Value of video monitoring for nocturnal seizure detection in a residential setting.
Following a sudden death at a residential care unit, the Dutch Health and Care Inspectorate advised intensification of the use of video monitoring (VM) at the unit. We assessed whether VM resulted in increased identification of seizures that required clinical intervention.



The unit provides care for 340 individuals with refractory epilepsy and severe learning disabilities. Acoustic detection systems (ADSs) cover all individuals; 37 people also have a bed motion sensor (BMS) and 46 people with possible nocturnal seizures are now monitored by VM. During a 6-month period, in all cases of a suspected seizure we asked the caregivers to specify which device alerted them and to indicate whether this led to an intervention. Staff costs of VM were estimated using payroll information.



We identified 1,208 seizures in 37 individuals: 4 had no nocturnal seizures and 393 (33%) seizures were seen only on video. In 169 (14%) of 1,208 seizures an intervention was made and this included 39 (10%) of 393 seizures seen only on video. When compared to seizures observed with an ADS or BMS, seizures seen only on video were more often tonic seizures (71% vs. 22%, p < 0.001) and occurred mostly in the beginning or at the end of the night (40% vs. 26%, p < 0.001). The extra staff costs of monitoring was 7,035 euro per seizure seen only on video and leading to an intervention.



VM facilitates nocturnal surveillance, but the costs are high. This underscores the need for development of reliable seizure detection devices.
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.|Department of Neurology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Marije
M
van der Lende
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
Fieke M E
FM
Cox
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
Gerhard H
GH
Visser
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.|Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom.|Epilepsy Society, Chalfont St Peter, United Kingdom.
Josemir W
0000-0001-6041-9661
JW
Sander
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.|Department of Neurology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.|Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom.|Epilepsy Society, Chalfont St Peter, United Kingdom.
Roland D
RD
Thijs
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D017028:Caregivers / Q000523:psychology; D003362:Cost-Benefit Analysis; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D055536:Vagus Nerve Stimulation / Q000379:methods; D014741:Video Recording / Q000379:methods*; D055815:Young Adult
D000927:Anticonvulsants
Acoustic detection system; Bed motion sensor; Seizure; Seizure detection; Sudden unexpected death in epilepsy