PURPOSE: The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers. METHOD: A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement. RESULTS: Complete responses were received from all (100%) EMUs surveyed. Continuous observation of patients was performed in 22 (81%) EMUs during regular working hours, and in 17 EMUs (63%) outside of regular working hours. Fifteen (56%) EMUs requested a signed informed consent before admission. All EMUs performed tapering/withdrawal of antiepileptic drugs, 14 (52%) prior to admission to an EMU. Specific protocols on antiepileptic drugs (AED) tapering were available in four (15%) EMUs. Standardized Operating Procedures (SOP) for the treatment of seizure clusters and status epilepticus were available in 16 (59%). Safety measures implemented by EMUs were: alarm seizure buttons in 21 (78%), restricted patient's ambulation in 19 (70%), guard rails in 16 (59%), and specially designated bathrooms in 7 (26%). Average costs for one inpatient day in EMU ranged between 100 and 2200 Euros. CONCLUSION: This study shows a considerable diversity in the organization and practice patterns across European epilepsy monitoring units. The collected data may contribute to the development and implementation of evidence-based recommended practices in LTM services across Europe.

Carola Davila University of Medicine Bucharest and Pediatric Neurology Clinic Alexandru Obregia Clinical Psychiatric Hospital Şos Berceni 10 12 Sector 4 Bucharest Romania

Claudio Munari Epilepsy Surgery Centre Niguarda Hospital Piazza Ospedale Maggiore 3 20162 Milan Italy

Clinic of Neurology and neurosurgery Medical Faculty Vilnius University Vilnius Lithuania; Epilepsy Center Department of Neurology Vilnius University Hospital Santariskiu Klinikos Vilnius Lithuania

Département de Neurologie 1 Place de l'Hôpital 67091 Strasbourg France

Département des Neurosciences Cliniques Centre Hospitalier Universitaire Vaudois Rue du Bugnon 46 CH 1011 Lausanne France; European Epilepsy Monitoring Unit Association France

Department of Child Neurology University Medical Center 3508 AB Utrecht The Netherlands

Department of Clinical Neuroscience and Rehabilitation Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg Sweden

Department of Complex Epilepsy National Centre for Epilepsy Oslo University Hospital Oslo Norway

Department of Epileptology University of Bonn University Medical Center Sigmund Freud Straße 25 53105 Bonn Germany

Department of Functional Neurology and Epileptology Hospices Civils de Lyon Lyon France

Department of Molecular and Cellular Therapeutics Royal College of Surgeons in Ireland Dublin 2 Ireland; Department of Neurology Beaumont Hospital Dublin 9 Ireland

Department of Neurology 2nd Faculty of Medicine Charles University Motol University Hospital 5 Úvalu 84 Prague 5 CZ 150 06 Czech Republic

Department of Neurology Christian Doppler Klinik Paracelsus Medical University and Centre for Cognitive Neuroscience Ignaz Harrer Straße 79 5020 Salzburg Austria

Department of Neurology Christian Doppler Klinik Paracelsus Medical University and Centre for Cognitive Neuroscience Ignaz Harrer Straße 79 5020 Salzburg Austria; European Epilepsy Monitoring Unit Association France

Department of Neurology Hospital Ruber Internacional La Maso 38 28034 Madrid Spain

Department of Neurology Kuopio University Hospital Kuopio Finland; School of Medicine University of Eastern Finland Kuopio Finland

Department of Pediatric Neurology 2nd Faculty of Medicine Charles University Motol University Hospital 5 Úvalu 84 Prague 5 CZ 150 06 Czech Republic

Epilepsiezentrum Kork Landstraße 1 77694 Kehl Kork Germany; European Epilepsy Monitoring Unit Association France

Epilepsy Surgery Center Neurosurgery department St Ivan Rilski University Hospital Sofia Bulgaria

European Epilepsy Monitoring Unit Association France; Danish Epilepsy Center Filadelfia University of Copenhagen Kolonivej 1 4293 Dianalund Denmark; IRCCS Institute of Neurological Sciences Bellaria Hospital Bologna Italy

Institute for Neuroscience Reference center for refractory epilepsy Gehnt University Hospital Belgium

Istanbul University Cerrahpaşa Medical Faculty Department of Neurology Division of Clinical Electro Neurophysiology 34098 Istanbul Turkey

Laboratory of Clinical Neurophysiology Medical School Aristotle University of Thessaloniki Thessaloniki 54124 Greece

Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department Ul Donskaya 43 Moscow 115419 Russia; Department of Neurology and Neurosurgery of Russian National Research Medical University Leninsky pr t 8 8 Moscow 119049 Russia

National Institute of Clinical Neurosciences Amerikai ut 57 Budapest H 1145 Hungary

Presurgical Epilepsy Evaluation Unit Functional Neurology and Neurosurgery Program of the University Hospitals of Geneva and Lausanne 1211 Geneva 14 Switzerland

University College London Institute of Child Health Great Ormond Street Hospital for Children NHS Foundation Trust London United Kingdom

Zagreb Epilepsy Center Department of Neurology University Hospital Vinogradska cesta 29 10000 Zagreb Croatia

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