Abstracts

Rationale: While inpatient epilepsy monitoring units (EMU) are generally safe, seizures in this setting can still produce significant morbidity. The recent MORTEMUS study revealed that the most feared consequence of an unattended seizure – sudden unexpected death in epilepsy (SUDEP) – does occur rarely in the EMU, and all cases identified occurred in the evening. We hypothesized that unwitnessed seizures would be more likely to occur during the night shift, and that response times to unwitnessed seizures would be slower at night due to fatigue, staffing levels, experience levels, or other variables.Methods: We performed a retrospective video EEG review of all seizures captured in 15 patients admitted to our EMU during a 4-week period in 2014. We measured the time between electrographic seizure onset and the arrival of an attendant at the bedside.Results: We identified 16 diurnal and 14 nocturnal seizures. The median response time during the day shift was approximately 22 seconds (SD 28 seconds) versus 49 seconds (SD 93 seconds) during the night shift (Mann-Whitney U Test; p=<0.03). Three subtle or subclinical seizures were excluded, as was one prolonged seizure lasting nearly 18 minutes. Excluded seizures occurred during the night shift and had longer response times.Conclusions: These preliminary findings indicate a statistically significant delay in response times to seizures in the EMU during the night shift. More research is needed into human factors, systems issues, or patient-related/physiological factors that slow response times to nocturnal seizures, and whether addressing these factors can improve patient safety in the EMU.