Abstracts

Simultaneous video-EEG monitoring in epilepsy monitoring units (EMU) is the goal standard to determine the etiology of spells (seizures vs. non seizures), and to evaluate patients with refractory epilepsy prior to epilepsy surgery. Reimbursement for EMU admissions, especially prolonged ones, by third party payers continue to be very challenging. Applying more aggressive [ldquo]activation maneuvers[rdquo], may trigger events early during admission to EMUs and may shorten duration of hospitalization. We conducted a survey to determine how different activation procedure including anti-epileptic drug (AED) withdrawal, sleep deprivation, hyperventalitation, and phtoic stimulation are utilized in different epilepsy centers. A 19 question EMU survey was e- mailed to epileptologists in the United States. Only one survey was sent to each epilepsy center that was surveyed. The survey asked questions regarding EMU hours of operation, fellowship program, activation procedures prior and during hospitalization, and management of AEDs prior and during EMU hospitalization. At the time of submitting this abstract, data from 18 epileptologists were collected and analyzed. In 67% of all EMUs, operation hours were seven days a week, and those were mainly in epilepsy centers that offer neurophysiology or epilepsy fellowships. Prior to admission to EMU, 28% of correspondents ask patients all the time to start to discontinue anti-epileptic drugs (AED), but none asks patients to be sleep deprived the night prior to admission. During EMU hospitalization, 78% sleep deprived patients, 67% hyperventilate patients and 61% do photic stimulation. Discontinuation of AEDs begins on the first day of admission by 72% of the correspondents. Excluding benzodiazepines and barbiturates, 56% decrease AEDs at a rate between 35-50%, and 11% stop AEDs abruptly. In patients taking more than on AED, 55% discontinue more than one AED simultaneously. Although most epileptologists used activation maneuvers to trigger seizures, the timing and methods of applying them vary significantly. Studies to determine the safety and the efficacy of such activation maneuvers may help to establish guidelines that can offer better patient care, shorten EMU admissions and may improve reimbursement.