Addition of a hospital bedside sitter during intracranial stereotactic EEG monitoring improves safety and seizure responses in an adult epilepsy monitoring unit.

Expert consensus statements recommend continuous observation for patients undergoing intracranial electroencephalography (EEG), but this practice is neither universal nor specific regarding the type of observation. We compared outcomes for patients who underwent intracranial stereotactic EEG (SEEG) before and after the adoption of continuous monitoring by a staff bedside sitter. We retrospectively studied 26 consecutive adult patients who underwent SEEG placement at our center over a three-year period. Thirteen patients were monitored with usual protocol (no-sitter group), and 13 patients had a full-time hospital-employed sitter at bedside (sitter group). We analyzed nursing responses for all electroclinical seizures and characterized seizure-related adverse events. More seizures went unrecognized without a sitter (33.3% versus 15.0% of all seizures; p = 0.03). Two unrecognized focal to bilateral tonic-clonic seizures occurred only in the no-sitter group. Nursing response was significantly faster in the sitter group in relation to both electrographic seizure onset (12.0 s, p = 0.04) and clinical seizure onset (13.5 s, p = 0.02). Two patients in the no-sitter group pulled their electrodes out periictally while none did so in the sitter group. The addition of a full-time staff bedside sitter improved nursing response times and lowered the rate of unrecognized seizures in patients with SEEG monitoring. Sitters also helped to eliminate inadvertent major electrode displacement.