Abstracts

Rationale: Prolonged video-EEG (VEEG) monitoring is an invaluable tool in the diagnosis and treatment of epilepsy and unclassified events. Previous reports from the adult literature have demonstrated an increased risk of status epilepticus and injury from seizures during the examination. The goal of our study was to review the safety and utility of our pediatric epilepsy monitoring unit (PEMU) experience. Methods: We retrospectively reviewed the PEMU reports and charts of 225 patients 18 years of age and younger with 241 admissions totaling 768 days at our tertiary hospital from January 1, 2009 to December 31, 2009. Demographic information, final event diagnoses, quantity of events, duration of events and medical complications due to monitoring were analyzed. Results: Of the 241 admissions to the PEMU, 106 (44.0%) captured epileptic seizures, 79 (33%) demonstrated non-epileptic events (NEE), and 36 (15%) failed to capture any events. The average length of stay was 3.2 days. The patients had a mean age of 9.4 years old with 113 males (47%). 20 (8.3%) evaluations were for the presence or absence of continuous spike and wave of slow-wave sleep of which 11 were positive. Five patients underwent intracranial monitoring (4 subdural grids and 1 depth wire). Medical complications include: 1 fall due to seizure, 1 subdural fluid collection associated with grid placement causing paresis, and 1 patient with hip pain following a seizure. No patients had any long-term complications. In evaluating the rate of status epilepticus, defined as seizure lasting longer than 15 minutes, 6 patients had 8 episodes. This constitutes 2.5% of all admissions and 5.1% of admissions with epileptic seizures. The median duration was 26 minutes and the mean duration was 67 minutes with 2 patients requiring transfer to the pediatric intensive care unit. Rescue medications were used in 11 patients (5.8%) of admissions, including 3 patients who had non-epileptic events. Conclusions: Medical complications from seizures occurring during VEEG monitoring are an increasing area of concern regarding patient safety. In comparison to some published adult literature, our patients experienced a higher rate of status epilepticus but a lower rate of medical complications. We also had a relatively short length of stay with a surprisingly high number of NEE. The 3 patients with NEE who received rescue medications highlights a need for improved real-time interpretation of VEEG data as it is being recorded to avoid over treatment. Overall, our study suggests that prolonged VEEG monitoring in the pediatric age group appears to be a safe diagnostic procedure.