Risk factors for behavioral and psychotic dysregulation at the epilepsy monitoring unit in patients with intracranial electrodes

M. E.A. Evers; J. Nelissen; M. C.G. Vlooswijk; V. H.B.M. van Kranen-Mastenbroek; A. F.G. Leentjens; R. P.W. Rouhl; Gwendolyn de Bruyn; Albert Colon; Jim Dings; Marc Hendriks; Danny Hilkman; Christianne Hoeberigs; Jochem van der Pol; Lotte de Jong; Kim Rijkers; Sylvia Klinkenberg; Pieter Kubben; Walter M. Palm; Paul Hofman; Olaf E.M.G. Schijns; Simon Tousseyn; G. Louis Wagner; Dorien Weckhuysen; Guido Widman; AWEC-study group

doi:10.1016/j.yebeh.2023.109448

Risk factors for behavioral and psychotic dysregulation at the epilepsy monitoring unit in patients with intracranial electrodes

M. E.A. Evers, J. Nelissen, M. C.G. Vlooswijk, V. H.B.M. van Kranen-Mastenbroek, A. F.G. Leentjens, R. P.W. Rouhl^*, Gwendolyn de Bruyn, Albert Colon, Jim Dings, Marc Hendriks, Danny Hilkman, Christianne Hoeberigs, Jochem van der Pol, Lotte de Jong, Kim Rijkers, Sylvia Klinkenberg, Pieter Kubben, Walter M. Palm, Paul Hofman, Olaf E.M.G. SchijnsSimon Tousseyn, G. Louis Wagner, Dorien Weckhuysen, Guido Widman, AWEC-study group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective: Aberrant behavior in patients with epilepsy (PWE) admitted to an epilepsy monitoring unit (EMU) can endanger their safety. We sought to identify predictive factors for post-ictal behavioral dysregulation and psychosis in patients with refractory epilepsy being monitored at an EMU. Methods: Retrospective data were gathered from electronic patient files of all patients with refractory epilepsy who underwent intracranial registration at our EMU. We assessed behavioral and psychotic dysregulations by reviewing clinical notes, administered emergency medication, and reports of injuries or casualties in patients and nurses. In addition, we compared patient demographic characteristics, clinical characteristics, and antiepileptic drug (AED) profiles between patients with and without behavioral and/or psychotic dysregulation. Results: Out of 73 admissions, 23 patients (32%) experienced behavioral dysregulation, and five patients experienced psychosis (7%). Behavioral dysregulation was only significantly associated with a previous history of interictal or postictal psychosis. Psychotic dysregulation is significantly associated with a psychiatric history, including a history of agitation or psychosis, whether or not epilepsy-related. For both types of dysregulations, there was no relation with a pre-admission frequency of seizures, clustering of seizures during monitoring, or a temporal focus of seizures. We could not report a relationship between AED use, tapering, and the occurrence of dysregulation. Conclusion: We conclude that a psychiatric history, including a history of agitation and psychosis, is related to an increased risk of behavioral and psychotic dysregulation in patients undergoing invasive seizure monitoring at the EMU.

Original language	English
Article number	109448
Number of pages	4
Journal	Epilepsy & Behavior
Volume	148
Issue number	1
DOIs	https://doi.org/10.1016/j.yebeh.2023.109448
Publication status	Published - 1 Nov 2023

Keywords

Agitation
Antiepileptic drugs
Behavioral dysregulation
Epilepsy monitoring unit
Psychosis

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10.1016/j.yebeh.2023.109448Licence: CC BY

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Evers, M. E. A., Nelissen, J., Vlooswijk, M. C. G., van Kranen-Mastenbroek, V. H. B. M., Leentjens, A. F. G., Rouhl, R. P. W., de Bruyn, G., Colon, A., Dings, J., Hendriks, M., Hilkman, D., Hoeberigs, C., van der Pol, J., de Jong, L., Rijkers, K., Klinkenberg, S., Kubben, P., Palm, W. M., Hofman, P., ... AWEC-study group (2023). Risk factors for behavioral and psychotic dysregulation at the epilepsy monitoring unit in patients with intracranial electrodes. Epilepsy & Behavior, 148(1), Article 109448. https://doi.org/10.1016/j.yebeh.2023.109448

