title: Patients' safety in the epilepsy monitoring unit: time for revising practices.
abstract: OBJECTIVE
  Long-term video-electroencephalography monitoring (LTM) in epilepsy monitoring units (EMUs) exposes patients to a variety of serious adverse events (SAEs) and safety issues, which have recently caught attention and are summarized in this review.
  
  
  RESULTS
  SAEs observed during LTM affect about 10% of patients and include secondary generalized tonic-clonic seizures, seizure clusters and status epilepticus, unusual for the patient; seizure-related falls, injuries, fractures, and aspiration; postictal psychosis; and cardiorespiratory distress, including sudden unexpected death in epilepsy (SUDEP) and near-SUDEP, which were encountered by more than 10% of European and Australian EMUs. Accordingly, 3% of US-based EMUs suffer a death within a 1-year duration census. Many of these SAEs might be promoted by antiepileptic drugs (AEDs) withdrawal, for which no specific guideline is currently available. Current recommendations regarding optimal organization of EMUs, and in particular continuous supervision by a dedicated staff, are not followed by respectively 20 and 26% of European and US-based EMUs.
  
  
  CONCLUSIONS
  SAEs during LTM are a significant concern and might be aggravated by suboptimal EMU organization and staff education. Lack of high-level evidence stands out as the main limiting factor to the development and dissemination of appropriate guidelines.
authors.affiliation: aDepartment of Functional Neurology and Epileptology and Institute for Epilepsies (IDEE), Hospices Civils de Lyon bINSERM U1028/CNRS UMR5292, Lyon Neuroscience Research Center, Lyon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rheims
authors.forename: Philippe
authors.initials: P
authors.lastname: Ryvlin
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D003645:Death, Sudden; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008991:Monitoring, Physiologic; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants