Objective: To evaluate the efficiency and safety of pre-surgical video-EEG monitoring with a slow anti-epileptic drug (AED) taper and a rescue benzodiazepine protocol. 

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Methods: fifty-four consecutive patients with refractory focal epilepsy who underwent pre-surgical video-electroencephalography (EEG) monitoring during the year 2010 were included in the study. Time to first seizure, duration of monitoring, incidence of 4-h and 24-h seizure clustering, secondarily gener-alised tonic-donic seizures (sGTCS), status epilepticus, falls and cardiac asystole were evaluated. 

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Results: A total of 190 seizures were recorded. Six (11%) patients had 4-h clusters and 21 (39%) patients had 24-h clusters. While 15 sGTCS were recorded in 14 patients (26%), status epilepticus did not occur and no seizure was complicated with cardiac asystole. Epileptic falls with no significant injuries occurred in three patients. The mean time to first seizure was 3.3 days and the time to conclude video-EEG mon-itoring averaged 6 days. 

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Conclusion: Seizure clustering was common during pre-surgical video-EEG monitoring, although serious adverse events were rare with a slow AED tapering and a rescue benzodiazepine protocol. Slow AED taper pre-surgical video-EEG monitoring is fairly safe when performed in a highly specialised and supervised hospital setting. 

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Addolorata Mascia, Giancarlo Di Gennaro, Vincenzo Esposito, Liliana G. Grammaldo, Giulio N. Meldolesi, Pier Paolo Quarato, Angelo Picardi, Antonio Sparano