Abstracts

Rationale: Clinical management and safety of patients are relevant issues in Epilepsy Monitoring Units (EMUs), however regulations and standardized protocols are lacking. In this study, the Task Force on Safety in EMU of the EEMA (European Epilepsy Monitoring unit Association) aimed to make inventory of standard practices in European EMUs, focusing in particular on safety issues. Methods: A questionnaire ( 87 items; multiple choice answers), exploring different activities performed in EMU, was distributed to European EMUs; 1 EMU in Israel was also enrolled. We analyzed the data obtained from 48 EMUs, located in 18 countries, that responded to the questionnaire. We report the results related to safety issues. Results: Thirty-six (75%) EMU monitor both adults and children, 37 (77%) perform both invasive and non-invasive recordings. Relevant findings on safety issues were: - continuous patient observation in 38 EMUs (80%-EMUs), intermittent or daytime in the remaining; observation performed mainly by technician (71%-EMUs) and nurse (71%-EMUs), often in combination; patient s relatives are also involved (50%-EMUs). Automatic systems for detection of seizures (15%-EMUs), movement (8%-EMUs), oxygen desaturation (33%-EMUs) and ECG abnormalities (17%-EMUs) have limited use. AED withdrawal/tapering is performed both for presurgical evaluation (100%-EMUs) and non-presurgical diagnostic EMU (96%-EMUs). Criteria taken in consideration for AEDs withdrawal/tapering are: seizure frequency (89%); seizure type (94%), history of status epilepticus (89%), however, protocols for AEDS withdrawal/tapering and management of status epilepticus/cluster of seizures vary widely among the different EMUs. Injury prevention consists mainly of protections in beds (96%-EMUs); measures such as anti-suffucation pillows (21%-EMUs), protections in EMU rooms (37%-EMUs) and bathrooms (25%-EMUs) are less common. All EMUs experienced a wide range of seizure-related adverse events (SRAE), although their incidence varied among the EMUs. The most frequently reported SRAE are falls/traumatic injuries (up to 10% of recordings), status epilepticus (up to 10% of recordings ), bone fractures (up to 5% of recordings), post-ictal psychosis (up to 3% of recordings), cardiorespiratory compromise (up to 2% of recordings). Two cases of SUDEP have occurred. The most common causes of extended EMU stays are inability to capture enough seizure for localization, injuries, reintroduction of AEDs.Conclusions: Our survey on European EMUs shows a wide variation in practice patterns. The incidence of some SRAE, such as status epilepticus and falls or traumatic injuries (both reported to occur in up to 10% of recordings) raises safety concerns. Definition of protective measures and of standardized and shared protocols is necessary for the development of an effective and safe management of patients in EMU.