title: Seizure clusters and adverse events during pre-surgical video-EEG monitoring with a slow anti-epileptic drug (AED) taper.
abstract: OBJECTIVE
  To evaluate the efficiency and safety of pre-surgical video-EEG monitoring with a slow anti-epileptic drug (AED) taper and a rescue benzodiazepine protocol.
  
  
  METHODS
  Fifty-four consecutive patients with refractory focal epilepsy who underwent pre-surgical video-electroencephalography (EEG) monitoring during the year 2010 were included in the study. Time to first seizure, duration of monitoring, incidence of 4-h and 24-h seizure clustering, secondarily generalised tonic-clonic seizures (sGTCS), status epilepticus, falls and cardiac asystole were evaluated.
  
  
  RESULTS
  A total of 190 seizures were recorded. Six (11%) patients had 4-h clusters and 21 (39%) patients had 24-h clusters. While 15 sGTCS were recorded in 14 patients (26%), status epilepticus did not occur and no seizure was complicated with cardiac asystole. Epileptic falls with no significant injuries occurred in three patients. The mean time to first seizure was 3.3days and the time to conclude video-EEG monitoring averaged 6days.
  
  
  CONCLUSIONS
  Seizure clustering was common during pre-surgical video-EEG monitoring, although serious adverse events were rare with a slow AED tapering and a rescue benzodiazepine protocol.
  
  
  CONCLUSIONS
  Slow AED taper pre-surgical video-EEG monitoring is fairly safe when performed in a highly specialised and supervised hospital setting.
authors.affiliation: Epilepsy Surgery Unit, Department of Neurological Sciences, IRCCS Neuromed, Pozzilli (IS), Italy. gdigennaro@neuromed.it
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Di Gennaro
authors.forename: Angelo
authors.initials: A
authors.lastname: Picardi
authors.forename: Antonio
authors.initials: A
authors.lastname: Sparano
authors.forename: Addolorata
authors.initials: A
authors.lastname: Mascia
authors.forename: Giulio N
authors.initials: GN
authors.lastname: Meldolesi
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Grammaldo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.forename: Pier P
authors.initials: PP
authors.lastname: Quarato
mesh_terms: D000328:Adult; D000927:Anticonvulsants; D001569:Benzodiazepines / Q000627:therapeutic use; D000075202:Contraindications; D004569:Electroencephalography / Q000009:adverse effects* / Q000379:methods*; D004827:Epilepsy / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D061214:Patient Safety; D057234:Preoperative Period; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*; D016896:Treatment Outcome; D014741:Video Recording / Q000379:methods
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines