# Utility and safety of epilepsy monitoring unit in an inpatient psychiatric setting in Japan

## TL;DR

An epilepsy monitoring unit in a psychiatric ward in Japan helped diagnose and manage epilepsy, with safety measures needed to prevent falls.

## Contribution

Demonstrates the feasibility and benefits of an epilepsy monitoring unit in a psychiatric setting in Japan.

## Key findings

- Habitual events were recorded during LTVEM in 69% of patients.
- 28% of patients had a change in diagnosis after EMU evaluation.
- 11 patients eventually underwent surgery for epilepsy.

## Abstract

•An EMU with LTVEM was launched in Japanese psychiatric ward.•Habitual events were recorded during LTVEM in 69 % of patients.•An EMU in the psychiatry setting can facilitate accurate diagnosis.•An EMU in the psychiatric setting can improve epilepsy management.•Fall prevention measures should be performed during and after LTVEM for safer EMU.

An EMU with LTVEM was launched in Japanese psychiatric ward.

Habitual events were recorded during LTVEM in 69 % of patients.

An EMU in the psychiatry setting can facilitate accurate diagnosis.

An EMU in the psychiatric setting can improve epilepsy management.

Fall prevention measures should be performed during and after LTVEM for safer EMU.

An epilepsy monitoring unit (EMU) with long-term video electroencephalographic monitoring (LTVEM) was launched in our psychiatric ward to facilitate close examination of patients with epilepsy and offer hospital experience to psychiatrists unfamiliar with epilepsy care in Japan. This study aimed to examine the usefulness and safety of the EMU in an inpatient psychiatric setting in Japan by retrospectively reviewing the clinical notes of EMU admission cases in the psychiatric ward of the University of Tokyo Hospital between August 2014 and March 2020. The usefulness of the EMU was evaluated in terms of 1) habitual seizure recordings, 2) change in diagnosis, 3) frequency of epileptic seizures, and 4) surgical cases after EMU admission, and 5) EMU safety. Habitual events were recorded during LTVEM in 69 % of patients. The diagnosis was changed post-EMU evaluation in 28 % of the patients admitted for differential diagnosis. Among 41 patients who received anti-seizure medications, seizure frequency improved in 22 (53 %), whereas 10 (24 %) became seizure-free, and seizures were reduced by >50 % in 12 (29 %). Eleven patients eventually underwent surgery for epilepsy. Among the total 134 patients, 13 (10 %) experienced adverse events during EMU stay and 6 experienced falls, but none required prolonged hospitalization. Furthermore, three patients had panic attacks, but no post-ictal psychiatric symptoms were observed. Admission to an EMU in the psychiatric setting can facilitate accurate diagnosis and improve epilepsy management. Fall prevention measures should be implemented during and after LTVEM for safer EMU evaluations.