The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic.

Autor: Babtain F; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. Electronic address: fbabtain@kfshrc.edu.sa., Atteyah D; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia., Milyani H; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia., Banjer T; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia., Alqadi K; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia., Baeesa S; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia., Al Said Y; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Jazyk: angličtina
Zdroj: Epilepsy & behavior : E&B [Epilepsy Behav] 2021 Sep; Vol. 122, pp. 108229. Date of Electronic Publication: 2021 Jul 24.
DOI: 10.1016/j.yebeh.2021.108229
Abstrakt: Purpose: The coronavirus disease 2019 (COVID-19) pandemic has impacted admission to epilepsy monitoring units (EMUs) for classification and presurgical evaluation of patients with refractory epilepsy. We modified the EMU admission protocol via anti-seizure medications (ASM) withdrawal implemented one day before admission; thus, we aimed to evaluate the efficacy and safety of this modified protocol.
Methods: In January 2021, we initiated ASM tapering 24 h before-rather than on the first day after-EMU admission, contrasting with the previous protocol. We retrospectively reviewed EMU admissions between January and April of 2018, 2019, and 2021, and identified the time required to record the first seizure, and EMU yield to confirm or change the epilepsy classification. We also evaluated the safety of the modified protocol, by monitoring the seizure frequency for up to 5 months after the discharge from the hospital.
Results: One hundred four patients were included (mean age: 30 years, men: 43%); excluding a longer disease duration and abundance of normal routine electro-encephalogram (EEG) in patients admitted before the pandemic, no differences were observed in patients' characteristics. On average, it took 41 h and 21 h to record the first seizure using the standard and modified protocols, respectively (p < 0.001, 95% CI: 10-30). Other characteristics were investigated both before and after the COVID-19 pandemic, and epilepsy classifications were confirmed twice using the modified protocol (OR = 2.4, p = 0.04, 95% CI: 1.1-5.5). Multivariate regression analysis confirmed the shorter time to record the first seizure using the modified admission protocol (23 h less, p < 0.001; 95% CI: 12-34). Finally, 36 (86%) patients admitted during the pandemic exhibited no increase in seizure frequency after the discharge from the hospital.
Conclusions: Initiating ASM withdrawal one day before EMU admission was deemed to be an efficient and safe way to confirm epilepsy classification and significantly decrease the length of hospital stay. Ultimately, this will shorten the long waiting list for EMU admission created by the COVID-19 pandemic.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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