To identify whether ictal assessment standardization leads to long-term changes in ictal testing behavior in the Epilepsy Monitoring Unit (EMU).

The information gathered via the performance of an ictal assessment is an important aspect of monitoring that allows a physician to reach a confident diagnosis. However, the unpredictable and variable nature of paroxysmal events limits the accuracy and detail of ictal assessments. It is assumed that using a standardized observational tool during ictal assessments may improve accuracy. Our past research has shown that ictal testing standardization can lead to short-term improvements in ictal testing, but we do not know if these improvements are sustained over time.

Consecutive patients admitted to the EMU were screened for the presence of “event button” triggered ictal assessments. Each assessment was evaluated, seeing if the assessor performed 8 high-yield testing elements (orientation, short term verbal memory, object identification, non-motor command, motor function, delayed verbal memory, presence of aura, and typicality of the event).

After a three month observational period, a standardized ictal testing protocol was provided to staff. They were expected to utilize the protocol for future ictal assessments. The quality of ictal assessments was re-assessed on patients admitted to the EMU during a subsequent three-month period, five months beyond the introduction of the ictal testing protocol.

More complete ictal testing was performed in the long-term follow up cohort than the pre-QI cohort (67.7% vs. 51.0% completed elements, p=0.05). Additionally, all eight individual ictal testing elements were more likely to be completed in the long-term follow up cohort, with the “delayed recall” testing element being statically significant between the groups.

Utilization of a standardized ictal testing battery leads to long-term improvements in ictal testing assessments. This likely provides more valuable diagnostic information regarding captured events however further research is needed on this subject matter.