Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery

Teia Kobulashvili; Julia Höfler; Judith Dobesberger; Florian Ernst; Philippe Ryvlin; J Helen Cross; Kees Braun; Petia Dimova; Stefano Francione; Hrvoje Hecimovic; Christoph Helmstaedter; Vasilios K Kimiskidis; Morten Ingvar Lossius; Kristina Malmgren; Petr Marusic; Bernhard J Steinhoff; Paul Boon; Dana Craiu; Norman Delanty; Daniel Fabo; Antonio Gil-Nagel; Alla Guekht; Edouard Hirsch; Reetta Kalviainen; Ruta Mameniskiené; Çiğdem Özkara; Margitta Seeck; Guido Rubboli; Pavel Krsek; Sylvain Rheims; Eugen Trinka

doi:10.1016/j.seizure.2016.03.009

Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery

Seizure. 2016 May:38:38-45. doi: 10.1016/j.seizure.2016.03.009. Epub 2016 Apr 1.

Authors

Teia Kobulashvili¹, Julia Höfler¹, Judith Dobesberger¹, Florian Ernst¹, Philippe Ryvlin², J Helen Cross³, Kees Braun⁴, Petia Dimova⁵, Stefano Francione⁶, Hrvoje Hecimovic⁷, Christoph Helmstaedter⁸, Vasilios K Kimiskidis⁹, Morten Ingvar Lossius¹⁰, Kristina Malmgren¹¹, Petr Marusic¹², Bernhard J Steinhoff¹³, Paul Boon¹⁴, Dana Craiu¹⁵, Norman Delanty¹⁶, Daniel Fabo¹⁷, Antonio Gil-Nagel¹⁸, Alla Guekht¹⁹, Edouard Hirsch²⁰, Reetta Kalviainen²¹, Ruta Mameniskiené²², Çiğdem Özkara²³, Margitta Seeck²⁴, Guido Rubboli²⁵, Pavel Krsek²⁶, Sylvain Rheims²⁷, Eugen Trinka²⁸

Affiliations

¹ Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria.
² Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, France; European Epilepsy Monitoring Unit Association (EEMA), France.
³ University College London Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
⁴ Department of Child Neurology, University Medical Center, 3508 AB Utrecht, The Netherlands.
⁵ Epilepsy Surgery Center, Neurosurgery department, St. Ivan Rilski University Hospital, Sofia, Bulgaria.
⁶ Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
⁷ Zagreb Epilepsy Center, Department of Neurology, University Hospital, Vinogradska cesta 29, 10000 Zagreb, Croatia.
⁸ Department of Epileptology, University of Bonn, University Medical Center, Sigmund Freud Straße 25, 53105 Bonn, Germany.
⁹ Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
¹⁰ Department of Complex Epilepsy, National Centre for Epilepsy (SSE), Oslo University Hospital, Oslo, Norway.
¹¹ Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
¹² Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, V Úvalu 84, Prague 5 CZ 150 06, Czech Republic.
¹³ Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl-Kork, Germany; European Epilepsy Monitoring Unit Association (EEMA), France.
¹⁴ Institute for Neuroscience, Reference center for refractory epilepsy, Gehnt University Hospital, Belgium.
¹⁵ "Carola Davila" University of Medicine Bucharest and Pediatric Neurology Clinic, "Alexandru Obregia" Clinical Psychiatric Hospital, Şos. Berceni 10-12, Sector 4, Bucharest, Romania.
¹⁶ Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Neurology, Beaumont Hospital, Dublin 9, Ireland.
¹⁷ National Institute of Clinical Neurosciences, Amerikai ut 57, Budapest H-1145, Hungary.
¹⁸ Department of Neurology, Hospital Ruber Internacional, La Maso 38, 28034 Madrid, Spain.
¹⁹ Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Ul. Donskaya 43, Moscow 115419, Russia; Department of Neurology and Neurosurgery of Russian National Research Medical University, Leninsky pr-t 8-8, Moscow 119049, Russia.
²⁰ Département de Neurologie, 1 Place de l'Hôpital, 67091 Strasbourg, France.
²¹ Department of Neurology, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland.
²² Clinic of Neurology and neurosurgery, Medical Faculty (MF), Vilnius University, Vilnius, Lithuania; Epilepsy Center, Department of Neurology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
²³ Istanbul University, Cerrahpaşa Medical Faculty, Department of Neurology, Division of Clinical Electro-Neurophysiology, 34098 Istanbul, Turkey.
²⁴ Presurgical Epilepsy Evaluation Unit, Functional Neurology and Neurosurgery Program of the University Hospitals of Geneva and Lausanne, 1211 Geneva 14, Switzerland.
²⁵ European Epilepsy Monitoring Unit Association (EEMA), France; Danish Epilepsy Center, Filadelfia/University of Copenhagen, Kolonivej 1, 4293 Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy.
²⁶ Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, V Úvalu 84, Prague 5, CZ 150 06, Czech Republic.
²⁷ Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France.
²⁸ Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria; European Epilepsy Monitoring Unit Association (EEMA), France. Electronic address: e.trinka@salk.at.

PMID: 27104922
DOI: 10.1016/j.seizure.2016.03.009

Abstract

Purpose: The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers.

Method: A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement.

Results: Complete responses were received from all (100%) EMUs surveyed. Continuous observation of patients was performed in 22 (81%) EMUs during regular working hours, and in 17 EMUs (63%) outside of regular working hours. Fifteen (56%) EMUs requested a signed informed consent before admission. All EMUs performed tapering/withdrawal of antiepileptic drugs, 14 (52%) prior to admission to an EMU. Specific protocols on antiepileptic drugs (AED) tapering were available in four (15%) EMUs. Standardized Operating Procedures (SOP) for the treatment of seizure clusters and status epilepticus were available in 16 (59%). Safety measures implemented by EMUs were: alarm seizure buttons in 21 (78%), restricted patient's ambulation in 19 (70%), guard rails in 16 (59%), and specially designated bathrooms in 7 (26%). Average costs for one inpatient day in EMU ranged between 100 and 2200 Euros.

Conclusion: This study shows a considerable diversity in the organization and practice patterns across European epilepsy monitoring units. The collected data may contribute to the development and implementation of evidence-based recommended practices in LTM services across Europe.

Keywords: Epilepsy; Epilepsy monitoring unit; Long-term monitoring; Presurgical evaluation; Safety; Video-EEG monitoring.

MeSH terms

Adolescent
Adult
Child
Child, Preschool
Drug Resistant Epilepsy / diagnosis*
Electroencephalography / statistics & numerical data*
Europe
Female
Humans
Infant
Infant, Newborn
Male
Monitoring, Physiologic / statistics & numerical data*
Young Adult