Chapter 7: Nursing Practice in a Video-EEG Monitoring Unit

Introduction

Patients referred to tertiary epilepsy centers frequently have complex and long-standing epilepsy. Many have frequent seizures, most are refractory to antiseizure medicines, and many report seizure-related injuries. Inpatient video-electroencephalography monitoring (VEM) has many indications and is pivotal to the diagnosis and treatment of seizure disorders. Nurses specialized in epilepsy care are an integral part of the medical team and play an essential role in patient care and education.

This chapter discusses the principles of nursing care in the inpatient VEM unit and the challenges inherent in safe care of patients during monitoring. A high level of nursing proficiency is essential to effective, efficient, and safe monitoring. Nursing care in the VEM unit is provided by two levels of practitioner; the bedside nurse and the advanced practice nurse (APN). Nursing care of patients undergoing an elective admission for seizure diagnosis demands a different skill set from other diagnostic groups seen in a general neuroscience setting. Patients with epilepsy are not acutely ill, but the effects of a chronic, episodic disorder frequently manifest in behaviors such as anxiety, depression, low self-esteem, and embarrassment. In communicating with patients, these issues need to be sensitively considered. Furthermore, the treatment goals in epilepsy are to control seizures completely and to reverse the spectrum of disability associated with the disease.

Specialized Epilepsy Centers: The Role of the Nurse

The National Association of Epilepsy Centers (NAEC) was formed in 1989 for the purpose of defining the services, personnel, and facilities that constitute a specialized epilepsy center. ¹ The NAEC defines a specialized epilepsy center as one that provides services exclusively to people with intractable epilepsy and is staffed by a multidisciplinary team with special training and experience in treating epilepsy. Epilepsy care is divided into four levels. (See Chapter 5 for a full description of these levels.) Inpatient VEM is a service provided by third- and fourth-level centers, but it is offered most often in fourth-level, large tertiary or academic institutions. These specialized centers provide complex evaluations of epilepsy, including evaluation with intracranial electrodes, and a range of surgical procedures. The provision of nurses skilled in recognizing, testing, and treating seizures is the hallmark of the VEM unit. Fourth-level centers require the supervisory skills of an APN (clinical nurse specialist or nurse practitioner) to provide coordination and oversight of both the nursing services and the coordinated care of patients as they progress through a multiphase treatment program.

VEM is expensive in terms of personnel, equipment, and time. However, these costs can be offset against the savings from improved diagnosis and treatment.² VEM is effective and is estimated to result in a change of epilepsy management for 73% of the patients who undergo it.³ There are cost benefits for patients rendered seizure free by surgery and for those patients not requiring antiepileptic drug (AED) treatment, such as those with a confirmed diagnosis of ...