With COVID-19 infections and hospitalizations once again surging, institutions are again considering restricting elective procedures. When this happened last year, at the height of the pandemic restrictions, many epilepsy monitoring units (EMU) were relegated to emergency use only.

While this resulted in a serious disruption in seizure management for many, it also presented a unique opportunity to take a closer look at the use of the EMU for emergent cases. The results highlight the important role video EEG plays in diagnosing and managing both epileptic and non-epileptic seizures.

A Case Study

Upon state mandate, the University of Texas Southwestern Medical Center closed its EMUs to all elective procedures between March 22, 2020 and May 18, 2020. Only urgent (non-COVID-19 related) admissions were allowed.

Researchers there took the opportunity to, for the first time, study this unique subset of patients. The results of their study were recently published in The Neurodiagnostic Journal.

Because the majority of EMU admissions are elective, and there can be long wait times, there is little data on emergency cases. The authors sought to learn three things about these patients:

  1. Their characteristics and who refers them
  2. The value of their EMU stay
  3. How pre-EMU diagnoses correlated with data collected in the unit

High Diagnostic Yield

Out of the 20 admissions recorded in the study period, 19 exhibited a typical event and a definitive diagnosis was made following three days of video EEG in the EMU. This represents an unusually high rate of captured seizures in the EMU, as other studies report event-capture rates closer to 50 percent, according to the authors.

Nearly half of the patients exhibited epileptic seizures (ES), while the remaining had psychogenic non-epileptic seizures (PNES).

Almost 90 percent of the patients that exhibited ES were given medication changes for better seizure management. The patients who exhibited PNES either weren’t on medication in the first place or had their medications discontinued.

The diagnostic yield of this study was high and significantly correlated with the patients’ pre-EMU diagnoses, especially those made by epileptologists. Only one patient who was thought to have epilepsy turned out to have PNES.

Value in Emergent Admissions

Most importantly, none of the patients originally diagnosed with PNES were found to have epileptic seizures.

While this study was small, it offers a rare look at the value of video EEG in emergent admissions. The rates of event capture were extraordinarily high as was the correlation between pre- and post-EMU diagnoses.

This underlines the importance of using video EEG for both the confirmation of a clinical diagnosis and for fine tuning medication in seizure management. It also serves as a reminder of the importance of keeping EMUs open, even as COVID cases rise once again.