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Occurrence of seizure clusters and status epilepticus during inpatient video-EEG monitoring

From the Columbia College of Physicians and Surgeons (A.B. Rose), New York, NY; Adult Comprehensive Epilepsy Treatment Center (Dr. McCabe), Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine; Department of Neurology (Dr. Gilliam), Epilepsy Center, University of Alabama at Birmingham; Department of Neurology (Dr. Smith), Henry Ford Hospital and Medical Centers, Detroit, MI; Department of Neurology (Dr. Boggs), Medical College of Virginia of Virginia Commonwealth University, Richmond; Department of Neurology (Dr. Ficker), University of Cincinnati College of Medicine, OH; Department of Neurology (Dr. Moore), The Ohio State University College of Medicine, Columbus; Department of Neurology (Dr. Passaro), University of Michigan, Ann Arbor; Department of Neurology (Dr. Bazil), Columbia University College of Physicians and Surgeons, New York, NY.

Address correspondence and reprint requests to Dr. Carl W. Bazil, Comprehensive Epilepsy Center, 710 West 168th Street, New York, NY 10032; e-mail: cwb11{at}columbia.edu

Objective: To investigate the occurrence of status epilepticus and seizure clusters, and the duration until first seizure at epilepsy monitoring units in the United States.

Methods: The authors examined the inpatient video-EEG monitoring reports of 514 consecutive patients admitted to five comprehensive epilepsy centers during the year 2000. Time to first seizure, seizure clustering, and seizure duration were ascertained from reports and entered into a database.

Results: In 169 admissions with complex partial seizures (CPSs) or secondarily generalized tonic-clonic (2GTC) seizures, there were 5 (3.0%) patients with status epilepticus, 30 (17.8%) with 4-hour seizure clusters, and 82 (48.5%) with 24-hour seizure clusters. There were no statistically significant differences between centers, except that seizure clusters were observed to be less common at the one center with a formal drug withdrawal protocol. The average time to CPS or 2GTC seizure was 2.1 days; the average number of days to nonepileptic event was 1.2 days (p = 0.001).

Conclusions: Although status epilepticus is uncommon at epilepsy monitoring units, clusters of seizures are common. Intensive monitoring with drug withdrawal must be performed in a highly supervised, hospitalized setting. Inpatient video-EEG monitoring is efficient, with recording of the first epileptic or nonepileptic events in 2 days or less.

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