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The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic
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 on...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302842/ https://www.ncbi.nlm.nih.gov/pubmed/34364025 http://dx.doi.org/10.1016/j.yebeh.2021.108229 |
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author | Babtain, Fawzi Atteyah, Daniah Milyani, Haneen Banjer, Tasnim Alqadi, Khalid Baeesa, Saleh Al Said, Youssef |
author_facet | Babtain, Fawzi Atteyah, Daniah Milyani, Haneen Banjer, Tasnim Alqadi, Khalid Baeesa, Saleh Al Said, Youssef |
author_sort | Babtain, Fawzi |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8302842 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-83028422021-07-26 The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic Babtain, Fawzi Atteyah, Daniah Milyani, Haneen Banjer, Tasnim Alqadi, Khalid Baeesa, Saleh Al Said, Youssef Epilepsy Behav Article 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. Elsevier Inc. 2021-09 2021-07-24 /pmc/articles/PMC8302842/ /pubmed/34364025 http://dx.doi.org/10.1016/j.yebeh.2021.108229 Text en © 2021 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Babtain, Fawzi Atteyah, Daniah Milyani, Haneen Banjer, Tasnim Alqadi, Khalid Baeesa, Saleh Al Said, Youssef The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic |
title | The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic |
title_full | The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic |
title_fullStr | The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic |
title_full_unstemmed | The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic |
title_short | The safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the COVID-19 pandemic |
title_sort | safety and efficacy of modifying the admission protocol to the epilepsy monitoring unit in response to the covid-19 pandemic |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302842/ https://www.ncbi.nlm.nih.gov/pubmed/34364025 http://dx.doi.org/10.1016/j.yebeh.2021.108229 |
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