Current practices in epilepsy monitoring units (EMU) in India

Baheti, Neeraj N; Rathore, Chaturbhuj; Bansal, Atma Ram; Kannan, Lakshminarayanan; Gopinath, Siby; Pillai, Anju S.; Jagtap, Sujit; Patil, Sandeep B.; Jabeen, Shaik Afshan; Turaga, Suryaprabha; Jayalakshmi, Sita; Ravat, Sangeeta; Shah, Urvashi; Mani, Jayanti; Singh, Atampreet; Nayak, Dinesh; Prakash, Sanjay; Rana, Kaushik; Khan, Fayaz; Udani, Vrajesh; Murthy, J. M. K.; Radhakrishnan, Kurupath

doi:10.1016/j.seizure.2021.10.004

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Most studies on EMU patient safety practices across the world have shown that these practices were often heterogeneous between centers. 1,3,[7][8][9][10][11] Differences in EMU structure, patient monitoring, staffing, use of standardized protocols, and general safety measures against injuries all contribute to this heterogeneity. Safety is paramount in the EMU, especially given that patients are often weaned off their medication to precipitate seizures.…”

Section: Discussionmentioning

confidence: 99%

“…7 Previous studies performed in Europe, Israel, the USA, and Canada published before December 2021 have also highlighted critical aspects of patient safety in EMUs and have emphasized the need for safety standards. 1,3,[8][9][10][11] As such, the 2021 ILAE/IFCN guidelines are a welcome step towards optimizing and standardizing EMU safety.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…1 Undertaken in epilepsy monitoring units (EMUs), LTVEM is used to record seizures for differential diagnosis, classification, and seizure quantification purposes. 2,3 More specific examples of LTVEM's usage include differentiation between epileptic and non-epileptic events, the classification of patients by seizure type or epilepsy syndrome, and the evaluation of drug-resistant PWE for resective brain surgery. 2,4 In the EMU, a combination of strategies is typically used to precipitate seizures so that they may be captured by video-EEG; these strategies include but are not limited to anti-seizure medication tapering, sleep deprivation, and photic stimulation.…”

Section: Introductionmentioning

confidence: 99%

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Patient Safety in Canadian Epilepsy Monitoring Units: A Survey of Current Practices

Nguyen

et al. 2023

Can. J. Neurol. Sci.

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Background: Guidelines on epilepsy monitoring unit (EMU) standards have been recently published. We aimed to survey Canadian EMUs to describe the landscape of safety practices and compare these to the recommendations from the new guidelines. Methods: A 34-item survey was created by compiling questions on EMU structure, patient monitoring, equipment, personnel, standardized protocol use, and use of injury prevention tools. The questionnaire was distributed online to 24 Canadian hospital centers performing video-EEG monitoring (VEM) in EMUs. Responses were tabulated and descriptively summarized. Results: In total, 26 EMUs responded (100% response rate), 50% of which were adult EMUs. EMUs were on average active for 23.4 years and had on average 3.6 beds. About 81% of respondents reported having a dedicated area for VEM, and 65% reported having designated EMU beds. Although a video monitoring station was available in 96% of EMUs, only 48% of EMUs provided continuous observation of patients (video and/or physical). A total of 65% of EMUs employed continuous heart monitoring. The technologist-to-patient ratio was 1:1–2 in 52% of EMUs during the day. No technologist supervision was most often reported in the evening and at night. Nurse-to-EMU-patient ratio was mostly 1:1–4 independent of the time of day. Consent forms were required before admission in 27% of EMUs. Conclusion: Canadian EMUs performed decently in terms of there being dedicated space for VEM, continuous heart monitoring, and adequate nurse-to-patient ratios. Other practices were quite variable, and adjustments should be made on a case-by-case basis to adhere to the latest guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient Safety in Canadian Epilepsy Monitoring Units: A Survey of Current Practices

Nguyen

et al. 2023

Can. J. Neurol. Sci.

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A survey of the prevalence and patterns of neuropsychological assessment practices across epilepsy surgery centers in India: Toward establishing a national guideline

Shah,

Rathore,

Radhakrishnan

et al. 2024

Epilepsia Open

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Neuropsychology plays an important role in optimizing epilepsy management, but there are no practice guidelines for low‐ and middle‐income countries with emerging services. The National Epilepsy Surgery Support Activity Network (NESSAN), a national working group that supports and optimizes epilepsy surgery programs in India, explored the present status of pre‐ and post epilepsy surgery neuropsychological assessment practices across India as an initial step in developing national evidence‐based test guidelines. An online survey was conducted using two questionnaires, one for neurologists and the second for neuropsychologists and speech–language pathologists working in epilepsy surgery centers. The questions to neurologists covered the setting, description, and nature of the neuropsychology services provided for adults and children as part of the epilepsy surgery program, and their perceptions about the importance and indications for neuropsychological assessment in epilepsy surgery. The questions to neuropsychologists inquired about their qualifications and training, pre‐ and postsurgical assessment procedures, and domain‐specific cognitive tests and scales for mood, quality of life, and language evaluations. Forty‐three centers responded, and neuropsychology services were available at three fourth of the centers, but a dedicated full‐time neuropsychologist was available in only 16% of centers. Ninety percent of the neurologists considered neuropsychological evaluation an indispensable part of presurgical evaluation. However, only a few of them believed that the results influenced their decision about the extent of resection and ruling against surgery. The survey found considerable heterogeneity in terms of qualifications and training of neuropsychologists, evaluation procedures, test protocols, and normative data that will need to be harmonized to ensure uniform practice across the country. We believe that the results from this survey provide a road map for implementing measures to minimize existing inadequacies and harmonize neuropsychology services in India and as well as in other countries with emerging neuropsychology services.Plain Language SummaryNeuropsychological assessment is an integral part of the pre‐ and post epilepsy surgery evaluations. In India, the National Epilepsy Surgery Support Activity Network (NESSAN), a body of multidisciplinary professionals, conducted a survey to examine existing neuropsychology practices. The responses from 43 centers across the country revealed considerable heterogeneity in tests and few trained and qualified neuropsychologists. In low‐ and middle‐income countries (LMIC) with emerging neuropsychology services, there is a need to have uniform test protocols, specialized training, and guidelines for optimizing neuropsychology services across all the epilepsy surgery centers.

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Intervention time and adverse events in a canadian epilepsy monitoring unit: An updated audit

Hagouch,

Li,

Forand

et al. 2024

Heliyon

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Current practices in epilepsy monitoring units (EMU) in India

Cited by 4 publications

References 19 publications

Patient Safety in Canadian Epilepsy Monitoring Units: A Survey of Current Practices

Patient Safety in Canadian Epilepsy Monitoring Units: A Survey of Current Practices

A survey of the prevalence and patterns of neuropsychological assessment practices across epilepsy surgery centers in India: Toward establishing a national guideline

Intervention time and adverse events in a canadian epilepsy monitoring unit: An updated audit

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