Abstracts

Rationale: The main purpose of admission to an epilepsy monitoring unit (EMU) is to perform video EEG (VEEG) monitoring for the detection of seizures. Activation methods such as withdrawal of antiepileptic medication and sleep deprivation are often used to induce seizures. Seizure-related falls are important adverse events for patients with epilepsy and may be inevitable, especially during EMU hospitalization. Therefore, extensive safety management is needed for patients in the EMU, but risk assessment for falls in the EMU has received little attention. The present study reviewed clinical features of patients who fell in EMU and characteristics of these falls. Methods: A total of 384 patients were admitted to our EMU from September 2010 to September 2013. Fourteen patients (3.6%; 8 men and 6 women, aged 14-44 years) had a fall during stays of 12 or 13 days in the EMU. Their stays were divided into 2 periods: the first 4-5 days for VEEG monitoring (VEEG period) and the following 7-9 days for other examinations including neuroimaging and neuropsychological assessment (other exam period). The clinical features of the 14 patients were investigated in terms of (1) their epilepsy classification and history of falls, and (2) time, place, and condition of falls in each period. Results: All observed falls were associated with epileptic seizures. Eight patients were diagnosed with symptomatic localization-related epilepsy, 4 with symptomatic generalized epilepsy, 1 with idiopathic generalized epilepsy, and 1 with unclassified epilepsy. Thirteen of the 14 patients had a history of falls before admission. Seven falls occurred during the VEEG period: 4 falls from the bed and 3 in the bathroom. Of those, 5 falls occurred under the condition of reduced antiepileptic medication. In addition, 11 falls occurred during the other exam period: 5 falls in the ward, 1 in the bathroom, and 4 outside the ward such as in the hallway, radiography room, and nuclear medicine laboratory. Conclusions: Withdrawal of antiepileptic medication greatly increases the risk of seizure-related falls. A history of falls is one of the strong risk factors for seizure-related falls during EMU hospitalization. Seizure-related falls may occur at various times, places, and conditions. Further studies are needed to establish more effective safety management in the EMU.