies with antiepileptic drugs tappering and thirty percent of our patients had three seizures obtained within 5 days of admission. These findings suggest that long term monitoring can provide important diagnostic information without antiepileptic drugs changes. This work was supported by the Epilepsy Foundation grant to HH.