Abstracts

RATIONALE: Epileptic seizures and their postictal periods are rich sources of information about the nature of epilepsy, but patients are rarely examined systematically during and following attacks in a way that is consistent from one patient to the next, even during long term EEG monitoring. This paper presents a standard procedure that can be done quickly and consistently, and one which covers areas providing much information about the underlying seizure disorders. After training with the materials we have developed, epilepsy long term monitoring staff are able to consistently test EEG monitored seizures using this uniform approach.
METHODS: An interdisciplinary team of nurses and psychometrists, with input from neuropsychologists and physicians, identified essential functions requiring testing during and following epileptic seizures. Mindful of the often very limitied time available to gather data during and immediately after a seizure, we developed a short, standard seizure testing system to assess orientation, ability to name objects, ability to read a sentence and follow directions, and to assess short term memory and motor function. The set of materials consists of a series of two sided, laminated cards with pictures and print for patients to view during testing, with cues for staff on the reverse sides of the cards. To assure standardized administration of the testing, all staff were trained with a ten minute video demonstration, a one page sheet of instructions, and individual training from charge nurses and supervisors.
RESULTS: The standard testing protocol has been used on our inpatient unit since September, 2001. A set of testing cards is kept on a shelf by each monitored patient[ssquote]s bed and in each of the neuropsychology testing rooms. This testing protocol is routinely used to test each monitored seizure on the inpatient unit. For over eight months, with an estimated minimum of 50 monitored, tested seizures per month, we have evaluated more than 400 seizures thus far using this uniform seizure testing system. Nurses now report more confidence in undertaking the procedure, and there is less delay in beginning testing after a seizure has begun. Physicians have stated that testing during seizures is more consistent, and that the information it generates is more useful in helping to arrive at correct diagnoses and appropriate treatment plans. Furthermore, with each seizure videotaped, a research tool is now in place which did not previously exist.
CONCLUSIONS: The standard seizure testing system has improved the consistency and quality of information available to neurologists, neurosurgeons, and neuropsychologists, and we believe that it has also improved our ability to develop care plans for our patients. The system can be used for a variety of research projects in the future.