A description of current practice in epilepsy monitoring units

In the epilepsy monitoring unit (EMU), a patient whose seizures may be under control is placed in a medication-withdrawal situation to induce seizures for direct observation and recording. This withdrawal introduces patient risk. In addition, because the EMU is a complex medical and restrictive physical environment, other risks are brought into play. Patient management to reduce danger while optimizing results should arise from current evidence, but gaps exist in the literature regarding best practice in the EMU. In this article the authors report results of two national surveys of health care practitioners in specialized epilepsy care regarding current EMU practice.

Two surveys were developed: one comprised of 17 questions for physicians who practice in an EMU, and one comprising 26 questions for nurses who practice in an EMU. Both surveys addressed such issues as protocols for medication withdrawal and rescue procedures, patient observers, and safety issues. Surveys were distributed via Zoomerang to 1500 physician and 105 nurse members of the American Epilepsy Society. Results were tabulated and presented as percentages for each question of each survey.

Responses came from 257 physicians (approximately 17%) and 39 nurses (37%). More than half of the responders practiced in large academic centers. No clear consensus of practice emerged on such questions as drug withdrawal, seizure observation, and rescue protocols. Safety precautions varied.

An initial attempt to understand current practice in EMUs, our survey study showed a wide variation in practice patterns, some of which raise safety concerns. The data gathered can aid design of future studies that more directly address specific questions of safety in the EMU.