Safety in the epilepsy monitoring unit: A retrospective study of 524 consecutive admissions
Safety in the epilepsy monitoring unit: A retrospective study of 524 consecutive admissions
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DOI：
10.1016/j.yebeh.2016.06.002
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发表时间：
2016-08-01
影响因子：
2.6
通讯作者：
Neufeld, Miri
中科院分区：
文献类型：
--
作者：
Fahoum, Firas;Omer, Nurit;Neufeld, Miri
癫痫监测单元（EMU）监测患者的收益取决于及时记录阵发性事件，然而，增加了安全性不良事件（AE）的风险。我们旨在回顾性研究三级医疗中心成人EMU所有连续入院病例中AE发生的频率和风险因素。我们还将我们的研究结果与其他中心发表的数据进行了比较。在2011年1月至2014年6月期间，特拉维夫Sourasky医疗中心连续收治了524例成人EMU。在47例（9.0%）住院患者中记录了不良事件。最常见的不良事件是4小时癫痫簇发作（58.7%的AE），与抗癫痫药物相关的AE发生率降低（AED，11.1%）、福尔斯和创伤性损伤（9.5%），静脉管路并发症（9.5%），电极相关（4.8%），癫痫持续状态（瑞典，3.2%），和心脏（1.6%）和精神科（1.6%）并发症。在发病时年龄较小的患者中，（p = 0.005），颞叶癫痫病史（p = 0.046），局灶性癫痫发作伴意识改变史（p = 0.008），SE病史（p = 0.022），使用迷走神经刺激器（p = 0.039），和智力残疾（p = 0.016）以及EMU监测的适应症为无创或有创术前评估时（p = 0.001）。当患者在EMU中发生更多事件时，不良事件发生率更高（p = 0.001），并在服用卡马西平（p = 0.037）、左乙拉西坦（p = 0.004）、氯巴占（p = 0.008）和舒硫安（p = 0.016）的患者中。有心因性非癫痫发作（PNES）病史的患者发生的AE显著较少（p = 0.013）。不良事件与年龄、性别、住院或监测时间、AED停用和更新、癫痫发作频率、主要精神共病、异常神经系统检查或脑磁共振成像病变的存在无关。总之，本研究表明，在EMU中，AE并不罕见，癫痫发作聚集是其中最常见的。在更严重的癫痫和智力残疾患者以及接受术前评估的患者中，不良事件发生率更高，而在PNES患者中发生率较低。(C)2016 Elsevier Inc. All rights reserved.
The yield of monitoring patients at an epilepsy monitoring unit (EMU) depends on the recording of paroxysmal events in a timely fashion, however, increasing the risk of safety adverse events (AEs). We aimed to retrospectively study the frequency and risk factors for AE occurrences in all consecutive admissions to an adult EMU in a tertiary medical center. We also compared our findings with published data from other centers.Between January 2011 and June 2014, there were 524 consecutive admissions to the adult EMU at the Tel Aviv Sourasky Medical Center. Adverse events were recorded in 47 (9.0%) admissions. The most common AE was 4-hour seizure cluster (58.7% of AEs) and, in decreasing frequency, AEs related to antiepileptic drugs (AEDs, 11.1%), falls and traumatic injuries (9.5%), intravenous line complications (9.5%), electrode-related (4.8%), status epilepticus (SE, 3.2%), and cardiac (1.6%) and psychiatric (1.6%) complications.There were significantly more AEs among patients with a younger age at disease onset (p = 0.005), a history of temporal lobe epilepsy (p = 0.046), a history of focal seizures with altered consciousness (p = 0.008), a history of SE (p = 0.022), use of a vagal nerve stimulator (p = 0.039), and intellectual disability (p = 0.016) and when the indication for EMU monitoring was noninvasive or invasive presurgical evaluation (p = 0.001).Adverse events occurred more frequently when patients had more events in the EMU (p = 0.001) and among those administered carbamazepine (p = 0.037), levetiracetam (p = 0.004), clobazam (p = 0.008), and sulthiame (p = 0.016). Patients with a history of psychogenic nonepileptic seizures (PNESs) had significantly fewer AEs (p = 0.013). Adverse events were not associated with the age, gender, duration of hospitalization or monitoring, AED withdrawal and renewal, seizure frequency by history, presence of major psychiatric comorbidities, abnormal neurological exam, or the presence of a lesion as on brain magnetic resonance imaging.In conclusion, this study reveals that AEs are not unusual in the EMU and that seizure clustering is the most common among them. Adverse events occur more frequently in patients with more severe epilepsy and intellectual disability and in patients undergoing presurgical evaluations and less frequently in patients with PNESs. (C) 2016 Elsevier Inc. All rights reserved.