Career Center AES Connect

Considerations for Pediatric EMU Admissions Post COVID-19

Last updated June 1, 2020

Many epilepsy monitoring units have been closed due to the COVID-19 pandemic and are now planning to re-open. There is a backlog of patients awaiting admission. For pediatric patients, please find below guidance on who to admit first. This list was created through a consensus process, as described below. In addition to the tiers outlined below, higher priority should be given to patients where the results of the EEG are likely to change management, or if there are safety concerns prompting the admission.

 

Highest Priority

  • Events concerning for seizures, age younger than 1 year
  • Infantile spasms diagnosis†

 

High Priority

  • Infantile spasms follow up†
  • Significant worsening of seizure frequency (i.e. monthly to daily)
  • Events concerning for seizures, age 1 year to 5 years
  • Semiology change
  • Phase II epilepsy surgery evaluation
  • New-onset epilepsy

 

Middle Priority

  • Background check - diagnostic uncertainty
  • Phase I epilepsy surgery evaluation
  • Events concerning for seizures, age 6 years to 18 years
  • Medication-related (adjustment, titration, toxicity)
  • Moderate worsening of seizures (i.e. monthly to weekly)

 

Low Priority

  • Background check - routine
  • Intravenous corticosteroids / other scheduled immunotherapy

 

Methods: A list of common pediatric indications for elective admission to the EMU was presented to two groups: (1) seven pediatric epilepsy neurologists at Weill Cornell Medicine, and (2) seven pediatric epilepsy neurologists from the AES Pediatric Content Committee and the AES Practice Management Committee (one overlapping member in both groups). Each participant ranked the importance of each indication. We normalized each participant’s ranks and calculated the median prioritization across all participants. In both groups, prioritization clearly fell into four tiers. The tiers were edited for clarity.

† Child Neurology Society (CNS). Management of infantile spasms (IS) during the COVID-19 pandemic. April 6, 2020. These CNS guidelines support the use of outpatient EEG for infantile spasms diagnosis and management.

Copyright © 2020 American Epilepsy Society (AES)

 

Contributors

include members of the American Epilepsy Society (AES) Practice Management and Pediatric Content Committees

Zachary Grinspan, MD, MS
Weill Cornell Medicine
New York, NY

Anup Patel, MD
Nationwide Children’s Hospital 
Columbus, OH

Sotirios Keros, MD, PhD
Weill Cornell Medicine
New York, NY

Jacqueline Gofshteyn, MD
Weill Cornell Medicine
New York, NY

Kevin Gurcharran, MD
Weill Cornell Medicine
New York, NY

Oyinkan Marquis, MD
Weill Cornell Medicine
New York, NY

Srishti Nangia, MD
Weill Cornell Medicine
New York, NY

Marvin Braun, MD
Weill Cornell Medicine
New York, NY

Erika Axeen, MD
University of Virginia
Charlottesville, VA

Luca Bartolini, MD
Hasbro Children’s Hospital 
Providence, RI

Asim Shahid, MD
Rainbow Babies and Children’s Hospital
Cleveland, OH

Susan Duberstein, MD
Montefiore Medicine
Bronx, NY

Susan Koh, MD
Children’s Hospital of Colorado
Aurora, CO

Janel Schneider, MD
Medical College of Wisconsin 
Milwaukee, WI

Sudha Kessler, MD
Children’s Hospital of Philadelphia 
Philadelphia, PA