Abstracts

Video-EEG monitoring is becoming a favored diagnostic tool for the differential diagnosis of seizure-like events and to optimize epilepsy treatment through medication or surgical therapies. However, payers are requesting that approvals for video EEG monitoring be justified by improved clinical outcomes. We therefore characterized the patients utilizing this resource by determining the primary reason for admission and assessed whether video EEG monitoring contributed to clinical care as demonstrated by a change in medication or referral for epilepsy surgery. Sequential patients admitted in 2001 to the Epilepsy Monitoring Unit (EMU) at New York Presbyterian Hospital, Columbia Campus were evaluated. Columbia is an urban Level IV Epilepsy Center. We retrospectively reviewed discharge summaries and EMU reports for specific criteria including reason for admission, change in therapeutic regimen and referral for epilepsy surgery. Data was acquired from 50 patients (18 male, 32 female) with a mean age of 40.4 years (range 18-87). The primary reason for admission to the EMU included; diagnosis of paroxysmal spells (40%), characterization of known seizures (32.7%), presurgical evaluation (11.5%), evaluation of subclinical seizures or non-convulsive status epilepticus (9.6%) and medication adjustment or toxicity (5.8%). As a result of their evaluation, 84% of patients had a change in therapeutic regimen and 21% were discharged with a referral for epilepsy surgery. Timely diagnosis and optimal treatment has a positive impact on patient outcome and quality of life. Determination of the nature of seizure-like events through video-EEG monitoring is truly helpful in guiding appropriate care to maximize therapeutic options including adjustment or change in drug regimen, determination of appropriate surgical referrals and initiation of proper treatment of paroxysmal events that are nonepileptic. Video EEG monitoring may also minimize unnecessary medical services by establishing a clear diagnosis.