Abstracts

Rationale: Epilepsy Monitoring Unit (EMU) is an important tool in the assessment, diagnosis, and management of epilepsy. While patients are in the EMU there is an increased risk for prolonged seizures, particularly as medication are withdrawn, patients are sleep deprived, and hyperventilation and photic therapies are performed. Due to this risk, many EMUs have a standard intravenous access (IV) policy, either encompassing all EMU patients or those patient with medication reduction or withdraw during admission. Methods: This is a retrospective chart review study from a tertiary pediatric EMU at a level 4 pediatric epilepsy center. Patients were assessed for a history of seizures lasting longer than 5 minutes over the last year, history of non-epileptic events, and reason for EMU admission. IV placement and utilization was reviewed including the utilization of rectal diazepam. An online survey was also utilized to evaluate practices at EMUs around the country. The online survey was sent to members of the American Association of Neuroscience Nurses who subscribe to an epilepsy list serve. Results: : The survey obtained 22 respondents. 68.2% (15) of respondents were from adult EMUs, 18.2% (4) from pediatric, and 13.6% (3) respondents had both adult and pediatric patients in the EMU. The average bed size was 5-9 beds. EMU policies required all patients admitted to the EMU to received IVs in 77.3% (17) of EMUs. 90.9% (20) reported that all patients who had medication withdraw received IVs with 2 respondents reporting that this was done based on provider preference. At our center, chart review was completed on all patients admitted to the EMU between January and December of 2012. This incorporated 250 patients with an average age of 8.5years with patients ranging from 2 months to 22 years. 6 (2%) of all patients admitted received rectal diazepam. A total of 61 patients (24%) had IVs placed. Three of those patients had IV access after receiving rectal diazepam. Of those three patients only one then received IV lorazapam. 9 (15%) total patients received IV lorazapam, one of those received lorazapam for a non-epileptic event. 19 (31%) patients who received IVs had a history of events lasting more than 5 minutes in the last year, 5 (26%) of those patients required IV lorazapam for prolonged seizures. 4 (21%) of patients with a history of events longer than 5 minutes were found to have only non-epileptic events. Patients who required IV lorazapam were more likely to be admitted for characterization of events (77.7%).Conclusions: The regular placement of IV access based on EMU policies yields low utilization rates (15%) and further research is needed to determine better identification of patients needing IVs and evaluation of less invasive medications that can be used for seizure cessation