Abstracts

Rationale: Agitation is characterized by excessive motor or verbal activity, irritability, threatening gestures, and, in some case, assault. Agitation is a common behavioral emergency associated with high risk of injury to patients and health care professionals. As epilepsy surgery is increasingly offered to patients with extra-temporal, non-lesional epilepsy, invasive subdural monitoring will continue to play an important role in determining the epileptogenic zone and adjacent functional eloquent cortex. Complications associated with intracranial monitoring are believed to be independent of the depth electrode technique or type of invasive EEG. No data are available on the corresponding risk of agitation in this patient population Methods: A retrospective chart review of adult and pediatric epilepsy patients with intracranial EEG monitoring in the Cleveland Clinic Epilepsy Center Epilepsy Monitoring Unit (EMU) between January 2008 and April 2010. The lead author (AD) reviewed the records to identify episodes of agitation and any interventions necessary to calm the agitated patient. The degree of agitation was quantified from written descriptions using the Riker Sedation-Agitation Scale (SAS). Potential causes of the agitation were identified from patient records. Multiple logistic regression was used to identify independent risk factors for the development of agitation in this patient group Results: During the study period, 170 patients underwent intracranial EEG monitoring. Behavior consistent with any degree of agitation (SAS score 5-7) was documented in 20 patients (11.7%). Severe or dangerous agitation (SAS 6 or7) was documented in 17 patients (10%). At least one episode of agitation was documented in 3 of 15 SDG (13.3%), 12 of 84 SDG depths (14.2%) and 6 of 42 SEEG patients (14.2%). The documented causes of agitation were post-ictal event (14 of 20, 70%), subdural hematoma (1, 5%) and unspecified (5, 25%). A significant correlation between agitation and Axis II diagnosis (p<0.29,95% Cl-1.2-37%) and older age (p<0.39,Cl-1-2.1%) was noted. Conclusions: In this retrospective review, agitation developed in 11.7% of 170 patients undergoing invasive intracranial EEG monitoring. There was no significant difference in frequency of agitation among the three groups of invasive EEG monitoring. Potential risk factors identified in this group included presence of Axis II diagnosis, older age and postictal confusion or psychosis