Abstracts

Rationale: Current epilepsy monitoring unit (EMU) practice proposals have focused on improving patient care and safety. However, many of the proposed practices have focused on patients admitted for phase I scalp EEG recording only. Although patients admitted for phase II intracranial monitoring require much more complex interdisciplinary collaboration, including neurosurgical and intensive care, practice proposals focused on patient care and safety during phase II monitoring are lacking. Identifying areas for quality and safety improvement during phase II epilepsy monitoring from an interdisciplinary perspective is needed.Methods: Four patients admitted for phase II epilepsy monitoring at a Veterans Administration hospital were selected for review. Charts were retrospectively analyzed from the time of electrode implantation to deplantation and discharge to identify areas for quality and safety improvement.Results: No intraoperative complications occurred in any of the cases reviewed. A non-contrast head CT was performed immediately postoperatively in 3 patients, and a spinal fluoroscopy was performed in 1 patient. Postoperative antibiotics, cefazolin or vancomycin/gentamicin, were administered for 48 hours in 3 cases. Antibiotics were continued throughout intracranial monitoring in 1 case due to persistent mild leukocytosis without clear clinical infection. No patients received dexamethasone. All patients were initially monitored in the surgical intensive care unit (SICU) under the primary care of the neurosurgery team until they were deemed stable enough to be transferred to the EMU (12-72 hours). Continuous video-EEG monitoring was initiated in the SICU and antiepileptic drugs were tapered at the discretion of the epilepsy team only after the patient was transferred to the EMU. All patients had a one-on-one sitter present 24 hours of the day. Seizures were captured in all 4 cases without seizure-related complications. Five seizures were captured via bilateral depth electrodes in a 51 y/o male over 10 days. Eight seizures were captured via bilateral strip placement in a 37 y/o male over 9 days. Six seizures were captured in a 63 y/o male over 12 days and 72 seizures captured in a 57 y/o male over 11 days via subdural grid and strip placement. One of these patients developed a large epidural hematoma with subdural components with neurologic deficits noted on post-operative day 3, detected by routine neuro checks by the primary physician, requiring emergency surgery to evacuate the hematoma with resultant reversal of deficits.Conclusions: Phase II epilepsy monitoring requires complex interdisciplinary and collaborative care; a number of areas for improvement across disciplines exist. Adherence to existing guidelines pertaining to EMU organization is essential, however measures must also be taken to ensure prevention of complications. Future research should place an emphasis on identifying special needs within this population, interdisciplinary team coordination, and implementation of protocols and checklists to optimize patient safety during phase II epilepsy monitoring.