Abstracts

To compare patients[apos] seizure documentation with seizure diaries and seizure count documented by in-patient video-EEG-monitoring. In addition, the benefit of daily reminding patients to carefully document all seizures was assessed in a randomized controlled trial (RCT)., Prospective investigation of all in-patients with a diagnosis of epilepsy who received video-EEG-monitoring for at least 24 hours (Oct 2004 - Jul 2005). In a RCT patients received a conventional seizure diary without (group A) or including daily personal reminding (B). Based on video documented semiology and EEG data all monitored seizures were classified as simple-partial seizures (SPS, including auras), complex-partial seizures (CPS) and generalized tonic clonic seizures (GTCS). Pre-ictal EEG-periods were classified regarding the patient[apos]s state of vigilance., We recorded a total of 613 classifiable seizures (190 SPS, 371 CPS, 52 GTCS) in 95 patients (mean age 39.3 years, 43 female). Seizure documentation quality of patients was different depending on seizure type and pre-ictal state of vigilance. Particularly, CPS (72%) and seizures beginning in sleep (86%) were at risk not to be documented by the patient.
59 patients (62%) had an incomplete seizure documentation including 41 patients (43%) who documented no seizure. Incompletely documenting patients had significantly less SPS but significantly more CPS during video-EEG-monitoring as compared to completely documenting patients (Mann-Whitney, p[lt].01). Furthermore they had more seizures beginning in sleep, higher risk for ammonshorn sclerosis, lower educational level and lower verbal learning performance. Regarding RCT group B (with reminding) yielded a higher rate of documented seizures as compared to group A but this difference was not significant., In this sample of in-patients with chronic epilepsies, a high rate of patients with incomplete documentation (62%) as well as a high rate of undocumented seizures (55%) could be revealed during video-EEG-monitoring. Regarding seizure types, CPS were the most common subtype in our study (61%). These, however, were documented most unreliably (72% missing in patients[apos] documentation). Seizures occurring from sleep were less reliably documented than seizures occurring from a waking state (86% versus 31% missing in patients documentation). Seizure frequency, particularly frequency of CPS and frequency of seizures in sleep, ammonshorn sclerosis, low educational level and low verbal learning performance were negative prognostic factors for correct seizure documentation. Although conditions in this investigation are not entirely comparable with out-patient condition at home, evaluations of the status and course of epilepsy in individual patients and clinical studies should consider that seizure diaries provide highly subjective data.,