How seizure detection by continuous electroencephalographic monitoring affects the prescribing of antiepileptic medications

Arch Neurol. 2009 Jun;66(6):723-8. doi: 10.1001/archneurol.2009.100.

Abstract

Objectives: To assess the effect of continuous electroencephalographic monitoring on the decision to treat seizures in the inpatient setting, particularly in the intensive care unit.

Design: Retrospective cohort study.

Setting: Medical and neuroscience intensive care units and neurological wards.

Patients: Three hundred consecutive nonelective continuous electroencephalographic monitoring studies, performed on 287 individual inpatients over a 27-month period.

Main outcome measures: Epileptiform electroencephalographic abnormalities and changes in antiepileptic drug (AED) therapy based on the electroencephalographic findings.

Results: The findings from the continuous electroencephalographic monitoring led to a change in AED prescribing in 52% of all studies with initiation of an AED therapy in 14%, modification of AED therapy in 33%, and discontinuation of AED therapy in 5% of all studies. Specifically, the detection of electrographic seizures led to a change in AED therapy in 28% of all studies.

Conclusions: The findings of continuous electroencephalographic monitoring resulted in a change in AED prescribing during or after half of the studies performed. Most AED changes were made as a result of the detection of electrographic seizures.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticonvulsants / administration & dosage*
  • Brain / drug effects
  • Brain / physiopathology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Decision Support Techniques
  • Drug Monitoring / methods
  • Electroencephalography / methods*
  • Epilepsy / diagnosis*
  • Epilepsy / drug therapy*
  • Epilepsy / physiopathology
  • Evoked Potentials / drug effects
  • Evoked Potentials / physiology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods*
  • Prescriptions
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Substances

  • Anticonvulsants