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• W53551810 abstract "The utility of long term video-EEG monitoring is well established and has diagnostic, prognostic, and therapeutic functions. Patients are admitted to the Epilepsy Monitoring Unit (EMU) to have medications lowered for seizure provocation. Electrographic and clinical information from the seizures are analyzed for the purpose of classifying and treating epilepsy. Clinical or ictal assessment is an interactive and demanding skill. Factors inherent in the seizures often limit the accuracy and detail of an ictal assessment. The literature suggests that an observational tool for use during ictal assessment may help to improve accuracy. To date, a standardized tool for use in seizure observation or ictal assessment has not been developed. The purpose of this article is to synthesize the current recommendations regarding the components of seizure observation and describe how they can be organized to formulate a standardized assessment tool. An observation tool that was developed with these recommendations in mind and is currently being used on a 10-bed EMU is described. CLINICAL ASSESSMENT TOOL FOR SEIZURE OBSERVATION 5 Direct seizure observation and assessment is an essential role of the neuroscience nurse (Barry & Teixeira, 1983; Wulf, 2000). A standardized and widely accepted tool for seizure observation was not identified after an exhaustive literature review. The purpose of this article is to synthesize the current recommendations regarding the components of seizure observation and describe how they can be organized to formulate a standardized assessment tool. Epileptic seizures present with a variety of symptoms or clinical features. Analysis of the clinical features or semiology of seizures is most often performed with long term video-EEG monitoring and direct observation in an Epilepsy Monitoring Unit (EMU). Information from long term video-EEG monitoring facilitates seizure classification and has etiological, diagnostic, therapeutic and prognostic relevance (Berg et al., 2010). Advancements in simultaneous video-EEG recording and seizure detection software have dramatically enhanced the process of seizure classification and the treatment of epilepsy however; they are not a substitute for direct observation of a patient during a seizure. Not all clinical components of a seizure can be assessed with video-EEG alone, without the use of an “observer” some clinical features of the seizure such as language and level of awareness cannot be reliably assessed. Information that is elicited through direct interaction, assessment, and observation during and after a seizure can provide the epileptologist with details that contribute to the classification and localization of the seizure. The National Association of Epilepsy Centers (2010) Guidelines for Essential Services, Personnel, and Facilities in Specialized Epilepsy Centers recommends that continuous observation of patients undergoing video-EEG monitoring in an EMU be performed by EEG technologists or epilepsy staff nurses. A study conducted by Bleasel et al. (1997) demonstrated that even individuals that were experienced in observing seizures the inter-observer reliability for subjective visual analysis of seizures was poor. Wulf (2000) concluded that no correlation existed between observer characteristics such as educational background and clinical experience, and the detail and quality of seizure observation. These findings would suggest that factors beyond experience and educational background limit the accuracy and CLINICAL ASSESSMENT TOOL FOR SEIZURE OBSERVATION 6 quality of seizure observation. Wulf hypothesized that the unpredictable and variable nature of seizures and the need to provide safety during a seizure impacts the accuracy of the ictal assessment. As education and training alone may not help the observer achieve the sophisticated level of proficiency that is required for reliable ictal assessment and factors inherent to the seizure that make observation difficult are not modifiable, other means for improving accuracy and reliability of seizure observation must be examined." @default.
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• W53551810 date "2011-01-01" @default.
• W53551810 modified "2023-09-24" @default.
• W53551810 title "Development of a Clinical Assessment Tool for Seizure Observation" @default.
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