BACKGROUND: The ictal examination is crucial for neuroanatomic localization of seizure onset, which informs medical and neurosurgical treatment of epilepsy. Substantial variation exists in ictal examination performance in epilepsy monitoring units (EMUs). We developed and implemented a standardized examination to facilitate rapid, reliable execution of all testing domains and adherence to patient safety maneuvers. METHODS: Following observation of examination performance, root cause analysis of barriers, and review of consensus guidelines, an ictal examination was developed and disseminated. In accordance with quality improvement methodology, revisions were enacted following the initial intervention, including differentiation between pathways for convulsive and nonconvulsive seizures. We evaluated ictal examination fidelity, efficiency, and EMU staff satisfaction before and after the intervention. RESULTS: We identified barriers to ictal examination performance as confusion regarding ictal examination protocol, inadequate education of the rationale for the examination and its components, and lack of awareness of patient-specific goals. Over an 18-month period, 100 ictal examinations were reviewed, 50 convulsive and 50 nonconvulsive. Ictal examination performance varied during the study period without sustained improvement for convulsive or nonconvulsive seizure examination. The new examination was faster to perform (0.8 vs 1.5 minutes). Postintervention, EMU staff expressed satisfaction with the examination, but many still did not understand why certain components were performed. CONCLUSION: We identified key barriers to EMU ictal assessment and completed real-world testing of a standardized, streamlined ictal examination. We found it challenging to reliably change ictal examination performance in our EMU; further study of implementation is warranted.
BACKGROUND: The ictal examination is crucial for neuroanatomic localization of seizure onset, which informs medical and neurosurgical treatment of epilepsy. Substantial variation exists in ictal examination performance in epilepsy monitoring units (EMUs). We developed and implemented a standardized examination to facilitate rapid, reliable execution of all testing domains and adherence to patient safety maneuvers. METHODS: Following observation of examination performance, root cause analysis of barriers, and review of consensus guidelines, an ictal examination was developed and disseminated. In accordance with quality improvement methodology, revisions were enacted following the initial intervention, including differentiation between pathways for convulsive and nonconvulsive seizures. We evaluated ictal examination fidelity, efficiency, and EMU staff satisfaction before and after the intervention. RESULTS: We identified barriers to ictal examination performance as confusion regarding ictal examination protocol, inadequate education of the rationale for the examination and its components, and lack of awareness of patient-specific goals. Over an 18-month period, 100 ictal examinations were reviewed, 50 convulsive and 50 nonconvulsive. Ictal examination performance varied during the study period without sustained improvement for convulsive or nonconvulsive seizure examination. The new examination was faster to perform (0.8 vs 1.5 minutes). Postintervention, EMU staff expressed satisfaction with the examination, but many still did not understand why certain components were performed. CONCLUSION: We identified key barriers to EMU ictal assessment and completed real-world testing of a standardized, streamlined ictal examination. We found it challenging to reliably change ictal examination performance in our EMU; further study of implementation is warranted.
Authors: Darcy Reed; Eboni G Price; Donna M Windish; Scott M Wright; Aysegul Gozu; Edbert B Hsu; Mary Catherine Beach; David Kern; Eric B Bass Journal: Ann Intern Med Date: 2005-06-21 Impact factor: 25.391
Authors: Philippe Ryvlin; Lina Nashef; Samden D Lhatoo; Lisa M Bateman; Jonathan Bird; Andrew Bleasel; Paul Boon; Arielle Crespel; Barbara A Dworetzky; Hans Høgenhaven; Holger Lerche; Louis Maillard; Michael P Malter; Cecile Marchal; Jagarlapudi M K Murthy; Michael Nitsche; Ekaterina Pataraia; Terje Rabben; Sylvain Rheims; Bernard Sadzot; Andreas Schulze-Bonhage; Masud Seyal; Elson L So; Mark Spitz; Anna Szucs; Meng Tan; James X Tao; Torbjörn Tomson Journal: Lancet Neurol Date: 2013-09-04 Impact factor: 44.182
Authors: Jerry J Shih; Nathan B Fountain; Susan T Herman; Anto Bagic; Fred Lado; Susan Arnold; Mary L Zupanc; Ellen Riker; David M Labiner Journal: Epilepsia Date: 2017-11-10 Impact factor: 5.864
Authors: Patricia O Shafer; Janice M Buelow; Katherine Noe; Ruth Shinnar; Sandra Dewar; Paul M Levisohn; Patricia Dean; David Ficker; Mary Jo Pugh; Gregory L Barkley Journal: Epilepsy Behav Date: 2012-09-20 Impact factor: 2.937