A survey of ictal physical examination during VEEG monitoring in a tertiary epilepsy center

TL;DR

This study evaluates how well medical staff perform ictal exams during EEG monitoring for seizures, finding significant gaps in training and compliance.

Contribution

The study identifies specific shortcomings in ictal examination practices and highlights the need for improved training for medical staff.

Findings

Only 38.4% of seizures had medical staff present at the bedside.

Compliance with 'naming' and 'memory testing' was less than 3%.

Most seizures were focal, and staff often arrived within 30 seconds of onset.

Abstract

Ictal examination based on video-based electroencephalography (EEG) is crucial for locating and lateralizing seizures. In this study, we aimed to evaluate the quality of ictal examination in the Comprehensive Epilepsy Center of West China Hospital, Sichuan University, in order to provide information for quality improvement in daily clinical practice.

Video recordings of 100 patients with epilepsy were retrospectively reviewed. The performance of the ictal examination was independently reviewed by two epileptologists using an ictal examination protocol.

In this retrospective analysis, 589 seizure episodes from 100 patients with epilepsy were reviewed. The ages of the patients ranged from 3 to 77 years, with a mean age of 25.8 ± 12.8 years. Among the 589 seizure episodes, a majority (93.7%) were focal seizures. For 226 (38.4%) seizures, the medical staff arrived at the bedside. Among them, 153 (153/226, 64.7%) seizure episodes, the medical staff arrival at the bedside within 30 s of onset, and 120 (120/226, 53.1%) seizures were tested by the medical staff. The compliance rates for "safety” and "visibility" reached 80% or higher while “naming”, “retelling”, and “memory testing” only reach less than 3%.

Our survey identified the main problems in ictal assessments. It is challenging to complete a standardized examination for new trainees at Epilepsy Monitoring Units. Regularly strengthening training in ictal examination and understanding of semiology may improve patients’ examination ability. However, further study of the implementation of training is necessary.