OBJECTIVETo evaluate the efficacy and safety of slow anti-epileptic drug (AED) taper protocol and a rescue benzodiazepine protocol in video-electroencephalography (video-EEG) monitoring for presurgical evaluation of epilepsy.

METHODSSixty-two of 109 patients with refractory focal epilepsy underwent pre-surgical video-EEG monitoring with a slow AEDs taper protocol and a rescue benzodiazepine protocol. Seizures were recorded by video-EEG in 56 patients. The time to the first seizure, duration of monitoring, incidence of 4-h and 24-h seizure clustering, secondarily generalized tonic-clonic seizures (sGTCS), status epilepticus, falls and cardiac asystole were evaluated.

RESULTSA total of 191 seizures were recorded in the 56 cases, and the diagnostic efficiency of video-EEG was 90.3%. The mean time to the first seizure was 2.4 days and the time to conclude video-EEG monitoring averaged 6.8 days. Eight (12.9%) patients had 4-h clusters and 24 (38.7%) had 24-h clusters. Seizure clusters were more frequent in extra temporal epilepsy than in temporal lobe epilepsy. While 19 sGTCS were recorded in 15 patients (26.8%), status epilepticus did not occur and no seizure was complicated by cardiac asystole. Epileptic falls with no significant injuries occurred in 4 patients.

CONCLUSIONSeizure clustering is common during presurgical video-EEG monitoring, but serious adverse events are rare with a slow AED tapering and a rescue benzodiazepine protocols. These two protocols are effective and save in presurgical video-EEG monitoring for refractory focal epilepsy.