Abstracts

Rationale: Correct diagnosis of pediatric epilepsy is critical for appropriate management. Inaccurate diagnosis and management can lead to poor developmental outcome, with refractory epilepsy, or unnecessary use of medications. The Epilepsy Monitoring Unit (EMU) plays a crucial role in epilepsy management. And appropriate utilization of the EMU has a great role having positive outcome. This study is designed to assess the utilization and study yield of the EMU in pediatric age group Methods: This is a Retrospective chart review, database driven study from a tertiary EMU at a level 4 pediatric epilepsy center. Data was collected from 1351 patients admitted to the EMU between January 1st 2003, and December 31st 2012. Demographics, clinical presentation, and video-EEG data were gathered. All studies were initially screened by a certified clinical neurophysiology technologist, or a clinical neurophysiology fellow. All the studies were reviewed and their interpretation was finalized by a certified clinical neurophysiologist. The Yield of the EMU studies, were divided into High yield: Captured the EI, Intermediate yield: No EI captured, but abnormal interictal findings and Low yield: No EI captured and interictal normal. Incidence of nonepileptic events with and without epilepsy and their distribution as per gender. Change in the discharge diagnosis and management. The evaluation of surgical suitability of the patient s with medically refractory epilepsy.Results: A total of 1351 subjects were included in the analysis. Females were 647(47.8%). Age ranged from 1 day to 23 years old, with a mean age of 7.5 years. Study duration of 1 -188 hours, with an average of 42.38 hrs per subject. High yield was found in 1077(79.71%), intermediate yield in 186(13.7%) and low yield in 88(6.51%). Presurgical evaluation was performed in 90 and was high yield in 82(91%). Change of management was seen in 585(43.30%). Change in diagnosis in 239(17.69%). A total of 124(9.17%) subjects had both epileptic and nonepileptic events, out of which 55(44.35%) were females. Nonepileptic events were seen in 607(44.9%) subjects, out of which 310(51.09%) were females. Epileptic events were seen in 346(25.6%) subjects. There were 38(49.35%) out of 77 subjects found to be poorly controlled on medications. 87.3% of the purpose of monitoring was reached by 49.3 hours.Conclusions: The EMU is a very important tool in diagnosis, and management of epilepsy, with the majority of the yield reached within the first 49.3 hours.