Abstracts

Rationale: Epilepsy affects approximately 15,000 children in Ontario with an estimated 30% of those having medically refractory epilepsy. Epilepsy surgery has shown positive outcomes with approximately an 80% chance that an individual will be seizure-free after surgery (Critical Care Services Ontario, 2015). However, surgical treatment is underutilized. The Epilepsy Implementation Task Force (EITF) recently developed a Comprehensive Epilepsy Program (CEP) and established a framework for epilepsy care in Ontario so as to streamline epilepsy care between District Epilepsy Centers (DEC) and Regional Epilepsy Surgery Centers of Excellence (RESC). The Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Canada, is a DEC. It acquired two pediatric EMU beds in May of 2014. In addition to providing monitoring for potential neurosurgical patients, the EMU is also utilized to clarify paroxysmal events, classify seizure types, and to provide monitoring during medical management. Two patients are monitored in our EMU from Monday to Wednesday of a given week. We performed an observational review of the patient population admitted to our EMU from May 2014 to April 2015.Methods: A retrospective chart review was performed on each patient admitted to our EMU from May 2014 to April 2015. Demographic information, information regarding seizure type & etiology, goals for monitoring and outcome parameters were entered into a Research Electronic Data Capture (REDCap) database. Analysis of our cohort was performed using the REDCap database statistical output tools.Results: Sixty Seven (60% male) patients were admitted for monitoring from May 2014 to April 2015. Thirty percent of patients had a structural lesion to account for seizures, 28% of patients had an unknown etiology, and 18% had a genetic etiology. Goals for monitoring included clarification of events for 80%, surgical evaluation for 15%, classification of seizure diagnosis for 13% and medical management for 12%. Several patients had more than one goal for monitoring. Goals for monitoring were achieved in 82% of our patient population. Of the 12 (18%) for which goals were not achieved during their EMU stay, 4 had continued monitoring with ambulatory EEG or with continuous EEG on the ward, with their goals still not achieved. The 8 patients who did not have further monitoring were followed up in clinic. Fifteen percent of our patients had an EMU stay with a goal of evaluation for neurosurgery and 5 (8%) were referred to a RESC for evaluation for surgical candidacy.Conclusions: Although a DEC serves as a valuable resource for epilepsy monitoring for pre-surgical evaluation, it also has significant utility in the clarification of events suspected to be seizures, classification of seizure type and aiding in medical management. The goals for monitoring were achieved in a large proportion of our patients. References: Epilepsy Implementation Task Force, Provincial Epilepsy Monitoring Unit (EMU) Guidelines for Ontario. Version 1.0, Critical Care Services Ontario, January 2015.