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Albarrak A. Challenges and Prospects in Epilepsy Monitoring Units: A Comprehensive Review of Logistic Barriers. Cureus 2024; 16:e59559. [PMID: 38832198 PMCID: PMC11144575 DOI: 10.7759/cureus.59559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Epilepsy is one of the most common neurological diseases with a prevalence ranging from 0.5% to 2% in different sittings. The World Health Organization (WHO) estimated that nearly 80% of this burden is borne by resource-poor countries where even conventional electroencephalogram (EEG) coverage is dramatically short. Video EEG monitoring applied for days as conducted in epilepsy monitoring units (EMUs) is aimed at seizure localization, anti-seizure medication (ASM) adjustment, or epilepsy surgery evaluation and planning. However, the EEG approach in EMUs has its obstacles. The present article is aimed to concentrate on the logistic challenges of EMUs, discussing existing data and limitations and offering suggestions for future planning to enhance the utilization of existing technology. Shortages of adult and pediatric epileptologists, qualified nurses, as well as EEG technologists have been reported in different countries. Moreover, injuries and falls, psychosis, status epilepticus, and unexpected death have been stated to be the most frequent safety issues in EMUs. Enhancements to mitigate logistical and healthcare system-related barriers in EMUs include the implementation of large cohort studies and the utilization of artificial intelligence (AI) for the identification and categorization of specific risks among EMU admissions. The establishment of EMUs and their associated challenges and barriers are best acknowledged through discussions and dialogue with various stakeholders.
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Affiliation(s)
- Anas Albarrak
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, SAU
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, SAU
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Banjer T, Attiya D, Baeesa S, Al Said Y, Babtain F. The impact of the time to last seizure before admission to the epilepsy monitoring unit (EMU) on epilepsy classifications. Epilepsy Behav 2023; 144:109252. [PMID: 37207403 DOI: 10.1016/j.yebeh.2023.109252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION AND BACKGROUND The impact of the timing of the last seizure (TTLS) prior to admission to the epilepsy monitoring unit (EMU) on epilepsy classification is unclear for which we conducted this study. METHODS We reviewed patients with epilepsy admitted to EMU between January 2021 and April 2022 and identified TTLS before EMU admission. We considered EMU yield as whether; it confirmed epilepsy classification, added new knowledge to the classification, or failed to classify epilepsy. RESULTS We studied 156 patients. There were 72 (46%) men, with a mean age of 30. TTLS was divided according to a one- or three-month cutoff. We confirmed the pre-EMU epilepsy classification in 52 (33%) patients, learned new findings on epilepsy classification in 80 (51%) patients, and failed to classify epilepsy in 24 (15%) patients. Patients with "confirmed epilepsy classifications" reported seizures sooner to EMU admission than other groups (0.7 vs. 2.3 months, p-value = 0.02, 95% CI; -1.8, -1.3). Also, the odds of confirming epilepsy classification were more than two times in patients with TTLS within a month compared to those with TTLS of more than a month (OR = 2.4, p-value = 0.04, 95% CI; 1.1, 5.9). The odds were also higher when the 3-month TTLS cutoff was considered (OR = 6.2, p-value = 0.002, 95% CI; 1.6, 40.2). Confirming epilepsy classification was also associated with earlier seizures recorded at one- or three-month cutoff (OR = 2.1 and OR = 2.3, respectively, p-value = 0.05). We did not observe similar findings when we modified the classification or failed to reach a classification. CONCLUSIONS The timing of the last seizure before EMU admission appeared to influence the yield of EMU and enhanced the confirmation of epilepsy classifications. Such findings can improve the utilization of EMU in the presurgical evaluation of patients with epilepsy.
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Affiliation(s)
- Tasneem Banjer
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Dania Attiya
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Saleh Baeesa
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Youssef Al Said
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Fawzi Babtain
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
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Al-Attas AA. Weighing Successes and Challenges in the Establishment of Additional Epilepsy Monitoring Units at the Saudi Arabian Kingdom's Capital City. Cureus 2023; 15:e38924. [PMID: 37313106 PMCID: PMC10259730 DOI: 10.7759/cureus.38924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Epilepsy has a prevalence rate of 6.54 per 1,000 people in Saudi Arabia, making it a prevalent chronic condition. Drug-resistant epilepsy (DRE) is thought to affect one-third of patients; in these circumstances, a complete presurgical examination in the epilepsy monitoring unit (EMU) is necessary. Unfortunately, to accommodate the growing number of referrals, the units' availability and number must be reviewed.
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Randhawa J, Hrazdil CT, McDonald PJ, Illes J. Strategic and principled approach to the ethical challenges of epilepsy monitoring unit triage. JOURNAL OF MEDICAL ETHICS 2023; 49:81-86. [PMID: 34497143 DOI: 10.1136/medethics-2020-107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
Electroencephalographic monitoring provides critical diagnostic and management information about patients with epilepsy and seizure mimics. Admission to an epilepsy monitoring unit (EMU) is the gold standard for such monitoring in major medical facilities worldwide. In many countries, access can be challenged by limited resources compared to need. Today, triaging admission to such units is generally approached by unwritten protocols that vary by institution. In the absence of explicit guidance, decisions can be ethically taxing and are easy to challenge. In an effort to address this gap, we propose a two-component approach to EMU triage that takes into account the unique landscape of epilepsy monitoring informed by triage literature from other areas of medicine. Through the strategic component, we focus on the EMU wait list management infrastructure at the institutional level. Through the principled component, we apply a combination of the ethical principles of prioritarianism, utilitarianism and justice to triage; and we use individual case examples to illustrate how they apply. The effective implementation of this approach to specific epilepsy centres will need to be customised to the nuances of different settings, including diverse practice patterns, patient populations and constraints on resource distribution, but the conceptual consolidation of its components can alleviate some of the pressures imposed by the complex decisions involved in EMU triage.
