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American Journal of Medical Quality
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Diagnostic Utility of an Epilepsy Monitoring Unit

Janice L. Smolowitz, EdD, DrNP

Columbia University School of Nursing and Department of Neurology, js928{at}columbia.edu

Sarah C. Hopkins, MPA

Columbia University School of Nursing

Tracey Perrine, CANP, MS, RN

Columbia Comprehensive Epilepsy Center, Neurological Institute of New York

Karen E. Eck, CFNP, MSN, RN

Columbia Comprehensive Epilepsy Center, Neurological Institute of New York

Lawrence J. Hirsch, MD

Columbia Comprehensive Epilepsy Center, Neurological Institute of New York

Mary O'Neil Mundinger, DrPH

Columbia University School of Nursing

Guidelines recommend that patients with persistent seizures not responsive to standard antiepileptic drugs after 1 year be referred to specialized epilepsy centers for evaluation, which may include inpatient video-electroencephalographic monitoring. This 1-year retrospective, limited-focus review of 213 admissions and 3-year postdischarge review of epilepsy surgery referrals sought to determine if admission to an inpatient adult epilepsy monitoring unit resulted in a definitive diagnosis, a change in diagnosis or treatment, and whether referral patterns were consistent with guidelines. The median duration of time since symptom onset prior to admission was 15 years. At discharge, 87.8% of admissions received a definitive diagnosis. Epilepsy was diagnosed in 73.3% and excluded in 21.6%. Admissions without epilepsy had been treated with antiepileptic drugs for a median of 9 years. Admission resulted in change in treatment in 79%. This review documents the diagnostic utility of an epilepsy monitoring unit while highlighting that time since symptom onset to admission exceeded established guidelines. (Am J Med Qual 2007;22:117-122)

Key Words: adults • epilepsy/diagnosis/epidemiology • inpatients/statistics • monitoring • retrospective studies • seizures/diagnosis/etiology/physiopathology • videotape recording

American Journal of Medical Quality, Vol. 22, No. 2, 117-122 (2007)
DOI: 10.1177/1062860606298295
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