@article{5d5448f2ff5a4e469f8023a9e3e94336,

title = "Risk factors for behavioral and psychotic dysregulation at the epilepsy monitoring unit in patients with intracranial electrodes",

abstract = "Objective: Aberrant behavior in patients with epilepsy (PWE) admitted to an epilepsy monitoring unit (EMU) can endanger their safety. We sought to identify predictive factors for post-ictal behavioral dysregulation and psychosis in patients with refractory epilepsy being monitored at an EMU. Methods: Retrospective data were gathered from electronic patient files of all patients with refractory epilepsy who underwent intracranial registration at our EMU. We assessed behavioral and psychotic dysregulations by reviewing clinical notes, administered emergency medication, and reports of injuries or casualties in patients and nurses. In addition, we compared patient demographic characteristics, clinical characteristics, and antiepileptic drug (AED) profiles between patients with and without behavioral and/or psychotic dysregulation. Results: Out of 73 admissions, 23 patients (32%) experienced behavioral dysregulation, and five patients experienced psychosis (7%). Behavioral dysregulation was only significantly associated with a previous history of interictal or postictal psychosis. Psychotic dysregulation is significantly associated with a psychiatric history, including a history of agitation or psychosis, whether or not epilepsy-related. For both types of dysregulations, there was no relation with a pre-admission frequency of seizures, clustering of seizures during monitoring, or a temporal focus of seizures. We could not report a relationship between AED use, tapering, and the occurrence of dysregulation. Conclusion: We conclude that a psychiatric history, including a history of agitation and psychosis, is related to an increased risk of behavioral and psychotic dysregulation in patients undergoing invasive seizure monitoring at the EMU.",

keywords = "Agitation, Antiepileptic drugs, Behavioral dysregulation, Epilepsy monitoring unit, Psychosis",

author = "Evers, {M. E.A.} and J. Nelissen and Vlooswijk, {M. C.G.} and {van Kranen-Mastenbroek}, {V. H.B.M.} and Leentjens, {A. F.G.} and Rouhl, {R. P.W.} and {de Bruyn}, Gwendolyn and Albert Colon and Jim Dings and Marc Hendriks and Danny Hilkman and Christianne Hoeberigs and {van der Pol}, Jochem and {de Jong}, Lotte and Kim Rijkers and Sylvia Klinkenberg and Pieter Kubben and Palm, {Walter M.} and Paul Hofman and Schijns, {Olaf E.M.G.} and Simon Tousseyn and {Louis Wagner}, G. and Dorien Weckhuysen and Guido Widman and {AWEC-study group}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = nov,

day = "1",

doi = "10.1016/j.yebeh.2023.109448",

language = "English",

volume = "148",

journal = "Epilepsy & Behavior",

issn = "1525-5050",

publisher = "Elsevier Science",

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Evers, MEA, Nelissen, J, Vlooswijk, MCG , van Kranen-Mastenbroek, VHBM , Leentjens, AFG , Rouhl, RPW, de Bruyn, G, Colon, A, Dings, J, Hendriks, M, Hilkman, D, Hoeberigs, C, van der Pol, J, de Jong, L, Rijkers, K, Klinkenberg, S, Kubben, P, Palm, WM, Hofman, P, Schijns, OEMG, Tousseyn, S, Louis Wagner, G, Weckhuysen, D, Widman, G & AWEC-study group 2023, 'Risk factors for behavioral and psychotic dysregulation at the epilepsy monitoring unit in patients with intracranial electrodes', Epilepsy & Behavior, vol. 148, no. 1, 109448. https://doi.org/10.1016/j.yebeh.2023.109448

TY - JOUR

T1 - Risk factors for behavioral and psychotic dysregulation at the epilepsy monitoring unit in patients with intracranial electrodes

AU - Evers, M. E.A.

AU - Nelissen, J.

AU - Vlooswijk, M. C.G.

AU - van Kranen-Mastenbroek, V. H.B.M.

AU - Leentjens, A. F.G.

AU - Rouhl, R. P.W.

