A European survey on current practices in epilepsy monitoring units and implications for patients' safety.
OBJECTIVE
This study aimed to survey current practices in European epilepsy monitoring units (EMUs) with emphasis on safety issues.


METHODS
A 37-item questionnaire investigating characteristics and organization of EMUs, including measures for prevention and management of seizure-related serious adverse events (SAEs), was distributed to all identified European EMUs plus one located in Israel (N=150).


RESULTS
Forty-eight (32%) EMUs, located in 18 countries, completed the questionnaire. Epilepsy monitoring unit beds are 1-2 in 43%, 3-4 in 34%, and 5-6 in 19% of EMUs; staff physicians are 1-2 in 32%, 3-4 in 34%, and 5-6 in 19% of EMUs. Personnel operating in EMUs include epileptologists (in 69% of EMUs), clinical neurophysiologists trained in epilepsy (in 46% of EMUs), child neurologists (in 35% of EMUs), neurology and clinical neurophysiology residents (in 46% and in 8% of EMUs, respectively), and neurologists not trained in epilepsy (in 27% of EMUs). In 20% of EMUs, patients' observation is only intermittent or during the daytime and primarily carried out by neurophysiology technicians and/or nurses (in 71% of EMUs) or by patients' relatives (in 40% of EMUs). Automatic detection systems for seizures are used in 15%, for body movements in 8%, for oxygen desaturation in 33%, and for ECG abnormalities in 17% of EMUs. Protocols for management of acute seizures are lacking in 27%, of status epilepticus in 21%, and of postictal psychoses in 87% of EMUs. Injury prevention consists of bed protections in 96% of EMUs, whereas antisuffocation pillows are employed in 21%, and environmental protections in monitoring rooms and in bathrooms are implemented in 38% and in 25% of EMUs, respectively. The most common SAEs were status epilepticus reported by 79%, injuries by 73%, and postictal psychoses by 67% of EMUs.


CONCLUSIONS
All EMUs have faced different types of SAEs. Wide variation in practice patterns and lack of protocols and of precautions to ensure patients' safety might promote the occurrence and severity of SAEs. Our findings highlight the need for standardized and shared protocols for an effective and safe management of patients in EMUs.
Danish Epilepsy Center, Filadelfia/University of Copenhagen, Kolonivej 1, 4293 Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Bellaria Hospital, via Altura 3, 40139 Bologna, Italy. Electronic address: guru@filadelfia.dk.
Guido
G
Rubboli
Neurophysiology Department, Danish Epilepsy Center, Visbys Alle' 5, 4293 Dianalund, Denmark; Department of Neurophysiology, Aarhus University, Norrebrogade 44, 8000 Aarhus. Electronic address: sbz@filadelfia.dk.
Sandor
S
Beniczky
Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands. Electronic address: sclaus@sein.nl.
Steven
S
Claus
Epilepsy Unit, San Paolo Hospital, Department of Health Sciences, University of Milan, Via Antonio di Rudinì, 8, 20142 Milan, Italy. Electronic address: mariapaola.canevini@unimi.it.
Maria Paola
MP
Canevini
INSERM U836, Univ. Grenoble Alpes, GIN, and Epilepsy Unit, Michallon Hospital, Boulevard de la Chantourne BP 217, 38043 Grenoble Cedex 9, France. Electronic address: philippe.kahane@ujf-grenoble.fr.
Philippe
P
Kahane
Epilepsy Center Erlangen (ZEE), University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany. Electronic address: Hermann.Stefan@uk-erlangen.de.
Hermann
H
Stefan
Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands. Electronic address: walterveb@gmail.com.
Walter
W
van Emde Boas
Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands. Electronic address: dvelis@sein.nl.
Demetrios
D
Velis
Department of Clinical Neurophysiology, SEIN - Epilepsy Institute in The Netherlands, Meer en Bosch, The Netherlands; Department of CNP at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands; Department of Neurosurgery at the Free University Medical Center, Achterweg 5/P.O. Box 540 2103 SW Heemstede/2130 AM Hoofddorp, The Netherlands. Electronic address: EReus@sein.nl.
Elise
E
Reus
Servicio de Neurologia, Hospital Ruber Internacional, Calle de la Masó, 38, 28034 Madrid, Spain. Electronic address: agnagel@gmail.com.
Antonio
A
Gil-Nagel
Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl-Kork, Germany. Electronic address: bsteinhoff@epilepsiezentrum.de.
Bernhard J
BJ
Steinhoff
Department of Neurology, Paracelsus Medical University, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, Strubergasse 21, 5020 Salzburg, Austria. Electronic address: e.trinka@salk.at.
Eugen
E
Trinka
Department of Clinical Neurosciences, CHUV, Bâtiment Champ de l'Air Rue du Bugnon 21, 1011 Lausanne, Switzerland; Translational and Integrative Group in Epilepsy Research (TIGER) and Institute for Epilepsies (IDEE), Lyon's Neuroscience Center, INSERM U1028, CNRS 5292, UCBL, Centre Hospitalier Le Vinatier 95 Bd Pinel, 69500 Bron, Lyon, France. Electronic address: philippe.ryvlin@chu-lyon.fr.
Philippe
P
Ryvlin
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004569:Electroencephalography / Q000592:standards / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy; D005060:Europe; D006301:Health Services Needs and Demand; D006757:Hospital Units / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D008991:Monitoring, Physiologic / Q000592:standards / Q000706:statistics & numerical data*; D010092:Oximetry / Q000706:statistics & numerical data; D061214:Patient Safety / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000209:etiology; D012640:Seizures / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000517:prevention & control*
D000927:Anticonvulsants
Adverse events; Cardiac monitoring; Complications; Epilepsy monitoring unit; Long-term monitoring; Safety; Seizure detection; Video-EEG