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Accuracy of Patient Seizure Counts

Christian Hoppe, PhD; Annkathrin Poepel, MD; Christian E. Elger, PhD, MD

Arch Neurol. 2007;64(11):1595-1599.

Objective  To evaluate the effects of a daily patient reminder on seizure documentation accuracy.

Design  Randomized controlled trial.

Setting  Monitoring unit of an academic department of epileptology.

Patients  Consecutive sample of 91 adult inpatients with focal epilepsies undergoing video-electroencephalographic monitoring.

Intervention  While all patients were asked to document seizures at the beginning of the monitoring period, patients from the experimental group were reminded each day to document seizures.

Main Outcome Measure  Documentation accuracy (percentage of documented seizures).

Results  A total of 582 partial seizures were recorded. Patients failed to document 55.5% of all recorded seizures, 73.2% of complex partial seizures, 26.2% of simple partial seizures, 41.7% of secondarily generalized tonic-clonic seizures, 85.8% of all seizures during sleeping, and 32.0% of all seizures during the awake state. The group medians of individual documentation accuracies for overall seizures, simple partial seizures, complex partial seizures, and secondarily generalized tonic-clonic seizures were 33.3%, 66.7%, 0%, and 83.3%, respectively. Neither the patient reminder nor cognitive performance affected documentation accuracy. A left-sided electroencephalographic focus or lesion, but not the site (frontal or temporal), contributed to documentation failure.

Conclusions  Patient seizure counts do not provide valid information. Documentation failures result from postictal seizure unawareness, which cannot be avoided by reminders. Unchanged documentation accuracy is a prerequisite for the use of patient seizure counts in clinical trials and has to be demonstrated in a subsample of patients undergoing electroencephalographic monitoring.

Author Affiliations: Department of Epileptology, University of Bonn Medical Centre, Bonn, Germany. Dr Poepel is now with the Swiss Epilepsy Centre, Zurich, Switzerland.

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