(721) Emergent Epilepsy Monitoring Unit Admissions during a period of State mandated restrictions due to the Covid 19 pandemic: clinical characteristics and outcomes

Rationale: Due to the COVID-19 pandemic the State of Texas limited elective procedures to conserve beds and personal protective equipment. Between March 18 and May 18, 2020 admission to the EMU at UT Southwestern was limited only to urgent and emergent cases. We evaluated the clinical characteristics and outcomes of all patients admitted to the EMU in this timeframe at our institution.

Methods: Using the master EMU admission schedule we obtained demographic, clinical and EEG data on the  patients admitted to the EMU between the dates listed above. Two invasive EEG studies were excluded from our analysis.

Results: Twenty-one patients were admitted; all patients passed a Covid clinical screen and had a negative COVID-19 nasopharyngeal swab study. Twelve were women and mean age was 35.04 (19-76 years). Mean duration of stay was 4.2 (1-9 days) with 16 having seen an epileptologist at our institution prior to admission. Eight admissions were for pre surgical evaluation, one was to monitor seizure frequency during immunotherapy, the remaining were diagnostic studies to identify event etiology (in one of these cases also to identify for possible acute drug reaction). Two admissions were from an Emergency department. One patient was admitted inappropriately as determined by the admitting epileptologist and discharged immediately. All other admissions were in the setting of worsening seizures. One patient had both epileptic seizures (ES) and psychogenic non epileptic seizures. Eight patients had epileptic seizures ranging from a total of two to several per hour. In these nine patients (ES and mixed) seizures were lateralized in one, well localized and lateralized in three. Ten patients had PNES and one had psychogenic pseudosyncope; of these ten, one patient had a PNES that was atypical without a typical event captured. PNES frequency ranged from a total of one to 12. EMU admission lead to antiseizure or psychiatric medication changes in six, medication increases in four, medication cessation in five and no changes in five.

Conclusions: While typically an elective admission, in the setting of the COVID-19 pandemic, urgent EMU admission, typically for increased seizure or event frequency. One admission from an outside provider was inappropriate and flagged prior to initiation of recording. In all other 20 cases seizures, either ES or PNES or both were captured with only one study indeterminate. In the vast majority of patients admission lead to medication changes to either better control seizures, modify drug adverse effects or to change therapeutics in the setting of PNES identification.
 

Funding: Please list any funding that was received in support of this abstract.: None