Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery.
OBJECTIVE
The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers.


METHODS
A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement.


RESULTS
Complete responses were received from all (100%) EMUs surveyed. Continuous observation of patients was performed in 22 (81%) EMUs during regular working hours, and in 17 EMUs (63%) outside of regular working hours. Fifteen (56%) EMUs requested a signed informed consent before admission. All EMUs performed tapering/withdrawal of antiepileptic drugs, 14 (52%) prior to admission to an EMU. Specific protocols on antiepileptic drugs (AED) tapering were available in four (15%) EMUs. Standardized Operating Procedures (SOP) for the treatment of seizure clusters and status epilepticus were available in 16 (59%). Safety measures implemented by EMUs were: alarm seizure buttons in 21 (78%), restricted patient's ambulation in 19 (70%), guard rails in 16 (59%), and specially designated bathrooms in 7 (26%). Average costs for one inpatient day in EMU ranged between 100 and 2200 Euros.


CONCLUSIONS
This study shows a considerable diversity in the organization and practice patterns across European epilepsy monitoring units. The collected data may contribute to the development and implementation of evidence-based recommended practices in LTM services across Europe.
Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria.
Teia
T
Kobulashvili
Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria.
Julia
J
Höfler
Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria.
Judith
J
Dobesberger
Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria.
Florian
F
Ernst
Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, France; European Epilepsy Monitoring Unit Association (EEMA), France.
Philippe
P
Ryvlin
University College London Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
J Helen
JH
Cross
Department of Child Neurology, University Medical Center, 3508 AB Utrecht, The Netherlands.
Kees
K
Braun
Epilepsy Surgery Center, Neurosurgery department, St. Ivan Rilski University Hospital, Sofia, Bulgaria.
Petia
P
Dimova
Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
Stefano
S
Francione
Zagreb Epilepsy Center, Department of Neurology, University Hospital, Vinogradska cesta 29, 10000 Zagreb, Croatia.
Hrvoje
H
Hecimovic
Department of Epileptology, University of Bonn, University Medical Center, Sigmund Freud Straße 25, 53105 Bonn, Germany.
Christoph
C
Helmstaedter
Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
Vasilios K
VK
Kimiskidis
Department of Complex Epilepsy, National Centre for Epilepsy (SSE), Oslo University Hospital, Oslo, Norway.
Morten Ingvar
MI
Lossius
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
Kristina
K
Malmgren
Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, V Úvalu 84, Prague 5 CZ 150 06, Czech Republic.
Petr
P
Marusic
Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl-Kork, Germany; European Epilepsy Monitoring Unit Association (EEMA), France.
Bernhard J
BJ
Steinhoff
Institute for Neuroscience, Reference center for refractory epilepsy, Gehnt University Hospital, Belgium.
Paul
P
Boon
"Carola Davila" University of Medicine Bucharest and Pediatric Neurology Clinic, "Alexandru Obregia" Clinical Psychiatric Hospital, Şos. Berceni 10-12, Sector 4, Bucharest, Romania.
Dana
D
Craiu
Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Neurology, Beaumont Hospital, Dublin 9, Ireland.
Norman
N
Delanty
National Institute of Clinical Neurosciences, Amerikai ut 57, Budapest H-1145, Hungary.
Daniel
D
Fabo
Department of Neurology, Hospital Ruber Internacional, La Maso 38, 28034 Madrid, Spain.
Antonio
A
Gil-Nagel
Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Ul. Donskaya 43, Moscow 115419, Russia; Department of Neurology and Neurosurgery of Russian National Research Medical University, Leninsky pr-t 8-8, Moscow 119049, Russia.
Alla
A
Guekht
Département de Neurologie, 1 Place de l'Hôpital, 67091 Strasbourg, France.
Edouard
E
Hirsch
Department of Neurology, Kuopio University Hospital, Kuopio, Finland; School of Medicine, University of Eastern Finland, Kuopio, Finland.
Reetta
R
Kalviainen
Clinic of Neurology and neurosurgery, Medical Faculty (MF), Vilnius University, Vilnius, Lithuania; Epilepsy Center, Department of Neurology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
Ruta
R
Mameniskiené
Istanbul University, Cerrahpaşa Medical Faculty, Department of Neurology, Division of Clinical Electro-Neurophysiology, 34098 Istanbul, Turkey.
Çiğdem
Ç
Özkara
Presurgical Epilepsy Evaluation Unit, Functional Neurology and Neurosurgery Program of the University Hospitals of Geneva and Lausanne, 1211 Geneva 14, Switzerland.
Margitta
M
Seeck
European Epilepsy Monitoring Unit Association (EEMA), France; Danish Epilepsy Center, Filadelfia/University of Copenhagen, Kolonivej 1, 4293 Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy.
Guido
G
Rubboli
Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, V Úvalu 84, Prague 5, CZ 150 06, Czech Republic.
Pavel
P
Krsek
Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France.
Sylvain
S
Rheims
Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, and Centre for Cognitive Neuroscience, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria; European Epilepsy Monitoring Unit Association (EEMA), France. Electronic address: e.trinka@salk.at.
Eugen
E
Trinka
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis*; D004569:Electroencephalography / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D055815:Young Adult
Epilepsy; Epilepsy monitoring unit; Long-term monitoring; Presurgical evaluation; Safety; Video-EEG monitoring