RESUMEN
PURPOSE: To investigate the performance of seizure detection methods and nursing staff response in our epilepsy monitoring unit (EMU). METHODS: We retrospectively reviewed 38 EMU patient admissions over a 1-year period capturing 133 epileptic and non-epileptic seizures with associated video-EEG data. We recorded detailed seizure event characteristics for further analysis. RESULTS: Rates of seizure detection, alarm usage, and time to nursing response varied by seizure type. Patients self-activated the push button (PB) alarm for 31.1% of all seizures, but only 8.9% of focal impaired awareness (FIAS) and focal to bilateral tonic-clonic seizures (FBTCS). In comparison, the Persyst automated seizure alarm reliably detected both electrographic seizures (76.2% of electrographic seizures) and FIAS/FBTCS (87.2% of FIAS/FBTCS), with a false positive alarm rate (FAR) of 0.14/hour, or every 7.3 h. 11.4% of all seizures went unrecognized by nursing staff, of which the majority (80.0%) were FIAS. The PB alarm was of higher yield for alerting nurses to focal aware seizures (FAS) and psychogenic non-epileptic seizures (PNES) versus FIAS and FBTCS (p < 0.001). In contrast, nurses relied more on the automated Persyst software alarm to detect FIAS (p < 0.001). Time to nursing response was no different following audible alarm onset for the PB compared to the Persyst alarms (p = 0.14). CONCLUSION: Automated seizure detection software plays an important role in our EMU in seizure recognition, particularly for alerting nurses to FIAS. More rigorous studies are needed to determine the best utilization of various monitoring techniques and to promote high quality standards and patient safety in the EMU.
Asunto(s)
Diagnóstico por Computador , Electroencefalografía , Epilepsia/diagnóstico , Monitorización Neurofisiológica , Reconocimiento de Normas Patrones Automatizadas , Convulsiones/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico por Computador/métodos , Electroencefalografía/métodos , Epilepsia/fisiopatología , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitorización Neurofisiológica/métodos , Atención de Enfermería , Admisión del Paciente , Reconocimiento de Normas Patrones Automatizadas/métodos , Estudios Retrospectivos , Convulsiones/fisiopatología , Programas Informáticos , Tiempo de Tratamiento , Grabación en Video , Adulto JovenRESUMEN
Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist.