Characterizing the driving dilemma among patients with psychogenic nonepileptic seizures: A single-center prospective cohort study.

Objective: Driving is a critical topic to counsel among patients with epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES), with significant legal and public health implications. This prospective cohort study examined the frequency of ES and PNES in a single institution's Epilepsy Monitoring Unit (EMU) and assessed driving-related issues between each group.

Methods: Adult patients from the Mayo Clinic Arizona Epilepsy Monitoring Unit (EMU) were given comprehensive surveys addressing driving history.

Nonconvulsive status epilepticus secondary to acute porphyria crisis.

Both variegate and acute intermittent porphyria can manifest with various neurological symptoms. Although acute symptomatic seizures have been previously described, they are typically tonic-clonic and focal impaired awareness seizures. Convulsive status epilepticus and epilepsia partialis continua are rare and have been described on a case report basis.

Usage of EpiFinder clinical decision support in the assessment of epilepsy.

Background: The diagnosis of epilepsy is at times elusive for both neurologists and nonneurologists, resulting in delays in diagnosis and therapy. The development of screening methods has been identified as a priority in response to this diagnostic and therapeutic gap. EpiFinder is a novel clinical decision support tool designed to enhance the process of information gathering and integration of patient/proxy respondent data.

Topiramate for Treatment in Patients With Migraine and Epilepsy.

Background: Antiepileptic drugs (AED) are often considered first line for monotherapy in treatment of patients with migraines, and also those with comorbid migraine and epilepsy. Topiramate, a newer generation AED, has broad mechanism of action and evidence of benefit in patients with either episodic or chronic migraine along with epilepsy, both generalized and focal.

Methods: Our goal is to review the relevant mechanisms of action along with any supportive evidence published to date on the use of topiramate (TPM) in patients with both migraine headache and epilepsy.

Fall prevention and bathroom safety in the epilepsy monitoring unit.

Falls are one of the most common adverse events occurring in the epilepsy monitoring unit (EMU) and can result in significant injury. Protocols and procedures to reduce falls vary significantly between institutions as it is not yet known what interventions are effective in the EMU setting. This study retrospectively examined the frequency of falls and the impact of serial changes in fall prevention strategies utilized in the EMU between 2001 and 2014 at a single institution.

Quality of life in psychogenic nonepileptic seizures and epilepsy: the role of somatization and alexithymia.

It is clear that many individuals with psychogenic nonepileptic seizures (PNESs) often present with poorer quality of life compared with those with epileptic seizures (ESs). However, the mechanisms linking seizure diagnosis to quality-of-life outcomes are much less clear. Alexithymia and somatization are emotional markers of psychological functioning that may explain these differences in quality of life.

The influence of staffing on diagnostic yield of EMU admissions: a comparison study between two institutions.

Patients with recurrent, stereotyped neurological events of unclear etiology often warrant admission for continuous video-EEG monitoring in an epilepsy monitoring unit (EMU) for diagnosis. Epilepsy monitoring unit admission duration has been reported to range from days to weeks. To date, there are limited data on the average duration of admission for patients admitted to the EMU for spell classification.

Outcome of intracranial electroencephalography monitoring and surgery in magnetic resonance imaging-negative temporal lobe epilepsy.

We evaluated the outcomes of intracranial electroencephalography (iEEG) recording and subsequent resective surgery in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE). Thirty-two patients were identified from the Mayo Clinic Epilepsy Surgery Database (Arizona, Florida, and Minnesota). Eight (25.

The influence of impression management scales on the Personality Assessment Inventory in the epilepsy monitoring unit.

The Somatic Complaints scale (SOM) and Conversion subscale (SOM-C) of the Personality Assessment Inventory perform best in classifying psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES); however, the impact of positive impression management (PIM) and negative impression management (NIM) scales on SOM and SOM-C classification has not been examined. We studied 187 patients from an epilepsy monitoring unit with confirmed PNES or ES. On SOM, the best cut score was 72.

The importance of cardiac monitoring in the epilepsy monitoring unit: a case presentation of ictal asystole.

Ictal asystole may be a potent marker for epilepsy patients at high risk for sudden unexpected death in epilepsy (SUDEP). The use of inpatient long-term video-electroencephalographic (VEEG) monitoring coupled with simultaneous continuous cardiac telemetry is an important tool to detect ictal asystole as well as other significant ictal cardiac arrhythmias. In this paper a case of ictal asystole detected during VEEG is presented.

Ellen R. Grass lecture: Back to the future: from grass roots to microchips.

The study of the electroencephalogram (EEG) and other clinical neurophysiology (CNP) measurement tools has evolved over the last 70 years. In this evolutionary process, Ellen Grass and many professional technologists along the way have been instrumental in the translation of new developments in CNP technology to clinical utility. Technological developments in long-term EEG/video intensive care unit (ICU) monitoring, intraoperative monitoring, high frequency oscillation (HFO) recordings, automated signal analysis tools, seizure prediction devices, and the study of implanted intracranial recording and stimulation devices will improve our understanding of how the nervous system works.

Iatrogenic seizures during intracranial EEG monitoring.

Cerebral edema with declining neurologic status is a known complication of intracranial electroencephalography (EEG) monitoring. The frequency and consequences of iatrogenic edema that is not clinically evident are presently poorly defined. We investigated the potential for intracranial electrodes to cause subclinical cerebral edema, and for such edema to cause iatrogenic seizures.

Randomized comparison of the Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory-2 in the epilepsy monitoring unit.

The two most common personality measures used in evaluation of patients on epilepsy monitoring units (EMUs) are the Personality Assessment Inventory (PAI) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Both have been evaluated separately for their ability to distinguish patients with epilepsy from patients with psychogenic events, but they have never been compared directly. The primary aim of this study was to provide comparison data in an EMU population between the PAI, MMPI-2, and the MMPI-2-RF (MMPI-2 Restructured Form).

Code blue: seizures.

Eyewitnesses frequently perceive seizures as life threatening. If an event occurs on the hospital premises, a "code blue" can be called which consumes considerable resources. The purpose of this study was to determine the frequency and characteristics of code blue calls for seizures and seizure mimickers.

Indeterminate EMU admissions: does repeating the admission help?

Epilepsy monitoring unit (EMU) admissions during 2007-2009 at Mayo Clinic Hospital Arizona were reviewed. Of the 106 indeterminate admissions, 13 (12%) went on to have a second admission. During the second admission, 8 (62%) were diagnosed.

Risk of choking and aspiration during inpatient video-EEG monitoring.

Seizures can cause airway compromise and aspiration. This is a potential concern during inpatient video-EEG monitoring (vEEG), where seizures are provoked for diagnostic purposes. The frequency of aspiration and efficacy of nursing interventions to protect the airway were evaluated in this retrospective study of 590 partial complex (PC) and generalized tonic clonic (GTC) seizures recording during vEEG.

Frequency of physician counseling and attitudes toward driving motor vehicles in people with epilepsy: comparing a mandatory-reporting with a voluntary-reporting state.

Driving for the person with epilepsy (PWE) remains an important issue. Requirements for reporting PWE to driving authorities vary across the United States. We studied the prior experiences of PWE regarding counseling for driving in a reporting state (37% in New Jersey) and a nonreporting state (52% in Arizona).