First Do No Harm: Safety in the Epilepsy Monitoring Unit

OBJECTIVE: To determine the rate of medical complications from long‐term video‐electroencephalographic (EEG) monitoring for epilepsy. PATIENTS AND METHODS: We reviewed the medical records of 428 consecutive adult patients with epilepsy who were admitted for diagnostic scalp video‐EEG monitoring at Mayo Clinic's site in Arizona from January 1, 2005 to December 31, 2006; 149 met inclusion criteria for the study. Seizure number and type as well as timing and the presence of seizure‐related adverse outcomes were noted. RESULTS: Of the 149 adult patients included in the study, seizure clusters occurred in 35 (23%); 752 seizures were recorded. The mean time to first seizure was 2 days, with a mean length of stay of 5 days. Among these patients, there was one episode of status epilepticus, three potentially serious electrocardiographic abnormalities, two cases of postictal psychosis, and four vertebral compression fractures during a generalized convulsion, representing 11% of patients with a recorded generalized tonic–clonic seizure. No deaths, transfers to the intensive care unit, falls, dental injuries, or pulmonary complications were recorded. An adverse event requiring intervention or interfering with normal activity occurred in 21% of these patients. Length of stay was not affected by occurrence of adverse events. CONCLUSION: Prolonged video‐EEG monitoring is an acceptably safe procedure. Adverse events occur but need not result in substantial morbidity or increase length of hospitalization. Appropriate precautions must be in place to prevent falls and promptly detect and treat seizure clusters, status epilepticus, serious electrocardiographic abnormalities, psychosis, and fractures.