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Affiliation(s)
- Jason Randhawa
- Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Chantelle T Hrazdil
- Division of Neurology, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Patrick J McDonald
- Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurosurgery, Department of Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Al-Bradie R, Jarad JA, Bokhari AR, Maddallah DK, Hedaithy A, Alqutub AA, Turkistani LN, Bashir S. Diagnostic utility of pediatric epilepsy monitoring unit: Retrospective single center study. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2023; 28:66-69. [PMID: 36617459 PMCID: PMC9987634 DOI: 10.17712/nsj.2023.1.20220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 10/05/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate drug resistance epilepsy (DRE) patients with persistent seizures after using of standard antiepileptic drugs. This single center study aimed to investigate the utility of Epilepsy Monitoring Unit (EMU) resulted in a definitive diagnosis. METHODS This was an observational retrospective study in 323 children who were admitted to the EMU for evaluation between 2012 and 2020. RESULTS Of the 323 patients, 168 (52.01%) were males. The most common referral for EMU were better characterization 91 (28.17%) and pre-surgical evaluation 56 (17.3%). Of the participants, 273 (84.5%) had seizures one to 2 times per day. At discharge, 75.5% of admissions received a definitive diagnosis. CONCLUSION The EMU admission for pediatric epilepsy patients is very important for early accurate diagnosis and management with surgery for those consider DRE patients.
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Affiliation(s)
- Raidah Al-Bradie
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
| | - Jumanah A Jarad
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
| | - Aziza R Bokhari
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
| | - Dana K Maddallah
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
| | - Abdullah Hedaithy
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
| | - Afnan A Alqutub
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
| | - Leenah N Turkistani
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
| | - Shahid Bashir
- From the Department of Pediatric Neurology (Al-Bradie, Jarad, Bokhari, Maddallah, Hedaithy, Alqutub, Turkistani), Neuroscience Center (Bashir), King Fahad specialist hospital Dammam, Dammam, Kingdom of Saudi Arabia
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Guglielmi G, Eschbach KL, Alexander AL. Smaller Knife, Fewer Seizures? Recent Advances in Minimally Invasive Techniques in Pediatric Epilepsy Surgery. Semin Pediatr Neurol 2021; 39:100913. [PMID: 34620456 DOI: 10.1016/j.spen.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
Children with drug-resistant epilepsy are at high risk for developmental delay, increased mortality, psychiatric comorbidities, and requiring assistance with activities of daily living. Despite the advent of new and effective pharmacologic therapies, about one in 5 children will develop drug-resistant epilepsy, and most of these children continue to have seizures despite trials of other medication. Epilepsy surgery is often a safe and effective option which may offer seizure freedom or at least a significant reduction in seizure burden in many children. However, despite published evidence of safety and efficacy, epilepsy surgery remains underutilized in the pediatric population. Patient and family fears about the risks of surgery may contribute to this gap. Less invasive surgical techniques may be more palatable to children with epilepsy and their caregivers. In this review, we present recent advances in minimally invasive techniques for the surgical treatment of epilepsy as well as intriguing possibilities for the future. We describe the indications for, benefits of, and limits to minimally-invasive techniques including Stereo-encephalography, laser interstitial thermal ablation, deep brain stimulation, focused ultrasound, stereo-encephalography-guided radiofrequency ablation, endoscopic disconnections, and responsive neurostimulation.
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Affiliation(s)
- Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Krista L Eschbach
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO
| | - Allyson L Alexander
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal IL; Section of Pediatric Neurology, Children's Hospital Colorado, Aurora CO; Department of Pediatrics, University of Colorado Anschutz School of Medicine, Aurora CO; Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora CO; Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora CO.
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The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic. Epilepsy Behav 2021; 122:108229. [PMID: 34364025 PMCID: PMC8302842 DOI: 10.1016/j.yebeh.2021.108229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has impacted admission to epilepsy monitoring units (EMUs) for classification and presurgical evaluation of patients with refractory epilepsy. We modified the EMU admission protocol via anti-seizure medications (ASM) withdrawal implemented one day before admission; thus, we aimed to evaluate the efficacy and safety of this modified protocol. METHODS In January 2021, we initiated ASM tapering 24 h before-rather than on the first day after-EMU admission, contrasting with the previous protocol. We retrospectively reviewed EMU admissions between January and April of 2018, 2019, and 2021, and identified the time required to record the first seizure, and EMU yield to confirm or change the epilepsy classification. We also evaluated the safety of the modified protocol, by monitoring the seizure frequency for up to 5 months after the discharge from the hospital. RESULTS One hundred four patients were included (mean age: 30 years, men: 43%); excluding a longer disease duration and abundance of normal routine electro-encephalogram (EEG) in patients admitted before the pandemic, no differences were observed in patients' characteristics. On average, it took 41 h and 21 h to record the first seizure using the standard and modified protocols, respectively (p < 0.001, 95% CI: 10-30). Other characteristics were investigated both before and after the COVID-19 pandemic, and epilepsy classifications were confirmed twice using the modified protocol (OR = 2.4, p = 0.04, 95% CI: 1.1-5.5). Multivariate regression analysis confirmed the shorter time to record the first seizure using the modified admission protocol (23 h less, p < 0.001; 95% CI: 12-34). Finally, 36 (86%) patients admitted during the pandemic exhibited no increase in seizure frequency after the discharge from the hospital. CONCLUSIONS Initiating ASM withdrawal one day before EMU admission was deemed to be an efficient and safe way to confirm epilepsy classification and significantly decrease the length of hospital stay. Ultimately, this will shorten the long waiting list for EMU admission created by the COVID-19 pandemic.
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