Epilepsy: accuracy of patient seizure counts.
OBJECTIVE
To evaluate the effects of a daily patient reminder on seizure documentation accuracy.


METHODS
Randomized controlled trial.


METHODS
Monitoring unit of an academic department of epileptology. Patients Consecutive sample of 91 adult inpatients with focal epilepsies undergoing video-electroencephalographic monitoring. Intervention While all patients were asked to document seizures at the beginning of the monitoring period, patients from the experimental group were reminded each day to document seizures. Main Outcome Measure Documentation accuracy (percentage of documented seizures).


RESULTS
A total of 582 partial seizures were recorded. Patients failed to document 55.5% of all recorded seizures, 73.2% of complex partial seizures, 26.2% of simple partial seizures, 41.7% of secondarily generalized tonic-clonic seizures, 85.8% of all seizures during sleeping, and 32.0% of all seizures during the awake state. The group medians of individual documentation accuracies for overall seizures, simple partial seizures, complex partial seizures, and secondarily generalized tonic-clonic seizures were 33.3%, 66.7%, 0%, and 83.3%, respectively. Neither the patient reminder nor cognitive performance affected documentation accuracy. A left-sided electroencephalographic focus or lesion, but not the site (frontal or temporal), contributed to documentation failure.


CONCLUSIONS
Patient seizure counts do not provide valid information. Documentation failures result from postictal seizure unawareness, which cannot be avoided by reminders. Unchanged documentation accuracy is a prerequisite for the use of patient seizure counts in clinical trials and has to be demonstrated in a subsample of patients undergoing electroencephalographic monitoring.
Hoppe
Christian
C
Department of Epileptology, University of Bonn Medical Centre, Sigmund-Freud-Strasse 25, FRG-53105 Bonn, Germany. christian.hoppe@ukb.uni-bonn.de
Poepel
Annkathrin
A
Elger
Christian E
CE
D000328:Adult; D004282:Documentation; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D018715:Microscopy, Video / Q000379:methods; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012640:Seizures / Q000145:classification / Q000503:physiopathology*; D012890:Sleep / Q000502:physiology; D018709:Statistics, Nonparametric; D014851:Wakefulness / Q000502:physiology