AU - de Bruyn, Gwendolyn

AU - Colon, Albert

AU - Dings, Jim

AU - Hendriks, Marc

AU - Hilkman, Danny

AU - Hoeberigs, Christianne

AU - van der Pol, Jochem

AU - de Jong, Lotte

AU - Rijkers, Kim

AU - Klinkenberg, Sylvia

AU - Kubben, Pieter

AU - Palm, Walter M.

AU - Hofman, Paul

AU - Schijns, Olaf E.M.G.

AU - Tousseyn, Simon

AU - Louis Wagner, G.

AU - Weckhuysen, Dorien

AU - Widman, Guido

AU - AWEC-study group

PY - 2023/11/1

Y1 - 2023/11/1

N2 - Objective: Aberrant behavior in patients with epilepsy (PWE) admitted to an epilepsy monitoring unit (EMU) can endanger their safety. We sought to identify predictive factors for post-ictal behavioral dysregulation and psychosis in patients with refractory epilepsy being monitored at an EMU. Methods: Retrospective data were gathered from electronic patient files of all patients with refractory epilepsy who underwent intracranial registration at our EMU. We assessed behavioral and psychotic dysregulations by reviewing clinical notes, administered emergency medication, and reports of injuries or casualties in patients and nurses. In addition, we compared patient demographic characteristics, clinical characteristics, and antiepileptic drug (AED) profiles between patients with and without behavioral and/or psychotic dysregulation. Results: Out of 73 admissions, 23 patients (32%) experienced behavioral dysregulation, and five patients experienced psychosis (7%). Behavioral dysregulation was only significantly associated with a previous history of interictal or postictal psychosis. Psychotic dysregulation is significantly associated with a psychiatric history, including a history of agitation or psychosis, whether or not epilepsy-related. For both types of dysregulations, there was no relation with a pre-admission frequency of seizures, clustering of seizures during monitoring, or a temporal focus of seizures. We could not report a relationship between AED use, tapering, and the occurrence of dysregulation. Conclusion: We conclude that a psychiatric history, including a history of agitation and psychosis, is related to an increased risk of behavioral and psychotic dysregulation in patients undergoing invasive seizure monitoring at the EMU.

AB - Objective: Aberrant behavior in patients with epilepsy (PWE) admitted to an epilepsy monitoring unit (EMU) can endanger their safety. We sought to identify predictive factors for post-ictal behavioral dysregulation and psychosis in patients with refractory epilepsy being monitored at an EMU. Methods: Retrospective data were gathered from electronic patient files of all patients with refractory epilepsy who underwent intracranial registration at our EMU. We assessed behavioral and psychotic dysregulations by reviewing clinical notes, administered emergency medication, and reports of injuries or casualties in patients and nurses. In addition, we compared patient demographic characteristics, clinical characteristics, and antiepileptic drug (AED) profiles between patients with and without behavioral and/or psychotic dysregulation. Results: Out of 73 admissions, 23 patients (32%) experienced behavioral dysregulation, and five patients experienced psychosis (7%). Behavioral dysregulation was only significantly associated with a previous history of interictal or postictal psychosis. Psychotic dysregulation is significantly associated with a psychiatric history, including a history of agitation or psychosis, whether or not epilepsy-related. For both types of dysregulations, there was no relation with a pre-admission frequency of seizures, clustering of seizures during monitoring, or a temporal focus of seizures. We could not report a relationship between AED use, tapering, and the occurrence of dysregulation. Conclusion: We conclude that a psychiatric history, including a history of agitation and psychosis, is related to an increased risk of behavioral and psychotic dysregulation in patients undergoing invasive seizure monitoring at the EMU.

KW - Agitation

KW - Antiepileptic drugs

KW - Behavioral dysregulation

KW - Epilepsy monitoring unit

KW - Psychosis

U2 - 10.1016/j.yebeh.2023.109448

DO - 10.1016/j.yebeh.2023.109448

M3 - Article

SN - 1525-5050

VL - 148

JO - Epilepsy & Behavior

JF - Epilepsy & Behavior

IS - 1

M1 - 109448

ER -

Risk factors for behavioral and psychotic dysregulation at the epilepsy monitoring unit in patients with intracranial electrodes

Abstract

Keywords

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