How seizure detection by continuous electroencephalographic monitoring affects the prescribing of antiepileptic medications.
OBJECTIVE
To assess the effect of continuous electroencephalographic monitoring on the decision to treat seizures in the inpatient setting, particularly in the intensive care unit.


METHODS
Retrospective cohort study.


METHODS
Medical and neuroscience intensive care units and neurological wards.


METHODS
Three hundred consecutive nonelective continuous electroencephalographic monitoring studies, performed on 287 individual inpatients over a 27-month period.


METHODS
Epileptiform electroencephalographic abnormalities and changes in antiepileptic drug (AED) therapy based on the electroencephalographic findings.


RESULTS
The findings from the continuous electroencephalographic monitoring led to a change in AED prescribing in 52% of all studies with initiation of an AED therapy in 14%, modification of AED therapy in 33%, and discontinuation of AED therapy in 5% of all studies. Specifically, the detection of electrographic seizures led to a change in AED therapy in 28% of all studies.


CONCLUSIONS
The findings of continuous electroencephalographic monitoring resulted in a change in AED prescribing during or after half of the studies performed. Most AED changes were made as a result of the detection of electrographic seizures.
Kilbride
Ronan D
RD
Epilepsy Service, Department of Neurology, ACC 7, Massachusetts General Hospital, 15 Parkman St, Boston, MA 02114, USA. rkilbride@partners.org
Costello
Daniel J
DJ
Chiappa
Keith H
KH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage*; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003661:Decision Support Techniques; D016903:Drug Monitoring / Q000379:methods; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D005071:Evoked Potentials / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D055656:Prescriptions; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants