Abstracts

Rationale: Video-EEG monitoring remains the golden standard for evaluating patients in the Epilepsy Monitoring Unit (EMU). Assessing the patient during the ictal period of an event is now recognized as part of the diagnostic evaluation of seizure onset location. There are several cognitive assessment tools that address memory and awareness. However, there are not specific ictal examinations that demonstrate the importance of assessing responsiveness, awareness, language and motor function in an orderly and concise manner. Video/EEG monitoring, observation of behaviors and an accurate ictal assessment has shown to be beneficial in diagnosing the seizure location. The nurse can play an important role in the evaluation of the monitored patient in the EMU byperforming an orderly, concise ictal assessment. Methods: Prior to May 2007, a literature search of peer-reviewed articles did not demonstrate evidence of a specific ictal assessment in use. The 15-bed epilepsy-monitoring unit at the Barrow Neurological Institute (BNI) did not have a detailed assessment tool to use for ictal assessment in the EMU. In October 2007 a specific and consistent ictal exam was developed and implemented to assess the patient's responsiveness, awareness, language and motor function. The nursing staff in the Epilepsy Monitoring Unit now utilize this tool. Each area of the ictal assessment tool provides specific direction for the nurse as he/she goes through each category of the exam. Results: Nurses at the BNI EMU perform prompt,concise ictal assessments that test responsiveness,awareness,language and motor function in a matter that is easy to follow. The ictal exam is performed each time there is questionable seizure activity in the EMU. This information is used to assist nine epileptologists in identification of seizure location. Conclusions: The staff is aware of the importance of ongoing assessment of responsiveness,awareness,language and motor function. The implementation of this concise ictal exam has facilitated the ability of the novice EMU nurse to improve on accuracy of the assessment of the patient with seizures. The information provides detailed information for the Epileptologists in conjunction with the video/EEG monitoring findings. The ictal exam is currently undergoing modification for use in the pediatric population. A concurrent data analysis of how this change of practice has improved on the performance of the ictal assessment is expected to be completed in the winter of 2008.